C-spine fracture Flashcards
How do you protect the neck of a pt with a suspected C-spine injury?
• Call an ambulance
• Stabilize and immobilise the neck- place heavy towels in either side of neck or hold head/neck
- ideally, immobilise in neutral position with full spine board, cervical collar, side head supporters, strapping of shoulders and pelvis
• First aid- avoid moving head/neck
- If CPR required, avoid head tilt (use jaw thrust)
- If vomiting/choking, roll pt with log roll (keeping head/neck/back aligned)
How do you assess the possibility of a C-spine fracture?
Nexus criteria to determine C-spine fracture
(mnemonic NSAID):
o N- neurological defect
o S- spinal tenderness
o A- altered mental state
o I- intoxication
o D- distracting injury (e.g. long bone #)
Describe the features characteristic of a CT at level C1?
C1 (Atlas)
- no vertebral body
- a dens (anterior protuberance, ontontoid process) -> point of rotation between C1 and C2
Describe the features characteristic of a CT at level C2?
C2 (Axis)
- bifid spinous process
Describe the features characteristic of a CT at level C3?
C3
- external jugular vein (periphery)
Describe the features characteristic of a CT at level C4?
C4
- hyoid bone
Describe the features characteristic of a CT at level C5?
C5
- thyroid cartilage
Describe the features characteristic of a CT at level C6?
C6
- cricoid cartilage
What are the deficits seen in an injury to C1-4?
C1-4
o Quadriplegia aNd loss of diaphragm function (C3, 4, 5 keeps diaphragm alive)
o Ventilator required
What are the deficits seen in an injury to C5?
C5
o Total paralysis of wrists, hands, trunk and legs
o Can raise arms (C5-6 abduction) and bend elbows (C5-6 flexion)
o Can speak and use diaphragm, but breathing weakened
What are the deficits seen in an injury to C6?
C6
o Paralysis of hands, trunk, legs
o Can speak and use diaphragm, breathing weakened
o Can raise arms (C5-6 abduction) and bend elbows (C5-6 flexion)
o Little/no voluntary control of bladder/bowel
What are the deficits seen in an injury to C7?
C7
o Lack of dexterity in hands and fingers (C7-8 finger flexion/extension, C8-T1 finger abduction/adduction)
o Allows limited use of arms, weakness in elbow extension (C7-8)
o Little/ no voluntary control of bladder/bowel
What are the deficits seen in an injury to C8?
C8
o Loss of dexterity in hands (C7-8 finger flexion/extension, C8-T1 finger abduction/adduction)
o Little/ no voluntary control of bladder/bowel
What are the short-term complications of a C6 fracture?
STM:
- lungs: breathing difficulty, hypoventilation (if diaphragm affected)
- upper limbs: loss of motor and sensory function, some motor control (shoulder abduction, elbow flexion), spastic triceps reflex
- lower limbs: UMN symptoms
- bladder/bowel: dysfunction (neurogenic incontinence)
- genitals: sexual dysfunction (sympathetic T10-L2, parasympathetic S2-4)
- autonomic dysreflexia (sensory input to spinal cord, reflex sympathetic surge, peripheral vasoconstriction)
What are the long-term complications of a C6 fracture?
LTM
• Lungs: pneumonia (reduced mobility, ventilation), PE (DVT) risk
• Bladder: incontinence
• MSK: muscular atrophy and disuse atrophy
• Neurological: neuropathic pain
• Spine: recurrence of SCI (due to instability or high risk activity)
• Skin: pressure sores
