Page 307 - Critical Care Nursing Demystified

292 CRITICAL CARE NURSING DeMYSTIFIED

NURSING ALERT

A patient who is cool, clammy to the touch, and tachycardic should be considered to
be in shock unless proven otherwise. The critical care nurse needs to recognize these
signs/symptoms and act as quickly as possible to identify and help correct shock.

Spinal Cord Injury (SCI)

What Went Wrong?
Although head trauma is considered to be the most common type of traumatic
injury, spinal cord injuries follow as a close second. MVCs are the number one
cause of SCI. SCI is classified according to the level of injury and the amount of
disruption to normal spinal cord function. Interventions are initiated with the goal
of preserving any remaining neurological function. Descriptions of spinal cord
injuries sustained depending primarily on the way in which the injury occurred
or the mechanism of injury. These mechanical forces disrupt neurologic tissue
and its vascular supply to the spinal cord. The spinal cord will become edema-
tous and ischemic as it is deprived of adequate blood perfusion, nutrients, and
oxygenation. The spinal cord can also become necrotic as a consequence of these Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
secondary events. Neuronal conduction is no longer possible.
MOI for SPI are included in Table 6–8.
SCIs are either complete or incomplete. A complete SCI causes a total loss
of sensory and motor function below the level of injury, despite the cause of
the injury. The spinal cord is completely severed and the result is quadriplegia.
An incomplete SCI results in a mixed loss of voluntary motor activity and sen-
sation that occurs below the level of the injury. Any remaining function below
the level of injury classifies the injury as incomplete. Common syndromes of
incomplete injuries include Brown-Séquard, anterior cord, posterior cord, and
central cord syndrome.
Brown-Séquard syndrome – Damage is located on one side of the spinal
cord. There is a loss of voluntary motor control on the same side as the injury,
but sensations such as pain and temperature continue to exist. On the op-
posite side of the body motor strength exists, but there is a loss of pain and
temperature sensations. Clinically, the limb with the best motor strength has
the poorest sensations, while the limb with the best sensations has the weak-
est motor strength.
Anterior cord syndrome – The anterior aspect of the spinal cord is damaged
with paralysis evident below the level of injury. There is also a loss of pain,
touch, and temperature. A sense of light pressure, position, and vibrations