Spinal Shock
What is spinal shock?
A. caused by a T6 or above injury causing the whole spinal cord to permanently be turned off
B. caused by a traumatic injury in the spinal cord which turns the spine off below the level of injury. It is temporary and reversible
C. Caused by the Sympathetic nervous system being overreactive caused by discomfort somewhere in the body.
D. caused by an SCI above T6 that causes the SNS to run off temporarily causing severe hypotension and loss of vascular tone
B. Caused by traumatic injury in the spinal cord which turns the spine off below the level of injury. It is temporary and reversible.
What is neurogenic shock?
A. a patients sympathetic nervous system is overstimulated causing an increased in blood pressure and vasoconstriction due to a SCI
B. a failure of the SNS causing the PNS to take over the body unchecked. Caused by a SCI above T6.
C. Hypotension and tachycardia associated with hypovolemia
D. Temporary and reversible shock caused by a SCI that causes massive spinal cord function loss
B. Neurogenic shock is caused by the SNS failing as a result of a T6 or higher injury causing severe hypotension and bradycardia that is fatal in 20-50% of people
A. A patient sustained a skull fracture and a SCI in 2025 after falling off a roof. They live in an assisted living facility and have a wheel chair. they have no use of either legs. This patient comes into the ED complaining od sweating and a headache that they just cannot get to go away. You notice that they have a really red and flushed face. When they get dressed in a hospital gown you discover their legs are pale and cold.
B. Your patient sustained a C6 injury after a motorcycle crash. They lose all ability in their body after being stabilized in the ED.
C. Your patient has a T4 injury and is stabilized in the ED. Out of no where their blood pressure drop to 80/30 and their HR drops to 38. They have flushed red extremities and their hands are edematous.
A. matches autonomic dysreflexia
what type of SCI would this be classified as? A patient who has respiratory difficulties and is not able to maintain their airway themselves. They are not able to move or feel arms or legs.
A. Thoracic
B. Lumbar.
C. Sacral
D. Cervical
Cervical
What type of SCI is described here: a patient with severe lower back pain and weakness or loss of movement in limbs. Loss of bowel and bladder control and sexual dysfunction. pain is localized to the Lumbar spine?
A. thoracic
B. lumbar
C. sacral
D. cervical
B. Lumbar
Which of these patients matches a patient with spinal shock?
A. A patient comes into the ED from a MVA. They are in a spinal collar with a suspected cervical spinal injury. The patients VS are: BP: 96/59 HR: 47 T: 95.7 RR: 30. They have absent DTRs in bilateral lower extremities. They are having a difficult time breathing on their own.
B. A patient come into the ED from a MVA. This patient is in a cervical collar with a suspected spinal cord injury. This patient has the following VS. BP: 90/40 HR: 35 T: 95.6. Upon assessment they have warm and flushed extremities.
C. A patient arrives from the ED after sustaining a SCI 6 months ago. They have the following VS: HR: 52 BP: 150/98 T:98.6. Their arms are red and warm however their legs are a pale blue color and cold to the touch. The patient is sweaty and reports a severe headache.
A. Spinal shock occurs after a SCI injury causing the rest of the spinal cord to turn off after and injury. B is describing neurogenic shock and C is describing autonomic dysreflexia.
Which of these patients matches a neurogenic shock patient.
A. A patient comes into the ER from a shooting. The patient sustained a gun shot would to the mid back at T4. Their current assessment and vitals. T: 96.3, BP: 80/32 HR:32, RR: 37 O2:76%. They have hands and feet that are pink and warm despite cyanosis around the lips.
B. A patient comes into the ER after being hit by a car on the highway. They sustained a SCI injury to the T3. They went home with the use on upper extremities but the loss of both lower extremities. This happened 4 months. ago. They present to the ER again complaining of a pounding headache and blurred vision. VS: 178/99 HR: 42 RR: 20 T: 97.5 O2:94%. The patients are are warm and flushed as well as their face however, their legs are pale and cool to the touch.
C. A patient comes into the ER with a suspected lumbar spinal injury following a skiing accident. They have no sensation to their arms or legs and begin to have respiratory distress. They are rapidly intubated despite the location of the SCI to be at L5.
A.
What are common triggers for urinary retention? SATA?
A. Heat exposure
B. sickness
C. urinary/ bladder retention
D. Loose fitting clothes
E. new laundry detergent
F. constipation
C. bladder/ urinary retention
E. new laundry detergent
F. Constipation
other triggers include pressure ulcers, tight fitting clothing, and fractures or trauma. Example in class was the patients legs being crossed and uncomfy
What is this type of injury? This patient has a loss of movement in their trunk, bowels and bladder as well as in their legs. They can breathe on their own but have ineffective coughing.
Thoracic
What SCI is being described here? Loss of movement and sensation to lower extremities, sexual dysfunction and bowel and bladder dysfunction. Pain with sitting.
A. sacral
B. lumbar
C. thoracic
D. cervical
A. Sacral
Is spinal shock reversible? If so how long does it typically take to resolve?
A. No it is not reversible. It is permanent paralysis below the point of injury
B. No it is not reversible.
C. It is reversible and can resolves anywhere between 48 hours to weeks after the spinal cord injury
D. it is reversible and can typically be resolved anywhere between 24-72 hours once swelling resolves.
C. It is reversible and can resolve anywhere between 48 hours to several weeks after the injury. This is due to the need for both the inflammation to resolve as well as the neurons in the spinal cord to begin firing again.
Select all that apply: what are signs and symptoms that make sense for a pt experiencing neurogenic shock.
A. Severe HTN
B. Severe hypotension
C. Bradycardia
D. Cool and cold lower extremities
E. Warm and dry extremities arms and legs
F. DecreasedVascular tone.
B. Severe hypotension
C. bradycardia
E. Warm and dry extremities arms and legs
F. decreased vascular tone
Please explain why the patient will have flushing and sweating above the area of injury but they will have pale cold skin below the level or injury?
The spinal cord is intact above the area of injury so the PNS system is able to correct the increased HTN so it causes dilation. The area below the injured spinal cord does not allow the PNS to pass below the area of injury so the hypertension is not able to be corrected leading to hypertension and vasoconstriction
What are the interventions we need to do for a pt with a cervical SCI?
A. TSLO brace, Psychosocial support, immobilization
B. Cervical collar, respiratory stabilization, immobilization and halo
C. Respiratory management, rehabilitative therapy, pain prevention
What are TSLO braces and what are some educational points we should give?
TSLO braces = brace molded specifically to each person to give extra support.
Should be worn all the time when sitting or standing up
can be taken off when laying down in bed or sleeping
What are the primary intervention for a patient suffering from spinal shock?
A. Fluid resuscitation, vasoporessors, DVT prevention
B. Airway management, neurological checks, vasopressors
C. High fowlers with legs lowered, straight caths, BP management.
B. For a pt with spinal shock the whole spinal cord will be turned off at the area of injury. In this case we are most worried about securing an airway, increasing BP from hypotension with vasopressors, and to do frequent neuro checks to manage the return of sensations or to sense any changes
What is the number 1 priority in treating neurogenic shock?
A. DVT prevention
B. vasopressors
C. Fluid resuscitation
D. Labs
C. fluid resucusitation because fluids are moving all from the inside of the vasculature into the tissues of the body. There is massive hypotension so fluid resuscitation is the priority follow directly by vasopressor use to increase vasoconstriction
What is the best intervention to correct autonomic dysreflexia? explain what is means
A. Sit--> search --> solve
B. Labs --> Sit --> search
C. Search --> sit --> solve
Sit, search, solve
- 1st intervention is to sit them at 90 degrees in high fowlers with the legs lowered. Then we search the body and look for the area of discomfort and then we solve the issue that is causing the dysreflexia
What are the main interventions for a thoracic SCI?
A. Immobilization, airway support, BP management
B. TSLO brace, logrolling, respiratory management based on swelling
C. rehabilitate, psychosocial support, bladder control
B. TSLO brace, logrolling, respiratory management based on swelling
Patients with lumbar and sacral SCI have some embarrassing dysfunctions. What is important to include in the plan of care for these patients?
Counseling and therapy for patients regarding the loss of sexual function and potentially bowel and bladder incontinence
Your patient comes in with suspected spinal shock after falling off a 3 story building head first. They are wearing a cervical collar and are unconscious. What is the most important assessment and intervention for this patient based on their presentation?
(no multiple choice for 500 points)
AIRWAY. with a cervical injury we are worried about airway issues and breathing. we need to first secure an airway whether that through RSI and ventilation or bagging them until we can get them stabilized.
What is the vasopressor of choice for neurogenic shock?
A. neosynephrine
B. epinephrine
C. Norepinephrine
D. phenylephrine
A. neosynephrine
Name 2 educational points to give a patient with autonomic dysreflexia
2. keep tube feeds patent
3. prevent UTIs
4. bowel regimens (fluids and fiber)
5. check skin daily
6. turns frequently
What complications are we worried about with cervical and thoracic SCIs? (3)
autonomic reflexia
neurogenic shock
spinal shock
for ALL SCIs what are we worried about from injury to about 72 hours after injury ESPECIALLY with cervical and thoracic SCIs.
SWELLING UP THE SPINAL CORD which can cause respiratory distress even when we think we have them stabilized.