SPINAL CORD INJURY Jessica Ryu, T4 Tulane University School of Medicine.
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Transcript of SPINAL CORD INJURY Jessica Ryu, T4 Tulane University School of Medicine.
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SPINAL CORD INJURY
Jessica Ryu, T4
Tulane University School of Medicine
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Anatomy• Anterior spinal artery, 2 posterior spinal arteries
• All 3 receive contributions from the radicular branches
• 4-10 radicular branches which arise from the vertebral, cervical, intercostal, lumbar arteries
• Anterior spinal supplies 2/3 of spinal cord (motor function)
• Posterior arteries supply posterior columns and horns
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Anatomy Continued • Cervical and superior thoracic region: derived from cervical branches of the vertebral and ascending and deep cervical arteries
• Middle and lower thoracic cord: radicular arteries less prominent
• Lower thoracic and lumbar cord: T7-conus blood supply is artery of Adamkiewicz
• Greatest susceptibility to cord ischemia: thoracic region
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Cervical Spine Injuries • Spinal shock, immediate, lasts for hours to about a month
• Flaccid paralysis• Bradycardia, hypotension and EKG changes • Alveolar hypoventilation, hypoxemia and decreased ability to
protect airway • Management:
• Induction: awake or IV rapid sequence (awake intubation is safest)
• Awake: nose is cocainized, oropharynx sprayed with 4% lidocaine, superior laryngeal nerve blocked by injection, recurrent laryngeal can be blocked by injection but in full stomach situation that is probably not advised (if RLN not blocked, cough ability retained)
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Cervical Spine Injuries Continued
• Important levels: • Diaphragm• Patients don’t survive with injuries above C2
• Important note: patients should be positioned for surgery before they are put to sleep if they have an unstable C-spine
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Paralysis• Two stages: flaccid and spastic
• Flaccid: 1-4 weeks, manifested by total absence of neuro function below lesion, usually characterized by spinal shock
• Spastic: occurs after 4 weeks, manigested by motor hyperreflexia and autonomic hyperreflexia
• Problems experienced by paraplegics: bowel, bladder, anemia, dehydration
• Spinal anesthesia is a good choice in paraplegics (blocks afferent impulses)
• To evaluate level of anesthesia in paraplegic test for sympathogalvanic response
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Monitoring
• Motor injury detection • Evoked potentials: somato-sensory evoked potentials provide ability to monitor sensory pathway functional integrity
• Wake up Test
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Important Facts to Remember• Flaccid paralysis (hypovolemia, bradycardia, increased sensitivity to anesthetics)
• Ventilation problems and increased risk of gastric aspiration
• Hyperkalemia (muscle membrane becomes chemically active – 1 day to 1 year)
• Hypothermia (no temp regulation below level of lesion)
• Renal insufficiency (risk of infection)
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Important Facts to Remember
• Unstable thoracic or lumbar spine injuries: patients can be put to sleep on their beds and then moved
• Sux contraindicated for about 1 day- 1 year after injury (causes release of K+ from motor end plate membrane and the muscle membrane after spinal cord injury is abnormal)
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Thank you