Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRTY2105 > Lecture 5 - cervical spine > Flashcards

Lecture 5 - cervical spine Flashcards

1
Q

What’re the freq of cervical spine injuries?

A

C1/2 = 25%
C3-7 = 75%
NON-CONTINGUOUS FRAC = 20%

C2
C6>C5
C7>C3
C4>C1

associated TL frac = 5-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the freq of frac that occur at specific vert sites?

A 
vert arch = 50%
vert body = 30%
IV disc =25%
post ligs = 16%
dens = 14%
facets = 12%
ALL = 2%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some clinical indications of cervical spine injury?

A

neck pain, occipital or shoulder pain after trauma

has torticollis (stiff neck)

restriction of neck movement

supports head in hand

found uncon after head injury (Esp MVA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How many formaina in a vervical vert?

A

transverse formaina
- allow passage of vert artery, veins and nerves

vert formaina = passage of spinal cord

IV foramina

  • just like lil windows
  • 45 deg angles to midsag plane, open anteriorly
  • directed 15deg inf angle because of shape and overlapping of C vert
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What projections are involved in the trauma series fro the C spine?

A

HBL C spine

supine chest

AP pelvis

standard trauma:
HBL LAT
AP
AP DENS 
SWIMMERS IF NECCESSARY
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Go over the use of the Canadian C-spine rule for alert stable trauma pts for imaging protocol

A

do not remove collar
do not move pt

High risk factors requires imaging

  • > 65
  • dangerous mechanism
  • paresthesia in extremities

low risk factors = ROM assessment (only if 45deg left right movement is ok)

  • simple rear-end MVA
  • seated in ED
  • ambulant any time
  • delayed neck pain
  • absence of midline cervical tenderness

IMAGING SHOULD BE DONE IF MOTION ASSESMENT SHOWS LACK OF rom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the reasons in the nexus criteria that indicate that imaging should be done?

A

post midline cervical tenderness

intoxication

reduced level of consciousness (GCS<15)

focal neurological deficit

painful distracting injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Views done to visualise the C spine

A

AP peg OPEN MOUTH (C1-2)

AP axial (C3-7)

lateral

swimmer’s lat (if needed - modified lat)

Bilat Obl (PA or AP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

AP OPEN MOUTH (PEG VIEW)

A

Significance:

  • to see C1C2
    tech:
  • 18x24 landscape
  • in bucky

pos:

  • PT SUPINE (IF trauma) or erect with mouth wide open
  • upper incisor to lowest part of occipital level must be parallel to beam and perpendicular cassette (DON’T MOVE THE PT FOR TRAUMA TO GET INCISOR AND OCCIPITAL IN LEVEL - RATHER ANGLE THE BEAM)

rotation:
- look at dens lat distances from medial surface of C1

beam:
- center of mouth
- ie. midline at level of inf border of upper incisors and parallel to a line joining this point and the tip of mastoid process

exp:
- 70 kVp, 15 mAs, use grid, 110 SID

collim:

  • lat: mandible
  • sup and inf: include upper and lower incsior

FOV
- include mandible
- include upper and lower incisors
- normal:
= joint spaces of C1-C2 symmetrical and open
= dens no frac
= upper incisor must superimpose base of skull (if not = bad position)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

AP AXIAL

A

significance:
- to see C3-C7

tech:
- 18x24 portrait
- in bucky

pos:

  • supine or erect
  • relax shoulders

rotation;

  • SP midline between pedicles
  • SP will rotate toward the pedicle that’s farther from IR

beam:

  • lower thyroid cartilage (C5-C6)
  • angulation = 15-20 deg cephalad

FOV:

  • open IV disc spaces
  • SP in midline and equidistant to pedicles (no rotation)

collim:

  • entire lat C spine
  • vertically: C2-T2
  • JUG NOTCH TO MANDIBLE

exp:
- 60-70 kVp, 16 mAs, yes grid, 110

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

LATERAL

A

significance:
- seeing joints and noticing fractures and dislocations, displacements

tech:

  • 24x30 portrait
  • suspend on expiration (breathing in will make pt lift shoulders up which is not wanted)
  • can be in or out of bucky
  • BUT OUT FOR HBL duh

pos:
- true lat: perp to bucky
- erect or supine
- shoulders pushed down to see C7T1 junction (can give weight to lower shoulders NOT IF ?#)
- chin slightly extended forward (angle of mandible away from upper spine)

beam:
- level of thyroid cartilage (follow line from mastoid process)

FOV:

  • vert bodies superimposed
  • articular pillars and facets superimposed
  • visualisation of C1-T1

collim:

  • vertic: C1-T1
  • hori: skin surface
  • top of EAM TO TIP OF SHOULDER

exp: 50-75 kVp, 20-50 mAs, 180 SID, grid yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What’s the air gap technqiue?

A

It’s used in lateral C spine

the distance between IR and the neck is separated by the shoulder, thus, creating an air gap.

this technique reduces scatter, but increased OID (thus, that’s why we increase SID)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SWIMMER’S LATERAL

A

modified lateral. NOT FOR TRAUMA

significance:

  • cervicothoracic junction (C7T1) visualisation
  • done when lateral doesn’t visualise junction (possibly due to the pt having very muscular shoulders)

tech:

  • 24x30 landscape
  • in bucky

pos:

  • supine: extend arm close to IR above head and rotate humeral head anteriorly
  • erect: flex elbow and rest forearm on head
  • mCP centred to midline of grid
  • if pt shoulder can not be depressed further (the one that’s not raised), angle beam 3-5 deg caudad

beam:
- T1
- 2.5cm above jug notch at level of vert prominens

FOV:
- visualise C7T1 and joint space
- vert bodies superimposed
pillars and joints superimposed

collim:

  • vert: C1-T3
  • top of EAM TO TIP OF SHOULDER

exp:
- 80 kVp, 60-80 mAs, 120-150 SID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Compare the anatomy criteria visualised between an anterior and post oblique

A

AO (preferred - due to low dose to thyroid and IV foramina closer to IR and so much sharper and less mag)

  • PA
  • (downside view) IV foramina and pedicles on side of pt closest to IR visualised
  • eg. RAO: right IV foramina
  • eg. LAP: left IV foramina

PO

  • AP
  • (upside view) IV foramina and pedicles on side of pt farthest from IR demonstrated
  • eg. LPO: right Iv foramina shown
  • eg. RPO: left IV formaina shown
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ANTERIOR OBLIQUE

A

significance:

  • IV foramina open, with a upside view
  • each obl image only shows one set of formaina open and the ones on the opposite side will be visualised as closed

tech:
- 18x24 portrait
- in bucky

pos:
- align midsagital to CR and midline of table and/or IR
- pts arms at side. if recumbent = place arms as needed for support
- rotate pt body and head 45 deg
= rotate head towards raised sides wall (true lat) in order to help prevent superimposition of mandible of upper vert but may cause some rotation of upper vert

ROTATION:
- if under rotated = foramina will be narrowed and SC joint would superimpose over vert column

beam:
- 15 deg caudad at C4 (upper margin of thyroid cart)

collim:

  • verti: C1-T1
  • hori: soft tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

POSTERIOR OBLIQUE

A

significance:
- open IV foramina but with a downside view

same shit as ant oblique but you will be visualising the IV foramina of the side away from IR and its AP

beam:
-15 deg cephalad at C4

17
Q

FUNCTIONAL LATERAL: HYPER EXTENSION AND FLEXION

A

no frac or pathology should be suspected before attempting these views. Performed with doctors?

significance:

  • demonstrates absence of normal movement from trauma or disease
  • pre and post operative to see extent of ROM

tech:

  • in bucky
  • 24x30 portrait
  • suspend on expiration

pos:

  • upright, seated or standing
  • No rotation

beam:
- level of C4 laterally along coronal plane

FOV:

  • hyperflex; SP well seperated
  • heperexten: SP in close proximity
18
Q

AP AXIAL - vertebral arch (pillars) projection

A

SHOULD ONLY BE DONE IF SPINAL INJURY HAS BEEN RULED OUT. NO ?#

significance:
- to see if there’s any pathology on the posterior vert arches of C4-7 OR the SP of CT vertebra

tech:
18x24 portrait

pos:

  • hyperextend neck
  • shoulder equidistant to IR and/or table top
  • midsagital plane perp to IR

beam:

  • 20-30 deg caudal
  • at C5 (lower margin of thyroid cart)

FOV:

  • posterior elements of mid to lower cervical spine demonstrated, including articular pillars
  • mandible above C3
collim:
- top of ear and include soft tissue of neck 
- JUG NOTCH TO MANDIBLE LEVEL
exp:
- 60-70 kVp, 16 mAs, 110 SID, yes grid
19
Q

How to utilise the PACEMAN for image critique?

A

Pos:

  • is pt pos well?
  • rotation?
  • necessary joint spaces open and visualised?

Area

  • FOV necessary anatomy shown?
  • correct anatomy has been expsoed?

Collim:
- too little or too much?

Exp:

  • good exp factors use?
  • good contrast and density distribution?
  • what can be done to better the image in terms of exposure?

Markers:

  • markers?
  • correct marker?

Aesth:

  • does it look good?
  • centered?
  • four way collim?

name:
- pt identification?

20
Q

what’s unique about the anatomy of the atlas?

A

no pedicles, lamia, or SP

21
Q

how do you logroll a pt?

A

requires one person to stabilise head and two people minimum on each side of pt to keep spine aligned

22
Q

What’s the golden rule for trauma pts?

A

DO NOT REMOVE COLLAR
- CAN ONLY DO SO AFTER hbl C spine and/or CT scan cleared by doctor

DO NOTADJUST HEAD/NECK

MRTY2105 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions