Patients with cervical spine trauma
Corey transferred a 23-year-old girl who had been treated in the hospital for a while due to cervical spine trauma in a car accident, and was transferred to our hospital due to the difficulty of being offline.
After I transferred, my college classmate called me and said that the patient was a relative of his, which was unfortunate.
The patient, a primary school teacher, took a colleague's car to work, and as a result of the car accident, everyone else was fine, because she was riding the co-pilot without wearing a seat belt, resulting in cervical spine trauma, was paralyzed when she was taken to the hospital, and was ready to get married next month.
The patient was transferred to our intensive care unit, and she herself did not know that this essence damage would not be better.
Every day when I rounded the room, I told her little by little about the knowledge of essence damage, told her that people's neurological cells can not regenerate, if the damage necrosis, generally can not be good, his function is generally through the exercise, other parts of the nerve to compensate, there may be a certain degree of recovery.
With the increase of medical knowledge explained every day, the patient's breathing state improves, and he can gradually get rid of the ventilator for a period of time every day, but the patient's limbs and trunk still do not feel anything, and at the same time, in addition to the head can move, the neck below is still unable to move.
The patient asked me if she had been paralyzed in bed all her life and would not be better.
In fact, it is so, but it is so cruel to tell this child directly, and I have to infiltrate it little by little.
Paralysis is if divided
Generally speaking, paralysis is divided according to the degree of loss of muscle strength in the body, if the muscle strength is partially lost, it is called paresis or incomplete paralysis, and if the loss is complete, it is called total paralysis.
This degree of paralysis is determined by the degree of loss of muscle strength.
Generally normal people's muscle strength is level 5, muscle can not move is level 0, the body's muscle contraction but can not drive limb activity is level 1, muscle can drive limb parallel movement is level 2, muscle can drive limbs upward lift to reach level 3, muscles can drive limbs up, while can resist a certain external force, is level 4; muscle strength can reach the level of normal people, very powerful is level 5.
1. Paresis is a weakened muscle strength, muscle strength is about 4 levels, generally does not affect daily life.
2. Incomplete paralysis is heavier than paresis, with a large range and muscle strength of 2-4 grades.
3. Total paralysis: muscle strength 0-1 level, paralyzed limbs can not move at all.
There is also a problem with one limb called hemiplegia, including facial muscles and tongue muscles problems called facial paralysis, if both limbs have problems, generally called paraplegia.
After explaining this to the patient, tell the patient that you can compare the knowledge I have taught and check how far you have reached.
Cervical vertebral fracture caused by tropic damage, resulting in paraplegia, this situation nerve damage is basically irreparable, which is a worldwide problem. Some patients may not be able to be taken offline due to the impact on the respiratory center of the neck and have always required the use of a ventilator.
This patient was fortunate enough to be able to successfully take off the ventilator later, and I had a patient who had a previous essence injury, and after careful care and efforts by his family, he was offline after 7 months.
Which to watch out for paralyzed patients
Many people think that if they are paralyzed, they will never be able to recover, not necessarily, generally depending on what cause, as well as the severity of the injury, and whether the treatment is timely.
For example, if it is a spinal cord injury, like the patient I said at the beginning, the cervical cord is completely broken, so that the paralysis caused by the cause cannot be recovered, if it is the paralysis caused by cerebral hemorrhage, the amount of bleeding is not much, or timely surgery, plus postoperative treatment and rehabilitation exercises are in place, it is possible to return to normal.
Therefore, whether paralysis can be restored depends on what causes it, and the specific disease is analyzed. But for paralyzed patients, treatment and care are connected during paralysis.
Paralyzed patients first have a weakened limb muscle strength, most of them will have limited mobility, more serious will be bedridden motionless, for such patients we should pay attention to the following matters:
1. Skin condition, because the patient's muscle strength is weakened, the movement is inconvenient, the bed is long, the skin is easily crushed, and pressure sores appear.
2. To prevent lung infection, especially patients with cervical spine trauma, the general ability to cough up sputum decreases, and sometimes it is difficult to cough up sputum, resulting in lung infection.
3, mental state is very critical, let the patient understand the paralysis, to what extent they are, whether they can get better, whether they can accept reality, which is of great help to the treatment and care of patients.
4. Actively prevent complications caused by long-term inactivity due to paralysis, such as contractures, stiffness, deformity, shoulder joint subluxation, shoulder-hand syndrome, periarthritis of the shoulder joint, toe flexion, adduction, etc., which poses a great challenge to the nursing staff, when the patient can not move, to often give the patient passive or the muscles and joints of the whole body.
In this way, according to the condition of paralyzed patients, passive exercise, massage exercise, assistive active exercise, active exercise and anti-resistance exercise should be carried out.