C-spine and cord trauma

Question 1

epi of C-spine injury (CSI)

Answer 1

• 1 with low E
• 10% with high E
• C2 most common
• C 6 and 7 next most
• more common with GCS

Question 2

6 causes of missed CSIs

Answer 2

1. head injury
2. intox
3. distracting injuries
4. need for urgent ETT
5. poor quality imaging
   6/ neuro Sx due to other causes

Question 3

what is key about blunt trauma

Answer 3

assume CSI

- immobilize

Question 4

keys to immobilize

Answer 4

hard collar+sandbags+ tape and roll

Question 5

what is needed to clear C-spine

Answer 5

• rule out bony and ligamentous injury
• can clear clincally w/out X-ray
• cannot clear with x-ray and no clinical

Question 6

5 things needed for clincal clearance

Answer 6

1. N sensorium (no intox)
2. no midline spine pain/tenderness
3. no neuro Sx
4. no distracting injuries
5. painless ROM of C-spine (AFTER ruled out 1-4)

Question 7

what happens if any of them are not met

Answer 7

must perform CT with 3D reconstruction

Question 8

3 things must have even when clear on CT

Answer 8

1. no pain tenderness
2. no neuro Sx
3. able to move head and neck w/out pain

Question 9

4 options if can’t clear C-spine (uncons, massive head injury)

Answer 9

1. leave collar on until awake
2. take off and reapply when wakes up
3. dynamic flex/ext views (not done
4. MRI - not routine

Question 10

2 general cats of cord injury

Answer 10

1. complete vs. incomplete

2. spinal shock vs neuro shock

Question 11

def. complete

Answer 11

NO motor or sense below, refexes hyper

- will not improve

Question 12

def. incomplete

Answer 12

• SOME motor/sense

- may improve

Question 13

def. spinal shock

Answer 13

complete loss of all cord function below

• NO motor, sense, reflexes
• days-weeks

Question 14

def. neurgenic shock

Answer 14

• hypotension
• loss of innervation T1-L2
• higher lesion, more sympathetics lost

Question 15

2 SCI goals

Answer 15

1. prevent 2ndry injury

2. prevent/treat complications

Question 16

4 ways to prevent more injury

Answer 16

1. immobilize
2. maintain cord perf pressure
3. avoid hyper glycemia/hyperthermia
4. ?? early surg?

Question 17

what is important resp complication

Answer 17

• C3,4,5 - diaphragm
• less FEV, FVC, less cough
• atelectasis
• prolonged vent

Question 18

4 CVS complications

Answer 18

1. hypotension
2. hypothermia (Can’s vasoconstrict)
3. DVT
4. autonomic dysreflexia

Question 19

what triggers autonomic dysreflexia

Answer 19

• full bowel or bladder
• get constriciton
• can;t cancel constriction

Question 20

2 GI complications

Answer 20

1. ulcers

2. gatric atony/ileus

Question 21

skin complications

Answer 21

ulcers