Spinal Cord Injury

Level of injury, shock, and autonomic dysreflexia

Med-Surg · Neuro

What the level means

C1–C4	Tetraplegia; often ventilator-dependent ("C3, 4, 5 keeps the diaphragm alive")
C5–C8	Tetraplegia with some arm and hand function; weak cough
T1–L1	Paraplegia; arms normal
Below L1	Mixed leg weakness; bowel and bladder problems

Complete injury = no function below the level. Incomplete = some preserved.

Acute care

Spinal motion restriction; jaw thrust to open the airway; log-roll.
Breathing first: watch vital capacity, cough, SpO₂ (especially cervical injuries).
Spinal shock: temporary loss of all reflexes below the injury (flaccid).
Neurogenic shock (injury at T6 or above): hypotension + bradycardia, warm dry skin → fluids, vasopressors, atropine.
High-dose steroids are no longer routine. Updated
DVT prevention, skin care, bowel and bladder programs, early rehab, emotional support.

Autonomic dysreflexia: emergency (injury at T6 or above)

Signs: sudden severe hypertension, pounding headache, bradycardia, flushing and sweating above the injury, pale cool skin below, nasal stuffiness, blurred vision.

Triggers: full bladder (most common: kinked catheter, retention), constipation or impaction, tight clothing, pressure injury, ingrown toenail, sexual activity.

Actions:

Sit the patient upright, legs down.
Loosen tight clothing.
Check the bladder: unkink or catheterize.
Check bowel (use anesthetic gel).
Check BP every 2–5 min; give antihypertensive as ordered if it stays high.
Notify the provider; teach the patient and family.

Long-term issues

Pressure injuries: turn often; teach weight shifts in the wheelchair.
Bladder: intermittent catheterization; UTI risk.
Bowel program at the same time each day.
Spasticity (baclofen), orthostatic hypotension, depression, sexuality counseling.

Memory hook Neurogenic shock = low and slow (low BP, slow HR, warm skin).
Autonomic dysreflexia = high BP from a hidden trigger below the injury: find and fix it.