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TNCC > Chapter 10, Spinal & Musculoskeletal Trauma > Flashcards

Chapter 10, Spinal & Musculoskeletal Trauma Flashcards

1
Q

Where does the spinal cord usually end in adults?

A

The level of the first lumbar vertebra.

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2
Q

How many pairs of spinal nerves are there?

A

31 pairs (8, 12, 5, 5)

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3
Q

What is a nerve plexus?

A

An area where nerves converge in groups.

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4
Q

What are the four major nerve plexuses?

A

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

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5
Q

When are the parasympathetic and sympathetic nervous systems innervated?

A

Parasympathetic: at rest
Sympathetic: during physiologic and psychological stress

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6
Q

How many vertebrae make up the vertebral column?

A

33 vertebrae (7, 12, 5, 5, 4)

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7
Q

What is another name for the first cervical vertebra?

A

The atlas.

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8
Q

What is another name for the second cervical vertebra?

A

The axis.

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9
Q

What is the purpose of tendons?

A

To connect muscle to bone.

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10
Q

What is the purpose of ligaments?

A

Connects bones to bones.

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11
Q

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?

A

Falls

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12
Q

What is the most common location of SCI?

A

C5 area.

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13
Q

What is a sprain?

A

Stretch or tear to a ligament.

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14
Q

What is a strain?

A

Stretch or tear to a tendon or muscle.

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15
Q

What are potential fractures from a FOOSH injury?

A

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)

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16
Q

What is a cord concussion?

A

A transient dysfunction of the spinal cord that lasts for 24-48 hours.

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17
Q

What is a cord concussion?

A

A transient dysfunction of the spinal cord that lasts for 24-48 hours.

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18
Q

What is a cord contusion?

A

Bruising of the neural tissue causing edema, ischemia, and possible infarction of tissue from cord compression.

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19
Q

What is a cord transection?

A

Complete disruption of the neural elements.

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20
Q

What is an incomplete cord transection?

A

An interruption in the vascular perfusion to the spinal cord may result in cord ischemia or necrosis.

21
Q

What concept improves long-term outcomes for patients with acute SCI?

A

Time to spine

22
Q

SCIWORA injuries may be caused by stretching or shearing and are most commonly seen in young children. What does the acronym stand for?

A

SCI without radiographic abnormality

23
Q

When does neurogenic shock occur?

A

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.

24
Q

What is often the first sign of increased compartment pressures?

A

Increased pain (a sign of worsening cellular hypoxia)

25
Q

Injury at what level can cause loss of phrenic nerve function resulting in respiratory arrest?

A

Injury to the cord at C3-C5

26
Q

Injury at what level may result in the loss of intercostal muscles and decreased respiratory effort?

A

T1-T11

27
Q

What are the effects of anterior cord syndrome?

A

Cause: extreme hyperflexion
Motor: loss of function below the injury
Sensory: Loss of pain and temperature below the injury (proprioception and vibratory sensation remains)

28
Q

What are the effects of posterior cord syndrome?

A

Cause: Hyperextension
Motor: intact
Sensory: Loss of deep touch, vibration, proprioception (pain and temperature spared)

29
Q

What are the effects of central cord syndrome?

A

Cause: Hyperextension or hyperflexion
Motor: Loss greater in upper extremities than lower extremities
Sensory: Loss greater in upper extremities than lower extremities

30
Q

What are the effects of Brown-Sequard syndrome (partial transection)?

A

Cause: Penetrating Trauma
Motor: Loss ipsilateral to cord lesion
Sensory: Ipsilateral proprioception and vibration loss. Contralateral pain and temperature sensation loss.

31
Q

Most fatalities related to SCI occur at what level?

A

The craniocervical junction

32
Q

How much blood can be lost from femur fractures?

A

1.5 liters or more

33
Q

Fat emboli can be detected in the lungs in what percentage of patients with long bone fractures?

A

90%

34
Q

When does fat embolism syndrome (FES) typically occur post injury?

A

24-72 hours

35
Q

What is a necessary early intervention for open fractures?

A

Antibiotics

36
Q

What are complications of crush injuries?

A

Compartment syndrome
Hyperkalemia
Acute kidney injury
Rhabdomyolysis

37
Q

What commonly causes elevated compartment pressures secondary to fractures?

A

Hematoma formation

38
Q

What are the most frequent sites of compartment syndrome?

A

Muscles of the lower leg and forearm.

39
Q

True or false. Basing a compartment syndrome diagnosis on the loss of palpable pulse may result in tissue damage?

A

True. This is a late sign.

40
Q

What are the Ps associated with neuromuscular compromise?

A

Pain
Pressure
Pulses
Paresthesis
Paralysis
Pallor
Poikilothermia

41
Q

What perfusion pressure has a 93% positive predictive value for the diagnosis of acute compartment syndrome?

A

< 30 mmHg for 2 hours
PP=DBP-Compartment Pressure

42
Q

What is the recommended urinary output until myoglobinuria is resolved?

A

100 mL per hour

43
Q

What is the best method for removing a patient from a spine board with a suspected spine injury?

A

Lift & slide
Six-person lift

44
Q

What type of dressing should be applied to an open fracture?

A

Moist sterile dressing

45
Q

What should be documented on a tourniquet?

A

Time of placement
May be left in place w/ only transient nerve dysfunction for ~6 hrs

46
Q

How should an amputated part be stored?

A

Wrapped in saline moistened sterile gauze
Placed in a sealed plastic bag
Placed in 50% ice 50% water mixture

47
Q

What are normal and elevated compartment pressures?

A

Normal: 0-8 mmHg
Suggestive of ischemia: 30-40 mmHg
Capillary bed occlusion: >30 mmHg

48
Q

What are the NEXUS criteria for cervical spine clearance?

A

No posterior midline cervical spine tenderness
No evidence of intoxication
Normal level of alertness
No focal neurological deficit
No painful distracting injury

TNCC (20 decks)

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