Chapter 32: Spinal Injury and Spine Motion Restriction Flashcards
common causes of spinal injuries
automobile crashes, shallow-water diving accidents, motorcycle crashes, falls, accidents during sports
central nervous sytem (CNS)
brain and spinal cord
peripheral nervous system
nerves located outside the brain and spinal cord
voluntary (somatic) nervous system
influences activity of voluntary muscles and movements
autonomic nervous system
influences the activities of involuntary muscles and glands, partly independent of the rest of the NS, contains sympathetic and parasympathetic NS
spinal column
vertebral column, principal support system of the body, made of 33 vertebrae
vertebrae
irregularly shaped bones, make up spinal cord, the body faces anteriorly, bound together by ligaments, disk between each two vertebrae
spinous process
posterior aspect of vertebra
disk
fluid filled pad of tough elastic cartilage, acts as shock absorber, between every 2 vertebrae
cervical spine
first seven vertebrae, most mobile and delicate
thoracic spine
12 vertebrae directly below cervical vertebrae, compose upper back
lumbar spine
next 5 vertebrae under thoracic spine, form lower back
sacral spine
sacrum, next 5 vertebrae under lumbar spine, fused together, form rigid posterior portion of pelvis
coccyx
tailbone, final four fused vertebrae at end of spine
spinal cord
composed of nervous tissue, exits brain through opening at base of skull
motor tracts
in spinal cord, carry impulses down spinal cord and out to muscle, tested by having patient move
pain tracts
in spinal cord, carry impulses from pain receptors up the spinal cord to brain, tested by pain, side that the tract controls is opposite
light touch tracts
in spinal cord, carry light touch impulses from sensory receptors up the spinal cord to brain, tested by applying light touch
most common cause of spinal injuries
automobile crashes
spinal cord injury without radiologic abdormality
SCIWORA, a spinal cord injury without any spinal column damage
compression
when weight of body is driven against head
flexion
when there is severe forward movement of the head in which the chin meets the chest or when the torso is excessively curled forward
extension
when there is severe backward movement of the head in which the neck is stretched or when the torso is severely arched
rotation
when there is lateral movement of the head or spine beyond its normal rotation
lateral bending
when the body or neck is bent severely from the side
distraction
when the vertebrae and spinal cord are stretched and pulled apart, common in hangings
penetration
injury from gunshot, stabbing, other type of penetrating trauma
spinal motion restriction (SMR)
steps to keep the spine in anatomic alignment and to restrict its movement
spinal column injury
injury to one or more vertebrae
spinal cord injury
involves damage to the nervous tissue that is enclosed in the hollow center of the spinal column
complete spinal cord injury
results when an area of the spinal cord has been completely cut crossways, causes total loss of motor and sensory function below the level of injury
spinal shock
temporary, concussion-like insult to the sponal cord that causes effects below the level of injury, usually occurs in cervical area, below injury: loss of muscle tone, patient cannot feel light touch/pinch, patient cannot move extremities or voluntary muscles, typically loses control of bladder/bowel, priapism for males…
priapism
involuntary erection of penis
neurogenic hypotension
from spinal shock, aka spinal-vascular or neurogenic shock, results from injury to spinal cord that interrupts nerve impulses to arteries, causes vasodilation and relative hypovolemia
incomplete spinal cord injury
occurs when the spinal cord is injured but not completely through all major tracts, only lose some function in some areas of the body. 3 most common types: central cord syndrome, anterior cord syndrome, Brown-Sequard syndrome
anterior cord syndrome
injury to the sensory and motor tracts in the anterior spinal cord, can cause loss of pain sensation and loss of motor function below cord injury site, can still feel light touch
central cord syndrome
central portion of spinal cord injured, causes weakness/paralysis and loss of pains sensation to upper extremities but NOT lower extremities, most commonly seen in elderly patients
Brown-Séquard syndrome
injury to a hemisection (right or left half) of the spinal cord, disrupts spinal tracts on only one side of cord, causes motor and sensory losses below the injury site (motor and light touch loss on one side, pain loss on other side)
self-restriction
patient himself keeps head, neck, and spine in alignment
indications for spine motion restriction based on assessment findings
- GCS score <15
- any suspected TBI
- any condition in which patient has altered mental status
- any pain/tenderness along vertebral column
- any paralysis, weakness, numbness, tingling, or prickling sensation
- deformity along vertebral column
- patient who sustained significant MOI and is under the influence, cannot communicate effectively/understand, has painful distracting injury
three major complications of spinal injury
- inadequate breathing effort
- paralysis
- inadequate circulation
guidelines for emergency care of suspected spinal injury
- take necessary standard precautions
- have patient self restrict, provide manual restriction of head/neck
- open airway with jaw-thrust maneuver
- assess PMS in all extremities
- assess cervical region and neck before applying cervical collar
- apply cervical collar
- secure patient to backboard, stretcher, vacuum mattress, or scoop stretcher
- reassess PMS
- transport
