Page 167 - Critical Care Notes

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Clinical Presentation
■ Spinal shock initially: flaccid paralysis with ↓ or absent reflex activity
■ Partial or total loss of motor function below the level of SCI (includes volun-
tary movement and movement against gravity or resistance)
■ Partial or total loss of sensory function below the level of SCI (includes
touch, temperature, pain, proprioception [e.g., position])
■ ↑ HR initially → bradycardia; ↑ BP initially →↓ BP
■ Acute pain in back or neck that may radiate along nerve
■ Abnormal deep tendon reflex and perianal reflex activity
■ Loss of sweating and vagomotor tone
■ Loss of sensory, motor, and deep tendon reflexes below the level of injury
■ Retention of lung secretions, ↓ vital capacity, ↑ PaCO 2 , ↓ O 2 → respiratory
failure and pulmonary edema
■ Bladder and bowel incontinence with urine retention and bladder distention
■ Paralytic ileus causing constipation and/or bowel impaction
■ Loss of temperature control → hyperthermia
■ Sweating above level of lesion
■ Priapism in male patients
■ Associated injuries resulting from trauma: broken teeth, swollen tongue,
neurological and orthopedic injuries, hemothorax, pneumothorax, flail
chest, intrathoracic injuries, abdominal and retroperitoneal injuries
Diagnostic Tests
■ Lateral, anteroposterior (cervical, thoracic, lumbar, sacral), and odontoid
films
■ CXR and ECG
■ CT scan, MRI
■ Myelography
■ Standard Neurological Classification of Spinal Cord Injury categorizes
motor and sensory impairments in SCI indicating the lowest spinal levels
demonstrating “unimpaired function.” The following worksheet may be
downloaded at: http://www.asia-spinalinjury.org/elearning/ ISNCSCI_Exam_
Sheet_r4.pdf
■ American Spinal Injury Association (ASIA) Impairment Scale
■ A = Complete: No motor or sensory function is preserved in the sacral
segments S4–S5.
■ B = Incomplete: Sensory but no motor function is preserved below the
neurological level and includes the sacral segments S4–S5.
■ C = Incomplete: Motor function is preserved below the neurological level,
and more than half of key muscles below the neurological level have a
muscle grade less than 3.
NEURO