What affects mortality from spinal cord injury?
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LEVEL OF INJRUY
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AGE
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COMORBITIES
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What are huge infections that are associated with spinal cord injury?
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PNEUMONIA
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UTI
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What makes up the CNS?
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BRAIN AND SPINAL CORD
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What is the spinal cord covered in?
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MENINGES
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Where does the spinal cord start and where does it end?
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BOTTOM OF BRAIN TO L3/L4
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Where is sensory?
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POSTERIOR-BACK
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REMEMBER-FEEL THE BACK
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What falls under sensory?
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FEEL THE BACK!!!
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PROPRIOCEPTION (POSITION)
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LIGHT TOUCH
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VIBRATION
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Where is motor?
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ANTERIOR-FRONT
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What falls under motor?
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PAIN/TEMP
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How many phases is spinal cord injury?
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2
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What is the primary phase of spinal cord injury?
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THE INITAL PUNCH
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NUEOR DAMAGE AT TIME OF INJURY
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What can happen in the primary phase of spinal cord injury?
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HEMORRHAGE, DECREASED BLOOD FLOW, INFLAMMATORY CASCADE-NEVER FIBERS=SWELLING
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Mechanical injury in primary phase of spinal cord injury?
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SHEARING/COMPRESSION FORCES
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CELL DEATH
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VASCULATURE DISRUPTIONS
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Disruptions in primary phase of spinal cord injury?
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RESP DIFFICULTY
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NUERO SHOCK
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INFLAMMATION
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MEMBRANE COMPROMISE
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ALTERATIONS IN ION AND NEUROTRANSMITTER LEVELS
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What is the secondary phase of spinal cord injury?
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HAPPEN BC OF THE INJURY, IN EFFECT OF IT
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What can happen in the secondary phase of spinal cord injury?
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ISCHEMIA, O2 NOT WHERE IT NEEDS TO GO, MORE EDEMA, HYPOXIA
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Ischemia in secondary phase of spinal cord injury?
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ACTIVATE ISCHEMIC CASCADE
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EXCESSIVE CALCIUM AND ROS PRODUCTION
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APOPTOSIS: DEATH OF CELLS
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Inflammation in secondary phase of spinal cord injury?
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ASTROGLIOSIS
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LYMPHOCYTE INFILTRATION OF LESION
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ACTIVATION AND PHAGOCYTIC MONOCYTES
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Excitiotoxicity of secondary phase of spinal cord injury?
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EXCESSIVE CALCIUM LEADING TO ROS PRODUCTION AND OXIDATIVE STRESS
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EXCESSIVE GLUTAMATE
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APOPTOSIS
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Does the healthcare team worry more about primary or secondary phase of spinal cord injury?
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SECONDARY
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What is complete spinal cord injury?
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CANNOT MOVE ANY PART BELOW THE INJURY
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What is paraplegia/diplegia complete injury?
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LOWER COMPLETE LOSS BELOW THE REGION OF INJURY
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LEGS
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What is tetraplegia/quadriplegia complete injury?
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ALL 4 EXTREMITIES-NO MOVEMENT BELOW INJURY. BELOW NECK
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What is incomplete spinal cord injury?
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MAY BE ABLE TO MOVE 1 ARM/LEG, FEEL SOMETHING
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What is a flexion injury?
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head on collision-neck goes forward and damages spinal cord
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What is hyperextension injury?
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SUDDEN ACCELERATION IN CAR, HIT FROM BEHIND, FALLS, HIT HEAD ON COUNTER
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NECK GOES BACK AND DAMAGES SPINAL CORD
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What is compression injury?
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DIVING
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SHATTERS INTO PIECES
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What is rotational injury?
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QUICK SNAPPING
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What patient is most unstable with injuries?
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FLEXION
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What do the cervical nerves affect?
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BREATHING!!
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What do the thoracic nerves affect?
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SOME BREATHING
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LOWER PART=GI
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What is the order of the nerves in the spine?
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1.CERVICAL
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2.THORACIC
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ABDOMINAL
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3. LUMBAR
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SACRAL
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How many nerves are in the cervical area?
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8
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THINK WAKE UP AT 8
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What nerves in the cervical area require ventilation?
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C1-C4
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What cervical area is known as "alive"?
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C5
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How many nerves are in the thoracic area?
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12
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THINK EAT LUNCH AT 12 (NOON)
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What do the lumbar nerves affect?
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LEG MUSCLES
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How many nerves are in the lumbar area?
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5
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THINK DINNER AT 5
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What do the sacral nerves affect?
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BOWEL, BLADDER, SEXUAL FUNCTION
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How many nerves are in the sacral area?
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5
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ANOTHER 5
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Do most spinal cord injuries have bowel/bladder issues?
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YES
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Where is C4?
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NAPE OF NECK
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Where is T4?
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PERKY NIPPLES
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Where is T10?
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UMBILICUS
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Where is sacral?
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GU
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What is a dermatome?
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PICTURE THAT SHOWS WHERE NERVES ARE
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Is incomplete more complicated that complete spinal cord injury?
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YES
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What is important to know about incomplete spinal cord injury?
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WILL HAVE VARYING DEGREES OF SENSORY AND MOTOR FUNCTION DEPENDENT ON THE PORTION OF THE SPINAL CORD AFFECT
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VERY DIFFERENT PRESENTATION
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Do nerves regenerate?
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YES
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Symptoms of spinal cord injury?
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PRESSURE IN THE HEAD,NECK, OR BACK
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INTENSE BACK PAIN
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PARALYSIS, LACK OF COORDINATION, OR WEAKNESS IN ANY PART OF THE BODY
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LESS OF SENSATION OR NUMBNESS OR TINGLING IN THE HANDS, FEET, FINGERS, OR TOES
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TWISTED OR ODDLY POSITIONED
What is the acronym for immediate care of the spinal cord injury?
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A: AIRWAY
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B: BREATHING
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C: CARDIAC
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D: NEUROLOGICAL DISABILITY
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E: EXPOSURE/ENVIRONMENT
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If someone needs to be incubated with a spinal cord injury, how would someone go about it?
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JAW THRUST-NOT THE HEAD TILT!
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What should the healthcare team always suspect with trauma occurs until it is rule out?
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SPINAL CORD INJURY
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After a CT scan is done on the pt what needs to happen?
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NEED TO COME OFF THE BACKBOARD
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For immobilization what does the patient receive?
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BACKBOARD, C-COLLAR, HEAD TAPED
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When does the patient receive Methylprednisolone?
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WITHIN 8 HR OF INJURY
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What is the loading dose for Methylprednisolone?
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30 MG/KG IV OVER 15 MIN
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What is the maintenance for Methylprednisolone?
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23-48 H
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If someone has a spinal cord injury, what unit are they on?
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ICU
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If someone has a spinal cord injury, what MAP is preferred?
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85
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PROMOTES PERFUSION
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REMEMBER NORMALLY IT IS 70-100
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If someone has a spinal cord injury, what systolic bp is minimum?
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90
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What is the grading of the spinal cord injury-chart?
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LOOKING AT EACH SPINAL CORD NERVE-SEE BASELINE OF PT
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Huge complications with spinal cord injury?
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SPINAL SHOCK
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NEUROGENIC SHOCK
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AUTONOMIC DYSREFLEXIA
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DVT: ON LMW HEPARIN
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Is spinal shock a true shock?
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NO
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What is spinal shock?
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NO SENSORY, MOTOR, OR REFLEXES
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EDEMA-"CONCUSSED" CORD
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When Spinal shock resolve?
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IN A FEW DAYS TO A WEEK
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Describe spinal shock
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IMMEDIATE RESPONSE FROM INJURY
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EVERYTHING BELOW THE INJURY DISAPPEARS WITH FUNCTION
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FLACCID PARALYSIS
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Why kind of shock is neurogenic shock?
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DISTRIBUTIVE SHOCK
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In what kind of injury does neurogenic shock occur?
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SCI WITH CERVICAL OR HIGH THORACIC INJURY (T7)
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What is there a loss of with neurogenic shock?
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SYMPATHETIC TONE
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Symptoms of neurogenic shock?
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BRADYCARDIA (FROM VASODILATION)
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HYPOTHERMIA
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HYPOTENSION
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What does the skin of someone in neurogenic shock look like?
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WARM AND DRY
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Is there vasoconstriction or vasodilation with neurogenic shock? Is there systemic vascular resistance? Is there good flow to the heart?
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VASODILATION
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NO SYSTEMIC VASCULAR RESISTANCE
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NO GOOD FLOW TO HEART
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What would be the course of action when treating neurogenic shock?
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INCREASE CVP AND FLUID VOLUME STATUS, MAKE THEM HYPERVOLEMIC
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WHEN FLUID VOLUME STATUS IS UP GIVE PRESSORS
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Would one give PRESSORS prior to bringing up the fluid volume status?
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NO
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What cvp does one want there to be?
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8
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What medication would be given to bring up the heart rate?
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ATROPINE
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With a risk of pneumonia what would the patient be put on?
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STEROIDS
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Where is the innervation for bowel/bladder?
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SACRAL NERVE
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What is autonomic dysreflexia?
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MASSIVE SYMPATHETIC RESPONSE
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Where must the injury occur for autonomic dysreflexia to occur?
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T6 OR ABOVE
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What could stimulate the sympathetic nervous system?
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FULL BLADDER OR STIMULUS FROM BOWEL
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NERVES ARENT WORKING
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What is the response to the sympathetic activation?
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SKY HIGH HTN-IN THE 200'S
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Is this an emergency?
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YES
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What would the skin of the patient and the patient look like above the injury and where there is parasympathetic response-not sympathetic?
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VASODILATION=FLUSHING
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NASAL CONGESTION
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What would the skin of the patient and the patient look like below the injury and where there is sympathetic response?
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COLD
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CLAMMY
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GOOSEBUMPS
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Interventions for autonomic dysreflexia?
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SIT PT UP-GRAVITATIONAL EFFECT
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What should the nurse be doing before the pt gets to this point?
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ASSESSING PT FOR STIMULATION-FOLEY/BOWELS
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What resp. Complications can occur fro SCI, and what interventions are there?
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COMPLICATIONS: RESP FAILURE, RESP INSUFFICIENCY, OR BOTH
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INTERVENTIONS: ADMIN BRONCHODILATORS, ASSESS RESP STATUS
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What cardiac Complications can occur fro SCI, and what interventions are there?
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COMP: ACUTE HYPOTENSION
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INTERVENT: MAINTAIN MAP >85 FOR FIRST 7 DAYS AFTER INJURY
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COMP: BRADYCARDIA
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INTERVENT: MONITOR HR, ADMIN MEDS FOR SYMPTOMATIC BRADYCARDIA
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COMP: DVT
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INTERVENT:: MONITOR DVT RISK, INITIATE PROPHYLAXIS
What Genitourinary Complications can occur fro SCI, and what interventions are there?
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COMP: URINARY RETENTION
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INTERVENT: DECOMPRESS THE BLADDER VIA INDWELLING CATHETER INSERTION AS ORDERED, IMPLEMENT INTERMITTENT STRAIGHT CATHETERIZATION PROTOCOL
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What GI Complications can occur fro SCI, and what interventions are there?
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COMP: ILEUS
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INTERVENT: MONITOR FOR ABDOMINAL DISTENTION
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COMP: CONSTIPATION
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INTERVENT: MAINTAIN BOWEL ELIMINATION
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What musculoskeletal Complications can occur fro SCI, and what interventions are there?
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COMP: CONTRACTURES
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INTERVENT: PROVIDE FREQUENT ROM, ADMIN ANTISPASMODICS
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What dermatological Complications can occur fro SCI, and what interventions are there?
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COMP: SKIN BREAKDOWN
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INTERVENT: PERFOM METICULOUS SKIN CARE AND OBSERVE UNDER SPLINTS/BRACES, REPOSITION Q2H, SHIFT WEIGHT Q30MIN WHEN PT OUT OF BED IN UPRIGHT WHEELCHAIR
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