Cardiovascular Complications – Nursing Interventions for Acute Spinal Cord Injury

00:00 So we looked at neurological.

00:01 We kinda looked at the brain and the spinal cord.

00:03 Now we're gonna move to the heart.

00:05 Talk about cardiovascular complications.

00:08 Now spinal cord injuries above T6, it impacts the function of the sympathetic nervous system.

00:14 Now we've talked about that a little bit.

00:16 I want you to pause and see if you can recall.

00:18 What's the impact on the cardiovascular system when we've lost that control of the sympathetic nervous system? Okay. Good. Let's see if my answers line up with yours.

00:29 Now, remember they might have a slow heart rate, bradycardia and hypotension.

00:35 So we might need to put an external pacer on the patient or give them atropine for the first couple of weeks if that bradycardia is symptomatic.

00:43 Meaning if the heart rate is slow enough that it drops that patient's blood pressure, an external pacer or some atropine might be enough to kinda overcome that and then maintain their blood pressure.

00:55 Now, that dysfunction of the sympathetic nervous system leads to decreased venous return to the heart.

01:01 Remember you've got that pooling. Those vessels are dilated.

01:04 They aren't able to constrict like we need them to, so less blood returns to the heart in the venous system.

01:10 With less preload, you have a lower blood pressure and less cardiac output.

01:16 It's called a relative hypovolemia.

01:18 Now, the reason we call it relative hypovolemia is that - well, there's plenty enough volume in there, but the vessels don't have enough tone to keep it at a good blood pressure, so that's why it's called relative hypovolemia.

01:33 We just kept dumping lots of extra fluid in there that's not gonna give us what we need cuz then we're gonna end up overloading the patient and putting the patient at increased risk for edema.

01:43 So, cardiovascular complications, you'll think blood pressure and heart rate.

01:50 So we're gonna try to increase that heartrate by drugs, like atropine or maybe an external pacemaker which could be just the patches that you put on the patient and it functions as a peacemaker.

02:00 So, I'm gonna have to monitor vital signs closely.

02:05 As a nurse, I'm gonna be watching that blood pressure closely because I know the patient is at risk for low blood pressure.

02:11 Gonna watch for signs of neurogenic shock, might not happen immediately with the patient or it might you always want to be on guard with a brand-new spinal cord injury.

02:21 So I'm watching for signs of shock that would be slow heart rate, bradycardia, peripheral vasodilation, just dilated down in the lower extremities, not as much blood coming back up to the heart as evidenced by low blood pressure.

02:34 So, think about other causes of hypotension though.

02:37 Because we're in hemorrhagic shock, is there something else going on? But always have in the back of your mind a spinal cord injury is at risk for low heart rate and low blood pressure.