6. Onset syndrome of massive imbalanced reflex sympathetic
discharge in patients with SCI above the splanchnic outflow (T5L2).
May appear within 24 weeks postinjury. Classically occurs in
patients with neurological complete SCI, although it may occur in
patients with incomplete SCI.
10. Orthostatic hypotension Treatment RepositionTrendelenburg/
recliner wheelchair Elastic stocking/abdominal binder/ace wrap LE
Accomodationuse of tilt table Fluid resuscitation: increase fluid
intake Pharmacological Salt tablets 1 gram QID Midodrine (alpha 1
adrenergic agonist): 2.510 mg TID Florinef (mineralocorticoid):
0.050.1 mg QD Use caution: once orthostatsis improves, the patient
may be at risk for autonomic dysreflexia.
11. 1 (94-1-93)
12. Treatment RepositionTrendelenburg/ recliner wheelchair
Elastic stocking/abdominal binder/ace wrap LE Accomodationuse of
tilt table Fluid resuscitation: increase fluid intake
Pharmacological Salt tablets 1 gram QID Midodrine (alpha 1
adrenergic agonist): 2.510 mg TID Florinef (mineralocorticoid):
0.050.1 mg QD Use caution: once orthostatsis improves, the patient
may be at risk for autonomic dysreflexia.
13. (98-1-64) spina bifida syringomyelia
14. Important Levels to Remember T6 and above: individuals with
SCI are considered to be at risk for Autonomic Dysreflexia
Orthostatic Hypotension T8 and above: if lesion above T8, patient
cannot regulate and maintain normal body temperature. (Note: an
easy way to remember this level is to spell the word temp eight
ture.) Central temperature regulation in the brain is located in
the hypothalamus.
15. 2 health care policy and research (99-2-61) 1.stage 0
2.stage I 3.stage II 4.stage III
16. MECHANISMS OF DEVELOPING A PRESSURE ULCER 1. Ischemia: lack
of blood supply to the tissue Frequently associated with hyperemia
in the surrounding tissue. Increased local O2 consumption occurs.
2. Pressure: Prolonged pressure over bony prominences, exceeding
supracapillary pressure (70 mmHg pressure) continuously for 2 hours
results in occlusion of the microvessels of the dermis with
subsequent tissue ischemia. 3. Friction (Shearing Forces): Friction
mechanically separates the epidermis immediately above the basal
cells.
19. Surgery Intervention Musculocutaneous flap: most common and
most often recommended in severe pressure ulcers in SCI. Skin
transferred with underlying muscle/blood vessels Rotation flap:
Semicircular flap rotating about a pivot point to close a
triangular defect Transposition flap: Rectangular flap rotates
about its base to fill an adjacent defect Advancement flap: Moved
into a defect without lateral or rotational movement
20. Postop Management for Musculocutaneous Flap Procedures
Strict bed restat least 34 weeks Vigilant pressure relief and
avoidance of shear forces Air-fluidized bed Temperature adjustable,
good pressure relief, absorption of wound fluids away,
bacteriostatic capabilities of the beads Sitting time: if no
problem after immobilization Slowly increased: start 15 minutes
daily and increase by 15 minutes BID. Monitor flap closely
afterwards.
21. (pressure ulcer) (93-1-72) 1. 2. 3. 4.
22. (100-1-57) 1. 2. 3. 4.
23. Female Infertility After SCI Immediately following SCI,
amenorrhea occurs in 85% of women with cervical and high thoracic
injuries and 5060% of women overall. However, 50 and 90%
(respectively) have return of menstruation within 612 months after
injury. SCI does not affect female fertility once menses
return.
24. Pregnancy The likelihood of pregnancy after spinal cord
injury is unchanged, since fertility is unimpaired. Pregnant women
with SCI may develop: Pressure ulcers Recurrent UTIs Increased
spasticity Decreased pulmonary function
25. Autonomic dysreflexia: may be the only clinical
manifestation of labor Uterine innervation arises from T10T12
level. Patients with lesions above T10 may not be able to perceive
uterine contractions. Treatment of choice is epidural anesthesia
Epidural should continue at least 12 hours after the delivery or
until the dysreflexia resolves Need to distinguish from
preeclampsia Slightly increased incidence of preterm labor
Constipation Thromboembolism Leg edema
26. (92-1-95) 1. 2. 3. 4.
27. (97-2-54) 1. 2. 3. 4.
28. SEXUAL DYSFUNCTION AFTER SCI Male Sexual Act Male erectile
and ejaculatory functions are complex physiologic activities that
require interaction between vascular, nervous, and endocrine
systems. Erections are controlled by parasympathetic nervous
system. Ejaculations are controlled by sympathetic nervous
system.
29. Male Infertility After SCI Fertility in men after SCI is
impaired. As mentioned above, two major causes are ejaculatory
dysfunction and poor semen quality. Poor semen quality is secondary
to: Stasis of prostatic fluid Testicular hyperthermia Recurrent
UTIs Abnormal testicular histology Changes in
hypothalamic-pituitary-testicular axis Possible sperm antibodies
Type of bladder management Long-term use of various
medications