Etiology and Pathophysiology
The spinal cord injury caused due to cord being compressed
o Compression can happen due to vertebrae displacement from trauma,
interruption of blood supply, traction from pulling on cord
Penetrating trauma can lead to cord tearing and transection; most dangerous
since functionality cannot be brought back
Initial injury: primary injury occurs, disrupts the flow of CSF, which causes
damage
Secondary injury: after 72 hrs. (3 days) of injury CSF swells up (edema),
ischemia, hypoxia, and micro-hemorrhage occurs
Spinal shock: loss of reflexes, flaccid paralysis below level of injury
Mechanism of Injury
Flexion: you snap forward from some kind of injury and column breaks in half
Hyperextension: neck pushed back and snaps
.Flexion rotation: flex with rotation that tears all the ligaments
Extension rotation
Compression: cones crushed
Types of Injury
Complete: transection (severed into two pieces) of cord; lose of all voluntary
motor and sensory function below level of injury
Incomplete: accident that causes compression of spinal cord but once
compression is relieved, preservation of some sensory and/ or motor function
is possible
Levels of Injury
Can be cervical (7 vertebrae), thoracic (12 vertebrae), or lumbar (5
vertebrae)
o As injury gets lower, the higher the possibility of maintaining function
Paraplegia: injury to thoracolumbar region (mid chest downward; t2-l1)
o Loss of motor function of lower extremities
Quadriplegia or tetraplegia: injury to cervical- thoracic regions (c1-t1)
o Loss of all extremities, trunk, pelvic organs
Location and injury
o C4 injury: tetraplegia, complete paralysis below neck
o C6 injury: partial paralysis of hands and arms as well as lower body
May be able to manage most ADLs with assistance (may drive
car)
o T6 injury: paraplegia, paralysis below the chest
o L1 injury: paraplegia, paralysis below the waist
Sympathetic nervous system from t1-l4 (high up) so damage to these
regions leads to issues with SNS (constriction; HR, BP regulation)
ASIA impairment scale used to determine how severe the loss/ injury is
Emergency Management
Initial care
o .Ensure airway, breathing, circulation
Glottis intubation instead of endotracheal tube
o Stabilize neck and spine using neck collar, backboard, log roll whole
body so nothing gets displaced or torn
Never do chin tilt
o Administer oxygen
, o Establish IV site
o Assess for other injuries from trauma ex. pneumothorax, broken leg
o Control external bleeding and control pain level
Respiratory (frequent cause of death)
o .Mechanical ventilation for life for all injuries higher than c4 (phrenic
nerve damage); phrenic nerve controls diaphragm so damage to this
region impairs breathing
o Cervical and thoracic injuries can cause paralysis of abdominal and
intercostal muscles so pt. unable to cough effectively or take deep
breaths (risk for atelectasis and pneumonia)
Cardiovascular
o Any injury above t6 is risk for neurogenic shock
Loss of sympathetic messaging and unopposed parasympathetic
system with neurogenic shock -> bradycardia and decreased
cardiac output; vasodilation with hypotension
o Atropine if HR drops into bradycardia; if unable to increase with
atropine, utilize pacemaker
o Peripheral vasodilation decreases venous return to heart since the
blood is just sitting in the periphery, which decreases cardiac output as
there's less blood in heart to push
o Lots of fluids (150 mL+) and vasopressors to increase BP and CO
Urinary system
o No bladder tone (atonic bladder) so it distends and doesn't empty;
need urinary catheter
o Weight bearing activity keeps calcium in bones and without
movement, bones can become demineralized and release in the blood
stream; renal calculi (kidney stones) from insoluble calcium
compounds
Gastrointestinal
o Any injury above t5 will have hypo-motility (decreased bowel sounds)
o Can get paralytic ileus from hypo-motility; no BM, can’t eat (will sit
unmoving and cause blockage)
Utilize NG tube, salum sump to suction bile and decompress
stomach, make NPO, TPN to maintain nutrition, IVF
o Prophylactic management of stress ulcers since HCL increases due to
illness
Guaiac stools to test for blood; test should be read in a minute,
blue means presence of blood
o Neurogenic bowel: decreased sphincter tone
Thermoregulation
o Unable to regulate temperature since messaging not going through
spinal cord to hypothalamus
o They get poikilothermic where their body temperature adjusts to room
temperature
Need to make sure room is warm so pt. is comfortable
o Decreased sweating and shivering (shiver to generate body heat)
below level of injury
Neurologic
o Flaccid paralysis: decreased function and sensory below level of injury
The spinal cord injury caused due to cord being compressed
o Compression can happen due to vertebrae displacement from trauma,
interruption of blood supply, traction from pulling on cord
Penetrating trauma can lead to cord tearing and transection; most dangerous
since functionality cannot be brought back
Initial injury: primary injury occurs, disrupts the flow of CSF, which causes
damage
Secondary injury: after 72 hrs. (3 days) of injury CSF swells up (edema),
ischemia, hypoxia, and micro-hemorrhage occurs
Spinal shock: loss of reflexes, flaccid paralysis below level of injury
Mechanism of Injury
Flexion: you snap forward from some kind of injury and column breaks in half
Hyperextension: neck pushed back and snaps
.Flexion rotation: flex with rotation that tears all the ligaments
Extension rotation
Compression: cones crushed
Types of Injury
Complete: transection (severed into two pieces) of cord; lose of all voluntary
motor and sensory function below level of injury
Incomplete: accident that causes compression of spinal cord but once
compression is relieved, preservation of some sensory and/ or motor function
is possible
Levels of Injury
Can be cervical (7 vertebrae), thoracic (12 vertebrae), or lumbar (5
vertebrae)
o As injury gets lower, the higher the possibility of maintaining function
Paraplegia: injury to thoracolumbar region (mid chest downward; t2-l1)
o Loss of motor function of lower extremities
Quadriplegia or tetraplegia: injury to cervical- thoracic regions (c1-t1)
o Loss of all extremities, trunk, pelvic organs
Location and injury
o C4 injury: tetraplegia, complete paralysis below neck
o C6 injury: partial paralysis of hands and arms as well as lower body
May be able to manage most ADLs with assistance (may drive
car)
o T6 injury: paraplegia, paralysis below the chest
o L1 injury: paraplegia, paralysis below the waist
Sympathetic nervous system from t1-l4 (high up) so damage to these
regions leads to issues with SNS (constriction; HR, BP regulation)
ASIA impairment scale used to determine how severe the loss/ injury is
Emergency Management
Initial care
o .Ensure airway, breathing, circulation
Glottis intubation instead of endotracheal tube
o Stabilize neck and spine using neck collar, backboard, log roll whole
body so nothing gets displaced or torn
Never do chin tilt
o Administer oxygen
, o Establish IV site
o Assess for other injuries from trauma ex. pneumothorax, broken leg
o Control external bleeding and control pain level
Respiratory (frequent cause of death)
o .Mechanical ventilation for life for all injuries higher than c4 (phrenic
nerve damage); phrenic nerve controls diaphragm so damage to this
region impairs breathing
o Cervical and thoracic injuries can cause paralysis of abdominal and
intercostal muscles so pt. unable to cough effectively or take deep
breaths (risk for atelectasis and pneumonia)
Cardiovascular
o Any injury above t6 is risk for neurogenic shock
Loss of sympathetic messaging and unopposed parasympathetic
system with neurogenic shock -> bradycardia and decreased
cardiac output; vasodilation with hypotension
o Atropine if HR drops into bradycardia; if unable to increase with
atropine, utilize pacemaker
o Peripheral vasodilation decreases venous return to heart since the
blood is just sitting in the periphery, which decreases cardiac output as
there's less blood in heart to push
o Lots of fluids (150 mL+) and vasopressors to increase BP and CO
Urinary system
o No bladder tone (atonic bladder) so it distends and doesn't empty;
need urinary catheter
o Weight bearing activity keeps calcium in bones and without
movement, bones can become demineralized and release in the blood
stream; renal calculi (kidney stones) from insoluble calcium
compounds
Gastrointestinal
o Any injury above t5 will have hypo-motility (decreased bowel sounds)
o Can get paralytic ileus from hypo-motility; no BM, can’t eat (will sit
unmoving and cause blockage)
Utilize NG tube, salum sump to suction bile and decompress
stomach, make NPO, TPN to maintain nutrition, IVF
o Prophylactic management of stress ulcers since HCL increases due to
illness
Guaiac stools to test for blood; test should be read in a minute,
blue means presence of blood
o Neurogenic bowel: decreased sphincter tone
Thermoregulation
o Unable to regulate temperature since messaging not going through
spinal cord to hypothalamus
o They get poikilothermic where their body temperature adjusts to room
temperature
Need to make sure room is warm so pt. is comfortable
o Decreased sweating and shivering (shiver to generate body heat)
below level of injury
Neurologic
o Flaccid paralysis: decreased function and sensory below level of injury
