Cortex- Spinal Injuries

Question 1

if you suspect a cervical spine injury what should you do

Answer 1

immobilised

Question 2

how can the spinal chord or nerve roots be damaged

Answer 2

contusion (bruise), compression, stretch or laceration

Question 3

what might vascular disruption and oedema cause in a spinal chord injury

Answer 3

further ischaemic damage and hypotension

Question 4

what is spinal shock

Answer 4

physiological response to injury with complete loss of sensation and motor function and reflexes below the level of injury. resolves in 24 hrs

Question 5

what is the bulbocavernous reflex

Answer 5

contraction of the anal sphincter with either:
-squeeze of the glans penis 
-tapping of the mons pubis 
-pulling of the urethral catheter 
(absent in spinal shock)

Question 6

what is neurogenic shock

Answer 6

occurs secondary to temporary shutdown of sympathetic outflow from T1-L2
usually due to injury in cervical or upper throacic cord
causes hypotension and bradycardia
resolvese within 24-48 hrs

Question 7

what is priapism

Answer 7

painful erection, caused by unopposed parasympathetic stimulation, may be present is neurogenic shock

Question 8

how is neurogenic shock treated

Answer 8

IV fluid therapy

Question 9

what are complete spinal chord injuries

Answer 9

when there is no sensory or voluntary motor function below the level of the injury (reflexes should return)

Question 10

what determines the level of injury

Answer 10

the most distal level with partial function- dermatomal sensation and myotomal skeletal muscle voluntary contraction (after spinal shock has resolved)

Question 11

what is the prognosis for recovery in complete spinal cord injuries

Answer 11

poor

Question 12

what are incomplete spinal cord injuries

Answer 12

where there is some neurologic function (sensory and/or motor) present distal to the level of injury

Question 13

what is the prognosis for incomplete spinal injuries

Answer 13

the greater the function present, the faster the recovery and better the prognosis

Question 14

in spinal injuries what does sacral sparing with preservation of perianal sensation, voluntary anal sphincter contraction and big toe flexion (FHL muscle, S1/2) show

Answer 14

continuity of the cortiospinal (motor) and spinothalamic (course touch, pain and temperature) tracts

sacral sparing indicates an incomplete injury with better prognosis than a complete injury

Question 15

what nerve abducts the arm

Answer 15

C5

Question 16

what nerve flexes the fingers

Answer 16

C8

Question 17

what nerve adducts and abducts the digits

Answer 17

T1

Question 18

what nerves flex the elbow

Answer 18

C5,6

Question 19

what nerve extends the elbow

Answer 19

C6,7,8

Question 20

what nerve adducts the toes

Answer 20

S2,3

Question 21

what nerve does great toe dorsiflexion

Answer 21

L5

Question 22

what nerves flex the leg

Answer 22

L1,2

Question 23

what nerve flexes the knee

Answer 23

L5,S2

Question 24

what nerve extends the knee

Answer 24

L3,4

Question 25

what nerve plantar flexes the foot

Answer 25

S1,2

Question 26

what is the ATLS primary survey

Answer 26

used in spinal chord injuries (with resuscitation and protection of the spine) as often high energy and occur with other injuries

Question 27

what is shock

Answer 27

organ hypoperfusion

Question 28

what shock is most common in spinal cord injuries

Answer 28

hypovolaemic

Question 29

in spinal cord injuries what does resus prevent

Answer 29

secondary hypoxic cord damage

Question 30

what helps prevent further damage in an unstable fracture or dislocation

Answer 30

immobilisation- cervical collar and sandbags, spinal board

Question 31

why might traction be required in spinal cord injuries

Answer 31

to reduce dislocations or stabilise unable cervical spines

Question 32

what might be needed if there is loss of intercostal muscle function (T1-T12)

Answer 32

ventilatory support