spinal cord injury case scenario
Weight loss and muscle atrophy are common soon after a spinal cord injury. This is known as a corpectomy. What is the function of the dens of C2, and why are fractures in this region so dangerous? m. Would you consider taking another medication to manage your pain? If the surgery is a complete success, she will be able to return to her previous activities with a greatly decreased chance of her spinal cord being compressed further. e. What kind of pain are you still experiencing? Reinforce and encourage continued participation in treatment. Belief that addiction is a moral issue and not a medical issue. This is done by an incision along the back of the neck. (Select all), -Jonathan complains of a loss of sensation below his shoulders. Make a donation. Wait to address his Dilaudid refill request until after you've discussed less threatening issues. Continue to gently ask questions. This patient is specifically requesting Dilaudid and indicating that this is the only medication that can work. This content does not have an Arabic version. Case One: A Spinal Cord Injury Patient With a Pain Medication Problem Scenario. 7. Motor tracts carry signals from your brain to control muscle movement. This test entails her lying down for about 45 minutes in a long-tube. Jonathan flips in midair and feels something pop in his neck as he lands hard on the ground. Being between the ages of 16 and 30. This is known as a fusion. Mrs. S was also informed of the surgical options. Don't move the injured person — permanent paralysis and other serious complications may result, Call 911 or your local emergency medical assistance number, Place heavy towels on both sides of the neck or hold the head and neck to prevent them from moving until emergency care arrives, Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck. This is what is responsible for the magnetic part of the magnetic resonance imaging (MRI). Mrs. S has had no problems urinating on her own, and no change in her bowel habits or control. Spinal cord injury. Use your rapport. What will happen to her if she doesn't choose surgery? Cervical Spinal Stenosis: Patient History and Case, Cervical and Lumbar Spinal Stenosis Overview, Spinal Stenosis: Causes Affect Treatment Options, Alternative Treatments for Spinal Stenosis, Exercise: Take Healthy Steps to Relieve Pain, Medications and Spinal Injections Help Manage Painful Spinal Stenosis, Video Exercises for Lumbar Spinal Stenosis, Spondylosis Symptoms, Causes, Diagnosis and Treatment, Patients Guide to Non-Fusion, Motion Preserving Treatment for Lumbar Spinal Stenosis, If You’ve Said “Yes” to the Needle, Here’s What to Expect at Your First Acupuncture Visit. Rehabilitation Services Allscripts EPSi. If it is clear that there is significant clinical impairment in the patient's biopsychosocial functioning as a result of his Dilaudid use, the patient should be referred to a substance abuse treatment provider for further evaluation and treatment. She didn't want to hear about it. and "Do you ever take anyone else's pills?" Get help! 1. Learn about a new treatment for spinal stenosis. If the patient does not have insurance that covers substance abuse treatment, or does not have the ability to pay for treatment, or if the physician has no knowledge of substance abuse treatment agencies, refer to SL County Division of Substance Abuse at 468-2009 or refer directly to Interim Group Services. Physician should obtain a release of information from the patient and provide referral information to the treating agency regarding concerns. Your bladder will continue to store urine from your kidneys. AskMayoExpert. Have you been prescribed pain medication in the past? This review explores the various trends in the management of pSCI along with a literature review. Jonathan Begay, a 22-year -old man of the Navajo Nation, is playing football with some of his friends in the park. Tracts in your spinal cord carry messages between your brain and the rest of your body. Spinal cord injury. 1. Make sure that your children wear a seat belt or use an age- and weight-appropriate child safety seat. Limited mobility may lead to a more sedentary lifestyle, placing you at risk of obesity, cardiovascular disease and diabetes. The lowest normal part of your spinal cord is referred to as the neurological level of your injury. Furthermore, it is even more unlikely for her neurologic symptoms to significantly improve. They have outlined the anatomy and covered the majority of pathological processes that afflict the cervical spine. 1. The motivation for use will help you determine if there is an addiction or whether the pain is being under managed. Acknowledge it may be difficult for the patient to share this information. In the event that the bone doesn't fuse in the front, a second surgery to fuse the back of the vertebra is performed. Fear that her pain won't be treated. Fear of rejection by friends or culture. Additional damage usually occurs over days or weeks because of bleeding, swelling, inflammation and fluid accumulation in and around your spinal cord. What nerve appears to have been inadvertently cut during the biopsy? Spinal trauma. Spinal cord trauma. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Address the stigma associated with having an addiction by reassuring the patient that this is a medical illness and not a question of moral character. Paralysis of the lower half of the body is called paraplegia. 2. This surprised Mrs. S the most, as she was sure that she had knee arthritis that was causing her leg symptoms. Request a Free Information Kit. 4. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017. At the doctor's office, she is given a full examination. Garfin and Bono are to be heartily congratulated. Provide reassurance that it is treatable. Interestingly, her legs are a bit wobbly, but she attributes that to some arthritis that has set in over the years. The likelihood of catching any disease from the cadaver bone is extremely low and is in fact much lower than contracting any disease from a blood transfusion. If patient is resistant, acknowledge that it is difficult and uncomfortable and explain that you believe this is a health issue and is part of your over all approach to patients. If you suspect the patient is minimizing or omitting other sources of medication, do a search on the Utah State Controlled Substance Database (csdb.utah.gov). Physician's family history causes countertransference (misperceptions based on personal experiences). What internal/external obstacles and biases might the patient face? First, if she has damage to her spinal cord already, what are the chances of her symptoms getting better with surgery? This five-part series is a "must read" for patients considering surgical intervention for cervical degenerative disease. If currently using alcohol or illegal drugs, ask questions as noted in section B. This page is best viewed with JavaScript enabled. Mayo Clinic does not endorse companies or products. This can make you more susceptible to pressure sores, but changing positions frequently — with help, if needed — can help prevent these sores. In the meantime, treatments and rehabilitation allow many people with spinal cord injuries to lead productive, independent lives. 3. This can be better termed as spondylosis. In this case, although the patient's spinal cord was not severed, impact from the dens caused a spinal cord hematoma resulting in quadriplegia. http://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Cord-Injury. Also, he understands that the plain x-ray is not a very good way of assessing the spinal cord or the space around it since it only shows the bony structures, not the soft tissue structures. Cervical Spinal Stenosis: Causes, Symptoms, Treatment. Whether the cause is traumatic or nontraumatic, the damage affects the nerve fibers passing through the injured area and may impair part or all of your corresponding muscles and nerves below the injury site. After diving he didnt come up. Cameron JL, et al., eds. Spinal cord injuries of any kind may result in one or more of the following signs and symptoms: Emergency signs and symptoms of a spinal cord injury after an accident may include: Anyone who experiences significant trauma to his or her head or neck needs immediate medical evaluation for the possibility of a spinal injury. It also provides the physician the opportunity to take an active role in the patient's substance abuse problems. Numbness or paralysis may occur immediately or come on gradually as bleeding or swelling occurs in or around the spinal cord. (Note: It is important to ask specifically about pills, as many people do not consider pills to be drugs of abuse. What is the pattern of patient's medication/drug use? Write. Video Series: Exercises to Keep a Healthy Back.   Vocational Analysis Although it is possible that she could live the rest of her life without any advancement of her problems, it is unlikely. Daroff RB, et al. The compression of the spinal cord is causing her to fumble with her knitting needles and shirt buttons, as well as giving her "wobbly" legs. Which intervention should be implemented for a paralytic ileus? Names of patients, physicians, health related professionals, hospitals, locations and all other identifying information have been changed. The possible complications include damage to the large arteries that supply blood to the brain and to the spinal cord. A nontraumatic spinal cord injury may be caused by arthritis, cancer, inflammation, infections or disk degeneration of the spine. Mayo Clinic, Rochester, Minn. June 24, 2019. The typical person who has cervical stenosis and myelopathy may be in his or her fifties or early sixties. You're most likely to suffer a traumatic spinal cord injury if you're between the ages of 16 and 30. Tell me how you are taking the Dilaudid. In fact, the tightening around the spinal cord can get to a point that she may lose control of her bladder and bowels. The time between injury and treatment can be critical in determining the extent and severity of complications and the possible extent of expected recovery. 417 Wakara Suite 2111 Salt Lake City, Utah 84108801-581-8216, Physical Medicine & Rehabilitation Case Studies, Case One: A Spinal Cord Injury Patient With a Pain Medication Problem, Case Two: A Traumatic Brain Injury Patient With a History of Heroin & Alcohol Use, Case Three: A Patient Who “Lost” Her Percocet Prescription, Case Four: A Patient With an Oxycontin Addiction, Case Five: A Patient Who Confuses Anxiety & Back Pain, Case Six: A Patient Who Insists You Prescribe Percocet, Case Seven: A Patient With a History of Alcohol Use, Family & Preventive Medicine Case Studies, Case Two: Patients Who Abuse Prescriptions, Case Three: Depressed Patients Who Self-Medicate, Case Four: Recovery & Medical Pain Management, Case Five: Patients Who Divert Medication, Case Seven: Treating Children of Alcoholics, Case Ten: Elderly Patients at Risk for Addiction, Case Eleven: Patients Who Endanger Others. Mrs. S asks what can be done about her condition, and the spine surgeon explains that it is likely that her finger and leg fumbling can get worse. 5. Fitness and wellness. He saw a previous physician of whom he is critical. Notify the ED healthcare provider (HCP) immediately, 8. Garfin and Bono are to be heartily congratulated. 4. Arrange a meeting with Jonathan, his family, and the healthcare team to discuss Jonathan's concerns. For example, ask, "Tell me why you think you need more Dilaudid?". After surgery, she remained in the hospital for three days. Outcome in Cervical Spinal Stenosis Case You may have spinal stenosis if walking long periods of time is difficult. © 1998-2020 Mayo Foundation for Medical Education and Research (MFMER). Case Presentation:  Patient with Cervical Spinal Stenosis Continue to monitor the patient's use of pain medications. 6. Ask questions.   Education & Research, Case Examples Advertising revenue supports our not-for-profit mission. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com.

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