 Hi and welcome to nursing school explained in this video on complications of spinal cord injury. If you haven't already done so please watch the other video that actually discusses the mechanism of injury and the signs and symptoms and treatment and nursing care of spinal cord injury in a separate video. So the three complications here that I'll be going over today are spinal shock, neurogenic shock and autonomic hyperreflexia. So spinal shock occurs immediately after the injury. It can last anywhere from 24 hours up to six weeks and it includes a complete but only temporary loss of certain functions that mostly include the musculoskeletal system. So motor and sensation as well as autonomic activity are usually lost below the level of the injury and that is because the brain is unable to transmit any signals to the muscles and organs because we have that injury and there is no communication below the level of the injury from the brain. And so signs and symptoms include flaccid paralysis, there are absent deep tendon reflexes that might be decreased visceral and somatic sensations that can also lead to anhydrosis which means an absence of sweating and then a paralytic illness because the visceral organs are also affected not only the muscles so keep in mind it's internal as well as external. And the treatment for that includes as with anybody with a spinal cord injury spinal stabilization supporting ABCs and then PT and OT and rehab and then other measures to support the bladder and bowel that I discussed in the other spinal cord injury video. And then neurogenic shock is a little bit different which can occur 30 minutes to six weeks after the injury and it is a distributive type of shock remember there are different types of shocks and the urgent shock falls into the distributive category here and that usually occurs when there's an injury either to the brain the cervical or thoracic spine so high level spinal cord injuries and it means that there is a loss of the autonomic nervous system control to the blood vessels because now again there is no communication from the brain all the way down to the blood vessels and so the patient loses their sympathetic nervous system and the sympathetic tone to their blood vessels which results in massive vasodilation keep in mind the sympathetic nervous system usually helps with vasoconstriction but now we don't have that because it's impaired so it results in massive vasodilation and which will result in in significant hypotension that can lead to tissue hyperperfusion and then impaired cellular metabolism and cell death it's basically low perfusion no oxygen to the tissues means the cells are going to die so signs and symptoms include significant hypotension because of this massive vasodilation but also the hard rate goes down and the temperature might be elevated or it might be low depending on what is going on with the patient in terms of how they can adjust to the external environment if at all now treatment for this includes again spinal stabilization as in anybody with spinal cord injury the administration of vasopressors to help constrict these blood vessels and bring the blood pressure up to ensure the tissue perfusion and those usually include norepinephrine which is also called liver fat or phenolephrine which is also called neosinephrine and then the patient because of the low heart rate here might also need atropine which basically counteracts the influence of the parasympathetic nervous system or the patient might need a pacemaker now this can be so significant like I just said that the patient might need a permanent pacemaker because this can last up to six weeks and we can't just continue to give them the patient now autonomic hyperreflexia is also a life-threatening injury as is neurogenic shock and what happens here is now the sympathetic nervous system below the level in the level of the injury responds to a stimulus of the sensory receptors and this can be as simple as a wrinkled sheet that the patient is laying on and this then leads to vasoconstriction because now we're hyper stimulating the sympathetic nervous system and the reflexes the primitive reflexes it controls and because of this vasoconstriction now will constrict the blood vessels the blood pressure goes up and it can be as high as 300 millimeters of mercury and you can imagine how that can be life-threatening to all the different organs and then there's no opposition from the parasympathetic nervous system because we have that spinal cord injury there is no communication but the barrel receptors that sit in the carotid arteries and then the aortic arch they stimulate the parasympathetic nervous system which is kind of like the backup system in case the the brain of the spinal cord can't communicate and that leads to a hypo brain cardiac but there is no basic dilation because of that spinal cord injury so usually the barrel receptors would stimulate the parasympathetic nervous system heart rate goes down perfor blood vessels dilate but now because the sympathetic nervous system is so overly excited um it it continues to raise a constrict so now we have a problem with low heart rate and high blood pressure so quite the opposite that we have over here with the super low blood pressure and the most common causes for high autonomic hyporeflexia are the standard bladder and bowel and this is something that usually comes up on an exam I'll tell you that right away um and but it can also be due to skin or pain receptor stimuli and like I said before this could be as simple as a wrinkled sheet that's putting a pressure or maybe the patient just rolls over and they inadvertently lay on the on the collides any kind of stimulus that can send their sympathetic nervous system into overdrive because the function is impaired now signs and symptoms here is because of this extremely high blood pressure the patient will also have a throbbing headache and maybe blurry vision as often goes along with high blood pressure there might be diaphoresis above the level of the spinal cord injury because that's still functioning normally and then we have a low heart rate sometimes in the 30s and 40s there might be pilo erection which basically means goosebumps above um and flushing above the level of the injury and the treatment for this life-threatening autonomic hyporeflexia is to check the blood right away if the patient complains of a headache so if you're treating a patient with with a spinal cord injury no matter if this is um right after the injury while they're still in the hospital while they're in rehab or maybe even if they've been discharged and they've been home for a year or two because this can certainly occur at any time and then we want to elevate the head of the bed to help with the vasodilation here and then we certainly have to determine the cause so if the most common causes are bladder and bowel dissension then we have to relieve that by maybe catheterizing the patient or helping them to get rid of any fecal impaction and then removing any skin stimuli such as you know like I talked about the wrinkle cheese or the colic that they might be laying on but also in order to control this really really elevated blood pressure we might need vasodilators such as nitroglycerin, nitroproside and sometimes hydrolysin is also used so in summary the autonomic hyporeflexia as well as the neurogenic shock of both life-threatening neurogenic shock is more a distributive shock where the sympathetic nervous system vasodilates resulting in low blood pressure and low heart rate. The autonomic hyporeflexia is high blood pressure because of that stimulus and that overdrive of the sympathetic nervous system so high blood pressure and then bradycardia and the spinal shock is more involving of the motor and motor and sensory system such as this flaccid paralysis, deep tendon reflexes and paralytic alias so we have to think of visceral as well as somatic innervation here that can be affected. So thank you for watching this video on complications of spinal cord injuries. Please give me a thumbs up if you enjoyed it and I'll see you again soon here on Nursing School Explained. Thanks for watching.