Chapter 10, Spinal & Musculoskeletal Trauma Flashcards
Where does the spinal cord usually end in adults?
The level of the first lumbar vertebra.
How many pairs of spinal nerves are there?
31 pairs (8, 12, 5, 5)
What is a nerve plexus?
An area where nerves converge in groups.
What are the four major nerve plexuses?
Cervical plexus (C3, C4, C5): innervates diaphragm
Brachial plexus (C5-C8 & T1): motor control to arm, wrist, hand
Lumbar plexus (L1-L4): anterior portion of lower body
Sacral plexus (L5-S4): posterior portion of lower body
When are the parasympathetic and sympathetic nervous systems innervated?
Parasympathetic: at rest
Sympathetic: during physiologic and psychological stress
How many vertebrae make up the vertebral column?
33 vertebrae (7, 12, 5, 5, 4)
What is another name for the first cervical vertebra?
The atlas.
What is another name for the second cervical vertebra?
The axis.
What is the purpose of tendons?
To connect muscle to bone.
What is the purpose of ligaments?
Connects bones to bones.
What is the leading cause of musculoskeletal injury in all age groups with the exception of teens and adults and the leading cause of death in older adults?
Falls
What is the most common location of SCI?
C5 area.
What is a sprain?
Stretch or tear to a ligament.
What is a strain?
Stretch or tear to a tendon or muscle.
What are potential fractures from a FOOSH injury?
Colles fracture (distal radius)
Scaphoid fracture
Monteggia fracture (ulnar shaft fracture with radial head dislocation)
Galeazzi fracture (distal radial fracture with distal ulnar epiphyseal fracture)
What is a cord concussion?
A transient dysfunction of the spinal cord that lasts for 24-48 hours.
What is a cord concussion?
A transient dysfunction of the spinal cord that lasts for 24-48 hours.
What is a cord contusion?
Bruising of the neural tissue causing edema, ischemia, and possible infarction of tissue from cord compression.
What is a cord transection?
Complete disruption of the neural elements.
What is an incomplete cord transection?
An interruption in the vascular perfusion to the spinal cord may result in cord ischemia or necrosis.
What concept improves long-term outcomes for patients with acute SCI?
Time to spine
SCIWORA injuries may be caused by stretching or shearing and are most commonly seen in young children. What does the acronym stand for?
SCI without radiographic abnormality
When does neurogenic shock occur?
When high thoracic or cervical damage to the spinal cord results in an abrupt disruption of sympathetic innervation and the regulation of vasomotor and vascular tone producing a loss of vascular resistance and vasodilation.
What is often the first sign of increased compartment pressures?
Increased pain (a sign of worsening cellular hypoxia)
Injury at what level can cause loss of phrenic nerve function resulting in respiratory arrest?
Injury to the cord at C3-C5
Injury at what level may result in the loss of intercostal muscles and decreased respiratory effort?
T1-T11
What are the effects of anterior cord syndrome?
Cause: extreme hyperflexion
Motor: loss of function below the injury
Sensory: Loss of pain and temperature below the injury (proprioception and vibratory sensation remains)
What are the effects of posterior cord syndrome?
Cause: Hyperextension
Motor: intact
Sensory: Loss of deep touch, vibration, proprioception (pain and temperature spared)
What are the effects of central cord syndrome?
Cause: Hyperextension or hyperflexion
Motor: Loss greater in upper extremities than lower extremities
Sensory: Loss greater in upper extremities than lower extremities
What are the effects of Brown-Sequard syndrome (partial transection)?
Cause: Penetrating Trauma
Motor: Loss ipsilateral to cord lesion
Sensory: Ipsilateral proprioception and vibration loss. Contralateral pain and temperature sensation loss.
Most fatalities related to SCI occur at what level?
The craniocervical junction
How much blood can be lost from femur fractures?
1.5 liters or more
Fat emboli can be detected in the lungs in what percentage of patients with long bone fractures?
90%
When does fat embolism syndrome (FES) typically occur post injury?
24-72 hours
What is a necessary early intervention for open fractures?
Antibiotics
What are complications of crush injuries?
Compartment syndrome
Hyperkalemia
Acute kidney injury
Rhabdomyolysis
What commonly causes elevated compartment pressures secondary to fractures?
Hematoma formation
What are the most frequent sites of compartment syndrome?
Muscles of the lower leg and forearm.
True or false. Basing a compartment syndrome diagnosis on the loss of palpable pulse may result in tissue damage?
True. This is a late sign.
What are the Ps associated with neuromuscular compromise?
Pain
Pressure
Pulses
Paresthesis
Paralysis
Pallor
Poikilothermia
What perfusion pressure has a 93% positive predictive value for the diagnosis of acute compartment syndrome?
< 30 mmHg for 2 hours
PP=DBP-Compartment Pressure
What is the recommended urinary output until myoglobinuria is resolved?
100 mL per hour
What is the best method for removing a patient from a spine board with a suspected spine injury?
Lift & slide
Six-person lift
What type of dressing should be applied to an open fracture?
Moist sterile dressing
What should be documented on a tourniquet?
Time of placement
May be left in place w/ only transient nerve dysfunction for ~6 hrs
How should an amputated part be stored?
Wrapped in saline moistened sterile gauze
Placed in a sealed plastic bag
Placed in 50% ice 50% water mixture
What are normal and elevated compartment pressures?
Normal: 0-8 mmHg
Suggestive of ischemia: 30-40 mmHg
Capillary bed occlusion: >30 mmHg
What are the NEXUS criteria for cervical spine clearance?
No posterior midline cervical spine tenderness
No evidence of intoxication
Normal level of alertness
No focal neurological deficit
No painful distracting injury
