Posted: January 1st, 2023
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Jack, a 16-year-old college student, fell from 20 feet to the earth while hiking. He was conscious but unable to move any of his extremities when paramedics arrived at the scene. He was also screaming because of his neck pain. . His responses to the concerns asked were appropriate. He complained not being able to perceive any sensation in his arms and legs. His pupils were equal and reactive to light. A few scrapes on his arms only. Apparently, no other signs of injury showed.His vital signs revealed a blood pressure of 110 / 72, heart rate of 82 beats per minute, respirations of 18 per minute He was placed on a back board, his head was immobilised with a cervical collar, and he was taken to the hospital by the paramedics.
When Jack was examined at the hospital, it was discovered that he had no triceps or wrist extensor reflexes and just a little degree of sensation in his biceps brachii stretch reflexes. There were no muscle stretch in either the upper or lower limbs. An imaginary line drawn across his chest, about three inches above the nipples, marked the bilateral end of his perception of sensory inputs (i.e. everything below felt numb). Although he could feel some sensation in his arms, he was unable to localise touch or consistently define texture there. He was able to raise his shoulders and slightly flex each arm’s biceps brachii, but he was unable to lift either arm against gravity. He attempted to move his lower extremities but they are stiff. The following vital signs were recorded once more at the hospital: blood pressure=9494 / 55; heart rate=64; respiratory rate=24 (with shallow breathing).
At hospital , X-rays showed a fractured vertebra at a specific site. X-ray of the chest, the lung expansion upon inhalation showed decreased. With the exception of a respiratory acidosis (blood pH = 7.25), blood tests were normal. In order to hold his neck immobile and prevent more harm, the neurosurgeons inserted tongs into the skull above his ears. Allen was transferred to intensive care and his condition was stabilized.
Th week later, a physical examination revealed normal vital signs, no change in the strength or sensation of his arms, as well as noticeable spasms and heightened stretch reflexes in his lower extremities. He also had urinary incontinence
1. At hospital, Jack’s breathing was rapid and shallow. Why? Explain
2. Jack lose some sensation in his arms and all sensation in upper trunk. Why?
3. What is the problem that doctor diagnosed? ‘
4. What is the primary muscle of respiration? What nerve innervates this muscle?
5. After a week, some of Jack’s signs and symptoms had changed. Allen’s arm muscles were still flaccid, yet his leg muscles had become spastic and exhibited exaggerated stretch reflexes. Why?
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