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105 Cards in this Set
- Front
- Back
biochemical effects of the trauma on brain and skull
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primary injury
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complications that result in additional changes and dysfunction of brain tissue
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secondary injury
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when does primary occur
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when you hit your head
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cannot be stopped
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primary inj
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ex of 2ndary inj
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- edema
- tissue death - |
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generally not displaced, no tx needed
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linear fx
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inward depression of bone fragments. may require surg
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depressed fx
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involves base of skull.
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basilar fx
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what does leakage of CSF from nose or ears indicate
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dural tear (basilar fx)
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what can skull inj result in
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underlying inj to brain tissue
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what does a depressed fx cause
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pushing against brain tissue and erruption of vessels---bleeding
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bleeding behind the ear and raccoon eyes
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battlesign
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what type of fx does battles sign appear
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basilar
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result of primary inj (6)
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- contusion
- epidural hematoma - subdural hematoma - traumatic subarachnoid hemo - diffuse axonal inj -concussion |
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ex of diffuse axonal inj
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shaken infant
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what does mgnt of 2ndary brain inj focus on
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minimizing inj by increasing 02 blood to brain and decreasing cerebral metabolic demands
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2ndary brain inj focus is on what (9)
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- hypoxemia
-hypotension -anemia -hypo-hyperglycemia -increasedmet demands (fever - loss of autoregulatory mech - increased ICP - hypo-hypercapnia -biochemical changes |
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why is it important to not have a decrease in BS
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decreases fuel
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most important indicator for severity of inj
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LOC
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Mild TBI
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GCS 13-15
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moderate GCS
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9-12
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severe GCS
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<8
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when does activation of organ donor systemstart
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at severe GCS <8
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how is LOC assessed
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GCS
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what can mild GCS score cause
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functional deficits wks to mths following inj
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what is CT used to identify with brain inj (4)
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- hematomas
- other bleeding -Fx - cerebral edema |
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what is MRI used to identify (3)
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- DAI
-brain stem inj - traumatic aneurysms |
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what should work up of brain inj include
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search for other injuries
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why do diffuse inj have the worst outcomes
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bc its throughout the brain tissue and causes stretching and shearing of axons
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what does mgnt of TBI focus on
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- optimizing functional recovery by minimizing 2ndary inj
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Mgnt for TBi (9)
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- airway mgnt
- oxygenation - ventilation - F&V mgnt - ICP mgnt - supporting cerebral perfusion - preventing increased cerebral 02 demand -preventing 2ndary complications (PE, pneum,DVT,Skin integrity) -family education/support |
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common causes of SCI (4)
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- MVA 48%
-falls 23% - ACts of violence 14% - sports related inj 9% |
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varies with SCI
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degree of paralysis and loss of sensation below level of inj
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what causes deficits in SCI
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-initial inj
-2ndary inj |
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predominant risk factors for SCI (4)
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- young age
-males - ETOH use -drug use |
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% of SCI that occur in males
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80
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50% of SCI occur in what ages
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16-30 yrs
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cervical regioin % for SCI
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50%
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what does SCI result from ____ entering spincal canal and disrupting the spinal cord or blood supply (3)
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-bone
-disk material -foreign object |
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what are the mechanisms of inj for SCI (5)
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- hyperflexion
- hyperextension - axial loading/compression - rotation - penetrating trauma |
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what is the most freq penetrating trauma for SCI
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GSW
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temp loss function
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concussion
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bruising including bleeding into cord (edema, possible neuronal death)
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contusion
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tear in cord,permanent inj
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laceration
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what can laceration involve (3)
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- contusion
-edema -compression |
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severing of cord w/complete loss function below level of inj
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transection
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SCI damage (6)
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- concussion
- contusion -laceration -transection -hemorrhage -blood vessel damage |
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what does laceration damage depend on
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area of the cord
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what does secondary inj result from
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cellular damage to spinal cord
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what does reduced blood flow to cord result in (3)
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- changes in metabolic function
- destruction cell membranes - release of free radicals |
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results of neurogenic shock (2)
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- loss SNS influence T1 to L2 (increase in HR, constricts vessels)
- increases hypoperfusion and 2ndary inj |
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motor assessment for SCI
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q4hrs
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what can acute injury have with supression of reflexes below inj
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spinal shock
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delayed by spinal shock
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evaluation of degree of injury
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increases damage to spine
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movement
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total loss of sensory and motor function below level of inj
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complete SCI
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what is the cause of complete SCI
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complete interruption of pathways
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varying degree of sensory and motor function disruption bc some tracts intact
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incomplete SCI
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more common SCI due to greatest amt of flexibility
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cervical and lumbar
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Class A SCI (2)
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- complete
-no motor/sensory function below level of inj |
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class E SCI
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- normal motor and sensory functions
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characteristics of central cord syndrome (3)
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- preservation of outer white
- weakness/paralysis -sensory loss > in upper Ex than lower |
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inj anterior portion cord, disruption blood flow through anterior spinal artery
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anterior cord syndrome
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injury central gray matter, preservation outer white
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central cord syndrome
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Se of anterior cord (3)
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- paralysis
-loss of pain and temp - preservation vibration and position sense |
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injury to posterior column
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posterior cord syndrom
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SE of post cord (3)
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- no motor loss
- loss vibration and position sense - preservation pain and temp |
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lateral inj to one side of cord
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brown-sequard syndrome
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SE of Brown seq syndrome (3)
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- ipsilateral paralysis
-ipsilateral loss vibration and position sense - contralateral loss pain and temp |
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ipsilateral
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same side
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contralateral
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opposite side
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have a high fall risk
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posterior cord
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what does CT show with incomplete SCI
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bone inj and cord compression
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what does MRI show with incomplete SCI (2)
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soft tissue involvement
ligamentous inj when no bony abnormalily |
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shows changes to bone structure
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xray
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can cause movement and pressure on cord
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damaged ligaments that move
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ways to immobilize acute SCi (4)
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- hard c-collar
-bedrest - log roll - determination of inj before change |
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done with high level injuries
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trach
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have impaired what with high level inj
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diaphragmatic innervation (C2)
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can cause bradycardia and hypotension
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neurongenic shock
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given for anti-inflam
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methylprednisone
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dose for methylprednisone
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loading 30mg/kg IV for 15 min with NS for 45 min
then maintenance at 5.4mg/kg/hr |
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how long is the maintenance i loading dose is given within 3 hrs of inj
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23hrs
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if loading dose is given b/w 3-8 of inj how long is the maintenance
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48 hrs
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prophylaxis should be given for what with SCI
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- GI ulcers
- blood glucose mtr d/t steroids |
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what does inflammation cause (2)
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pressure
compromises blood supply |
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what is usually the result of giving methylprednisone
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-insulin drip
-PPI |
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PPI can cause what
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pneumonia d/t decreased acidity
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types of traction that can be used
(3) |
- gardner wells tongs
-cervical collar - halo traction |
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long term complications of SCI (8)
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- premature aging
- disuse syndrome - autonomic dysreflexia - bladder and kidney infection - spasticity - depression - pressure ulcer - heterotopic ossification hips/knees/ shoulders/elbows |
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bowel and bladder mgnt for SCi (2)
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-stool softener
-foley for hourly I&O |
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pain mgnt for SCI (5)
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- opiates
-muscle relaxants - antidepressants (neuro pain) - anticonvulsants (neuro pain) -massage/imagery/ diversional activities |
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prevention for paralytic ileus
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early gut feedings and ulcer prophylaxis
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resp complications for SCI
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pneumonia
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high risk due to decreased blood flow and decreased cutaneuos response to focal presure
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skin breakdown
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blood pools in LE due to loss sympathetic vascular tone
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ortho hypotension
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tx for ortho hypo (4)
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- stockings
- wraps to legs - hydration - gradual progression to upright position |
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altered thermoregulation due to what
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inj above T6 level---- lack of vasoconstriction or shivering---cant sweat
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DVT prophylaxis with SCI
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LMWH
filter |
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during spinal shock total loss of motor function below injury but once resolved what occurs
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spasticity
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life threatening complication w/ inj at or aboveT6 that can cause Sz or stroke
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autonomic dysreflexia/hyperdysreflexia
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what causes AD and AH
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unopposed symphathetic response below level of inj
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triggers AD and AH (5)
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bladder distention
constipation infection pressure sores pain |
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SE of AD and AH (10)
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-elevation in BP(life threatening)
- severe HA - nasal congestion -SOA - nausea - blurred vision - facial flushing - diaphoresis - piloerection - anxiety |
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tx for AD and AH (4)
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- move to sitting position STAT
- identify and tx underlyin cause - mtr BP and pulse (Presitin IV) - mgnt of bowel and bladder function |