Topic: Week 3-Discussion1 X History: Allen Dexter, a 19-year-old college student
ID: 245675 • Letter: T
Question
Topic: Week 3-Discussion1 X History: Allen Dexter, a 19-year-old college student, was rock climbing when he fell 30 feet to ground. Paramedics arriving at the scene found him lying in the supine position, unable to mov any extremities and complaining of neck pain. He was awake, alert, and oriented to his current location, the date and day of the week, and the details of his fall. His responses to questioning were appropriate. He complained that he could not feel his arms and legs. His pupils were equal and reactive to light. He showed no other signs of injury except for several scrapes on his arms. vital signs revealed a blood pressure of 110/72, heart rate of 82 beats per minute, respirations 18 per minute. The paramedics applied a cervical collar, placed him on a back board, immobilized his head, and transported him to the trauma center by helicopter. Upon examination at the hospital, Allen had minimal biceps brachii stretch reflexes, but no triceps or wrist extensor reflexes. All other muscle stretch reflexes in the upper and lower extremities were absent. His perception of sensory stimuli ended bilaterally at an imaginary line drawn across his chest about 3 inches above the nipples (i.e. everything below felt numb). He had some sensation in his arms, but could not localize touch or describe texture with any consistency there He was able to raise his shoulders and tighten his biceps brachii slightly in each arm, but could not raise either arm against gravity. His lower extremities were flaccid, despite attempts to move them Vital signs were taken again at the hospital and were as follows: blood pressure 94/55: heart rate 64; respiratory rate-24 (with shallow breathing). His oral temperature was 102.2 degrees F Re- His color was dusky and his skin was warm and dry to the touch. X-rays taken upon arrival revealed a fractured vertebra at a particular location. A chest X showed a decreased lung expansion upon inhalation. Blood tests were normal, with the exception ray of a respiratory acidosis (blood pH 7.25). The neurosurgeons immobilized his neck by inserting tongs into the skull above the ears to hold his neck in a position so that no further injury could occur. Allen was transferred to intensive care and his condition was stabilized A physical examination four days later revealed normal vital signs and no change in his arm strength or sensation, but also marked spasms and exaggerated stretch reflexes of the lower extremities. He also had urinary incontinence which required the placement of a Foley catheter connected to a urine collection bag QuestiExplanation / Answer
1. After a fall, Due to several scrapes in the body, the hemostatic respond to the scrapes and make several changes. The blood vessels constricts and platelets aggrgate one another in the process of coagulation. This decreases the flow of blood which results in fall of blood pressure and pulse rate.
2. Neck injury may cause damage, irritation, or compression of one of the nerve whic results in numbness or loss of sensation of the arms and upper trunk. The Brachi plexus is a set of nerves which supplies to the shoulder, arm, and chest. Damage to the Brachial plexus results in loss of sensation to the arms and the legs.
3. Usually, after injury Bruise develops. Bruise is a skin discolouration that occurs as a result of leakage of blood from the tiny blood vessels. The collection of blood causes less moisture of skin and it becomes dry. There is a increased need of energy for the injury repair. So the basal metabolic increases based on the severity of injury. Additionaly , increased white blood cells to fight against the foreign bodies as a result normal body immune response results in fever.
4. The normal blood PH is 7.35 - 7.45. Allen has blood PH has 7.25. the lower blood PH is due to respiratory acidosis. He retains too much of carbondioxide and becomes hypoventilate due to decreased lung expansion.
5. The main muscles of respiration in normal quiet breathing are the intercostal muscles and the diaphragm. During difficult or deep breathing it is assisted by the muscles of the neck, shoulders, and abdomen. There are 11 pairs of intercostal muscles present between 12 pairs of the ribs. They are arranged as external (extends downward and forward) and intercostal muscle fibers(extends downward and backward). This muscle is innervates by the phrenic nerve.
6. The respiratory muscles are innervated by Phrenic motor neurons which lie in the C3 - C5 of cervical spinal cord. The respiratory intercostal intercostal muscles are exit through the spinal cord from T1 - T11 and from T7 -L2. Sensory supply by the phrenic nerve to central tendon.
7. The leg muscles are influenced by several lower motor neurons. Damage to the cortico spinal tract affect the motor and sensory neuron which helps in muscle strecth. Damage to the cortico spinal of C5 tract affects the upper motor neuron stimulation. Further, the muscle strecth reflex arc is exaggerated with loss of voluntary muscle control in the brain centers.
8. Due to spinal cord injury, the spinal pathways are destroyed from the brain to the urinary system. As a result, the voluntary control is lost. the detrusor muscle contraction are insufficient to empty the bladder completely, so the urine retains in the bladder. So, Allen has no control over his external urinary sphincther.