Chapter 32: Spinal Injury and Spine Motion Restriction

Question 1

common causes of spinal injuries

Answer 1

automobile crashes, shallow-water diving accidents, motorcycle crashes, falls, accidents during sports

Question 2

central nervous sytem (CNS)

Answer 2

brain and spinal cord

Question 3

peripheral nervous system

Answer 3

nerves located outside the brain and spinal cord

Question 4

voluntary (somatic) nervous system

Answer 4

influences activity of voluntary muscles and movements

Question 5

autonomic nervous system

Answer 5

influences the activities of involuntary muscles and glands, partly independent of the rest of the NS, contains sympathetic and parasympathetic NS

Question 6

spinal column

Answer 6

vertebral column, principal support system of the body, made of 33 vertebrae

Question 7

vertebrae

Answer 7

irregularly shaped bones, make up spinal cord, the body faces anteriorly, bound together by ligaments, disk between each two vertebrae

Question 8

spinous process

Answer 8

posterior aspect of vertebra

Question 9

disk

Answer 9

fluid filled pad of tough elastic cartilage, acts as shock absorber, between every 2 vertebrae

Question 10

cervical spine

Answer 10

first seven vertebrae, most mobile and delicate

Question 11

thoracic spine

Answer 11

12 vertebrae directly below cervical vertebrae, compose upper back

Question 12

lumbar spine

Answer 12

next 5 vertebrae under thoracic spine, form lower back

Question 13

sacral spine

Answer 13

sacrum, next 5 vertebrae under lumbar spine, fused together, form rigid posterior portion of pelvis

Question 14

coccyx

Answer 14

tailbone, final four fused vertebrae at end of spine

Question 15

spinal cord

Answer 15

composed of nervous tissue, exits brain through opening at base of skull

Question 16

motor tracts

Answer 16

in spinal cord, carry impulses down spinal cord and out to muscle, tested by having patient move

Question 17

pain tracts

Answer 17

in spinal cord, carry impulses from pain receptors up the spinal cord to brain, tested by pain, side that the tract controls is opposite

Question 18

light touch tracts

Answer 18

in spinal cord, carry light touch impulses from sensory receptors up the spinal cord to brain, tested by applying light touch

Question 19

most common cause of spinal injuries

Answer 19

automobile crashes

Question 20

spinal cord injury without radiologic abdormality

Answer 20

SCIWORA, a spinal cord injury without any spinal column damage

Question 21

compression

Answer 21

when weight of body is driven against head

Question 22

flexion

Answer 22

when there is severe forward movement of the head in which the chin meets the chest or when the torso is excessively curled forward

Question 23

extension

Answer 23

when there is severe backward movement of the head in which the neck is stretched or when the torso is severely arched

Question 24

rotation

Answer 24

when there is lateral movement of the head or spine beyond its normal rotation

Question 25

lateral bending

Answer 25

when the body or neck is bent severely from the side

Question 26

distraction

Answer 26

when the vertebrae and spinal cord are stretched and pulled apart, common in hangings

Question 27

penetration

Answer 27

injury from gunshot, stabbing, other type of penetrating trauma

Question 28

spinal motion restriction (SMR)

Answer 28

steps to keep the spine in anatomic alignment and to restrict its movement

Question 29

spinal column injury

Answer 29

injury to one or more vertebrae

Question 30

spinal cord injury

Answer 30

involves damage to the nervous tissue that is enclosed in the hollow center of the spinal column

Question 31

complete spinal cord injury

Answer 31

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

Question 32

spinal shock

Answer 32

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…

Question 33

priapism

Answer 33

involuntary erection of penis

Question 34

neurogenic hypotension

Answer 34

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

Question 35

incomplete spinal cord injury

Answer 35

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

Question 36

anterior cord syndrome

Answer 36

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

Question 37

central cord syndrome

Answer 37

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

Question 38

Brown-Séquard syndrome

Answer 38

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)

Question 39

self-restriction

Answer 39

patient himself keeps head, neck, and spine in alignment

Question 40

indications for spine motion restriction based on assessment findings

Answer 40

• 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

Question 41

three major complications of spinal injury

Answer 41

• inadequate breathing effort
• paralysis
• inadequate circulation

Question 42

guidelines for emergency care of suspected spinal injury

Answer 42

1. take necessary standard precautions
2. have patient self restrict, provide manual restriction of head/neck
3. open airway with jaw-thrust maneuver
4. assess PMS in all extremities
5. assess cervical region and neck before applying cervical collar
6. apply cervical collar
7. secure patient to backboard, stretcher, vacuum mattress, or scoop stretcher
8. reassess PMS
9. transport