What is spinal shock?
Option 1
G. H. is a 26-year-old male who was involved in a serious motorcycle accident that fractured his vertebrae and compressed his spinal cord at the level of T8. Answer the following questions:
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What is spinal shock? How long can it last? Why is it difficult to determine the degree of injury and impairment during this time frame?
Immediately after this injury, what should you expect to occur for each of the following:
Range of movement for his arms? For his legs? Why?
Spastic or flaccid paralysis? Why?
Bowel and/or bladder dysfunction? Why or why not?
Breathing difficulties? Why or why not?
After the period of spinal shock, what changes should you expect to see (if any) in the manifestations listed in #2 above?
What type of rehabilitative treatments might G. H. need to promote his recovery and return to function?
If G. H. has mild-to-moderate chronic back pain one year after his accident, explain the pain management medications you would suggest to improve his quality of life and why you selected those particular medications.
Option 2
How would you determine which of the following pain medication(s) to give a patient who:
Has just had breast augmentation surgery?
Has chronic neck and back pain from a car accident?
Has terminal metastatic cancer?
Had their wisdom teeth removed?
Suffers from migraines?
Has rheumatoid arthritis?
Use the opioid conversion table found in your text, and the following chart to assist you:
Analgesic Strength Equivalent dose
(relative) (10 mg Oral morphine)
Aspirin (non-opioid) 1/360 3600 mg
Ibuprofen (NSAID, non-opioid) 1/222 2220 mg
Naproxen (NSAID, non-opioid) 1/138 1380 mg
Dextropropoxyphene 1/13 to 1/20 130–200 mg
Codeine 1/10 180 mg (PO)
Tramadol 1/10 >200 mg
Pethidine (meperidine hydrochloride) 1/3 30 mg SC/IM/IV, 300 mg PO
Hydrocodone 1 10 mg
Morphine (oral) (1) (10 mg) (30 mg PO)
Oxycodone 1.5 6.67 mg
Morphine (IV/IM) 3 3.33 mg
Methadone (acute) 3–4 2.5–3.33 mg
Diamorphine (Heroin; IV/IM) 4–5 2–2.5 mg
Hydromorphone 5 1.5 mg SC/IV/IM, 7.5 mg PO
Oxymorphone 7 10 mg PO, 1 mg IV
Methadone (chronic) 2.5 to 5 3.33 mg
Fentanyl 50–100 0.1 mg (100 mcg) IM/IV
Sample Solution
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