B.L., age 17, has a compression fracture at C5 to C6, a result of diving from a bridge into a river and hitting a submerged rock. Fortunately, a companion who had first aid training as a lifeguard rescued her and tried to minimize any secondary damage. In the emergency department, B.L. could not move her limbs or sense touch and lacked reflexes in her limbs.
1. Explain why caution is needed when handling a person with a possible spinal cord injury.
2. Describe a compression fracture and how it can affect neurological function.
3. Explain why reflexes are absent in B.L. at this early stage. Explain what type of paralysis is present? Include the manifestations.
4. Explain why and how B.L.'s respiratory function may be impaired at any time.
5. Explain why the full extent of permanent damage cannot be estimated in this initial period. Surgery was performed to relieve pressure and stabilize the fracture site.
6. Describe several additional factors that may result in secondary damage to the spinal cord.
7. Explain the anticipated effect in the immediate period of this injury on B.L.'s blood pressure and bladder function.
Several weeks later, routine examination indicated that some spinal cord reflexes were returning in the lower extremities. Gradually, more reflexes returned. Some muscle tone and movement of the shoulder and upper arm became apparent, but no other function returned.
8. Explain the change to be expected in bowel and bladder function as reflexes return. Also, include why these changes are expected and what they are in explanation.
One day, B.L. suddenly developed a severe headache and blurred vision. Her blood pressure was 210/120 mm Hg, and her pulse was 62 beats per minute.
9. Explain what has probably caused this effect and what action needs to be taken?
10. Suggest the four specific components for a rehabilitation program for B.L. Expand your comments on an area of particular concern to you.