Management of Spinal Cord Injury Flashcards
The major causes of death in a spinal cord injury patient are aspiration and shock. Initial survey of a trauma patient should be done according to the ATLS protocol in which airway, breathing, and circulation should be assessed. Which of the following are the management steps in the field?
● A. Spine immobilization (by placing the patient on board, placing sandbags on both sides or using a rigid collar)
● B. Blood pressure is maintained for which dopamine is the agent of choice and is preferred over fluids but fluids are also given as necessary
● C. Oxygenation is maintained for which intubation may be needed and chin lift is done for intubation without neck extension
● D. Brief motor examination should be done to identify deficits in a conscious patient by asking him/her to move legs or arms or hands or toes
● E. All of the above
E. All of the above
Which of the following are the management steps of a patient at hospital with suspected spinal injury?
● A. NG intubation and Foley catheterization
● B. DVT prophylaxis and temperature regulation
● C. Checking electrolytes
● D. More detailed neurological examination, radiographic evaluation, and medical management which includes methylprednisolone and other experimental drugs
● E. All of the above
E. All of the above
Methylprednisolone for the treatment of acute spinal cord injury is not recommended and high dose steroids can be associated with harmful effects and even death. Following are the management options for the management and prophylaxis of
deep vein thrombosis except?
● A. LMW heparin, rotating beds, adjusted dose of heparin, or some combination of these
● B. LMW heparin (titrating dose of SQ heparin every 12 hours to a PTT of 1.5 times control or 5,000 units SQ every 12 hours) plus pneumatic compression stockings or electrical stimulation
● C. Low-dose heparin and oral anticoagulation should not be used alone
● D. Vena cava interruption filters should be used as routine prophylaxis in all the patients
● E. Duplex Doppler ultrasound, impedance plethysmography, venography, and clinical examination are recommended as diagnostic tests for DVT in patients with SCI
D. Vena cava interruption filters should be used as routine prophylaxis in all the patients
Radiographic studies are not needed in a patient with no mental status change with no neck pain or posterior midline tenderness (with no distracting pain), no focal neurologic deficit and with no associated significant injuries that would detract or distract from the evaluation. Following are the criteria that should be met before removal of the cervical collar except?
● A. Asymptomatic patients who are alert with no neck pain or tenderness with full range of motion and without neurologic deficit or distracting pain
● B. Penetrating brain trauma unless the trajectory suggests direct cervical spinal cord injury
● C. In an obtunded patient with normal cervical CT scan and gross movement of all four extremities, there is strong recommendation to get flexion–extension X-rays
● D. Patients who are awake with neck pain or tenderness and normal cervical CT scan after either normal and adequate dynamic flexion and extension cervical spine X-rays and normal cervical MRI
● E. If MRI is normal, the collar may be safely removed
C. In an obtunded patient with normal cervical CT scan and gross movement of all four extremities, there is strong recommendation to get flexion–extension X-rays
What are the indicators that should alert a surgeon that there may be significant spinal cord injury?
● A. Retropharyngeal space more than 7 mm and retrotracheal space more than 14 or 22 mm in children
● B. Displaced paravertebral fat stripe
● C. Tracheal deviation and laryngeal dislocation
● D. Loss of lordosis or acute kyphotic angulation or torticollis
● E. All of the above
E. All of the above
Flexion–extension X-rays help to identify ligamentous injuries. Which of the following are the contraindications of these X-rays?
● A. Noncooperative patient with some mental impairment
● B. Subluxation of more than 3.5 mm at any level on neutral lateral c spine X-ray which is a marker for possible instability
● C. The patient is not neurologically intact
● D. In obtunded patients
● E. All of the above
E. All of the above
After a suspected spinal cord injury, MRI should be done within what time?
● A. 48 to 72 hours
● B. 24 hours
● C. 12 hours
● D. 5 days
● E. 8 hours
A. 48 to 72 hours
Traction is used in a patient to reduce fracture dislocations, maintain normal alignment, and immobilize the cervical spine to prevent further spinal cord injury. Following are the contraindications of traction except?
● A. Atlanto-occipital dislocation
● B. Very elderly patients or patients with demineralized skull can undergo cervical traction without any problem
● C. Type 2A or 3 hangman’s fracture
● D. Skull defect at anticipated pin site or if age is less than 3 years
● E. Patients with an additional rostral injury or patient with movement disorders
B. Very elderly patients or patients with demineralized skull can undergo cervical traction without any problem
Which of the following tongs can be used for applying traction?
● A. Crutch filed tongs
● B. Gardner Wells tongs
● C. Screw ring tongs
● D. Halo ring
● E. Halo vest
C. Screw ring tongs
After spinal cord injury, surgical decompression should be done within what time?
● A. 12 hours
● B. 24 hours
● C. 36 hours
● D. 48 hours
● E. 72 hours
B. 24 hours
Deep venous thrombosis (DVT) prophylaxis is indicated in spinal cord injury patients because the incidence of DVT in spinal cord injury might be up to what percent?
● A. 5%
● B. 10%
● C. 25%
● D. 50%
● E. 100%
E. 100%
Regarding radiographic imaging in trauma patients who are obtunded or unevaluable, what is the imaging modality of choice?
● A. AP/Lateral X-ray
● B. Open mouth odontoid view
● C. Dynamic X-rays
● D. CT scan
● E. MRI of spine
D. CT scan
For evaluation of traumatic cervical spine injury, cervical spine must be cleared radiographically from the cranio-cervical junction up to C7–T1 junction. Which view can be used to evaluate cervicothoracic junction if it is being missed on lateral view?
● A. AP view
● B. Oblique view
● C. Open mouth odontoid view
● D. Swimmer’s view
● E. Pillar’s view
D. Swimmer’s view
Neural foramina are well demonstrated on which view?
● A. AP view
● B. Oblique view
● C. Open mouth odontoid view
● D. Swimmer’s view
● E. Pillar’s view
B. Oblique view
One of the radiographic signs of C-spine trauma is the status of soft tissues and retropharyngeal space. In adults when is it considered a sign of injury?
● A. > 1 mm
● B. > 2 mm
● C. > 3 mm
● D. > 5 mm
● E. > 7 mm
E. > 7 mm
