BACK BONE INJURIES

♠ Definition

Spinal cord injury is a disorder which in today's more challenging because the patterns of change and progress in the field of trauma and its management. Spinal cord injury caused by spinal fractures and the majority of cervical and lumbar regions.

♠ Etiology

Spinal cord injuries occur as a result of:

1. falls from height, eg coconut trees, accidents in the workplace.

2. traffic accidents

3. sports accidents

injuries caused by hiperfleksi, hyperextension, compression or rotation of the spine. Thoracic area is not much happening because of the structure protected by a piston.

Fractures may be simple fractures, compression, kominutif, and dislocation, while the damage to the spinal cord can be a bruising, contusions, transverse damage, lacerations with or without circulatory disorders, or bleeding.

Abnormalities secondary to the spinal cord can be caused by hypoxemia and ischemia. Ischemia caused by hypotension, edema, or compression.

Be aware that damage to the spinal cord is permanent damage that will not happen because the regeneration of nerve tissue. In the early phase after trauma can not be ascertained whether the disorder is caused by damage to the actual function of neural tissue or caused by pressure, bruising or edema.

Clinical manifestations ♠

Clinical picture depends on the location and magnitude of the damage. Damage to cross its manifestations: loss of motor and sensory function of the caudal accompanied damage in spinal shock. Spinal shock occurs in the spinal cord damage due to sudden loss of central excitatory. Characterized by:

1. Paralysis flasid

2. anesthesia

3. arefleksi

4. Loss prespirasi

5. Impaired function of rectum and bladder

6. Priapism

7. bradycardia and hypotension.

After spinal shock restored, there will be hiperrefleksi. You can also see signs of autonomic dysfunction, in the form of dry skin because it does not sweat, and orthostatic hypotension and impaired bladder and bowel disorders.

Spinal cord syndrome showed the front of the striated muscle paralysis below the site of damage with loss of pain and temperature on both sides, while the sense of touch and position is not compromised.

Central spinal cord injury is uncommon. This situation generally occurs due to injury to the cervical area and is caused by sudden hyperextension thus driven from the dorsal spinal cord by the ligamentum flavum is folded. Manifested by partial tetraparese. Disturbances in the bottom ekstermitas lighter than the upper extremities, whereas the perianal area is not disturbed.

Brown-Sequard syndrome is caused by damage to the spinal cord lateral separu. Clinical symptoms of motor disturbances and loss of vibration and position sense ipsilateral; there are disturbances in the contralateral pain and temperature.

Damage to the spinal vertebrae L1-L2 level resulted in perianal anesthesia, impaired function of defecation, micturition, impotence and loss of reflexes and reflex anal bulbokavernosa. This syndrome is called the conus syndrome medularis.

Cauda equine syndrome is caused by compression of the lumbo sacral roots medularis tall conical tip and cause paralysis and anesthesia in the lumbosacral region that is similar to the conical medularis syndrome.

Prevention and management ♠

Spinal cord injury if not handled properly can cause death or abnormalities that persist in the form of permanent paralysis. Paralysis that occur have a treatment effect are tricky and require lots of equipment. There are two main goals of spinal cord injury treatment:

1. The achievement of a stable spine and no pain

2. Preventing spinal cord injury secondary latitude.

Action taken to the handling of spinal cord injury:

1. Do immobilization at the scene (base board).

2. Optimization of physiology ABC: airway, breathing and blood circulation.

3. Handling of the abnormalities is more urgent (pneumotorak?)

4. Neurologic examination to determine the lesion

5. Radiological examinations (sometimes required)

6. Follow-surgical (decompression, reposition or stabilization)

7. Prevention of complications

• Paralytic ileus → gastric sonde

• complications of bladder paralysis

• pneumonia

• decubitus

Nursing Diagnosis emerging ♠

1. Self-care deficit

2. Impaired physical mobility

3. Body image disturbance

4. Damage to skin integrity bd mechanical factors (pressure sores occur)

5. Risk of infection