Spinal Shock | Western Sydney University

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

29

Pages:

4
Author:

Mariam A. A.

Spinal Shock Definition Temporary reversible loss of all neurological function below the level of an acute spinal cord injury Causes Traumatic SCI Most common Mechanical compression Vascular ischemia Structural instability Clinical features Flaccid paralysis Total loss of reflex activity Total loss of sensations Bowel and urinary dysfunction Key Info In a trauma scenario a hypotensive patient is considered hypovolemic until proven otherwise Investigations Plain radiographs Non-contrast CT MRI Gold standard CT angiography For high-risk individuals Management ABCDE Airway high cervical injury high risk of diaphragmatic paralysis Breathing especially of C3 – C5 involved (phrenic nerve) Circulation Hypotension is common aim to maintain a MAP of 85 to 90 mmHg IV fluids first line If persistent norepinephrine Disability/neurology assessment Serial ASIA neurological exams Once reflexes return monitor for features of autonomic dysreflexia Exposure/spine protection C-collar and spine immobilization Log roll if necessary MAINTAIN NEUTRAL SPINE ALIGEMENT Prevent secondary injury from: Hypotension Hypoxia Hypercapnia Early neurosurgical consult Neurogenic shock support Bradycardia + HoTN Atropine for symptomatic bradycardia Vasopressors for HoTN Neurosurgical management if needed Indications Progressive neurological deterioration Clinically/radiological proven compression Dislocation type injury Spinal tumour, epidural abscess or haemorrhage SC compression Adjunctive care DVT prophylaxis Pressure injury prevention Bladder charts Bowel charts Laxatives Pain management MDT Physiotherapy OT Social work Family counselling NDIS Monitoring for Red Flags Persistent HoTN and bradycardia Ongoing neurogenic shock Monitor for autonomic dysreflexia once reflexes return Complications Cardiovascular dysfunction Hypotension Most common Respiratory failure DVT from prolong immobilisation Neurogenic bladder and bowel Thermoregulatory failure Autonomic dysreflexia Long term paralysis and neuropathic pain Prognosis Temporary Full recovery takes 4 to 12 weeks? Recovery timeline Phase Timeline Progress I 0 to 24 hours Areflexia or hyporeflexia below lesion II 1 to 3 days Initial return of reflexes beginning with the bulbocavernosus reflex III 4 days to 1 month Early hyperreflexia IV 1 month to 12 months Final spasticity phase where the synapses reorganise