Medical and Surgical Management Flashcards
What is the emergency care of a person?
treat as if SCI has occurred
immobilize entire spine
ensure circulation/ventilation are adequate
(do not use chin lift tech)
What are the hospital care goals?
treat life threatening conditions
preserve neuro function
ventilation/circulation
(neurological assessment after life-threatening conditions- motor/sensory/reflexes, LOC, cranial nerves)
What imaging is used for SCI?
CT entire spine
MRI of areas known or suspected of SCI
evaluate other systems
methylprednisolone
What is methylprednisolone?
steroid that is given between 8-48 hours to reduce secondary damage
increase risk of infection, sepsis, pneumonia, GI bleed, ulcers, iliius
What is the fracture management in a SCI?
reduce and stabilize
could be combo of traction, positioning, surgery and/or orthoses (C-spine usually traction, fusion usually for T/L)
non-surgical
surgical
What are tongs and how are they used?
tongs are used with traction for closed reduction of fracture
immobilized patient and pulley system is attached by 4 screws in the skull
temporary solution
Why are turning frames/beds used for?
immobilization during acute phase
allows for positional changes
What is the roto-rest system?
turns patient off of supine but not all of the way prone
What is the stryker frame?
turns patient completely 360
What are the indications for surgical management of a fracture in SCI?
unstable fracture
evidence of cord compression
deteriorating neuro function
(optimal timing is up for debate and is usually fused)
What is atlanto-occipital disassociation?
head slides forward on the atlas from sever flexion injury
usually fatal
What is a burst (Jefferson) fracture of C1?
fracture of the superior and inferior arches
from vertical compression force transmitted through occipital condyles to lateral masses (diving and landing on head)
What are the types of odontoid fractures?
type 1: tip is broken (5%)
type 2: base is fractured (65%) most common
type 3: subdentate-into body (30%)
What is a hangman’s fracture?
fracture through C2 pedicles and C2 slides anterior from C3
most common C-spine fracture
forced hyperextension (under chin)
usually unrestrained passenger
What is a flexion tear drop fracture?
severe flexion causes vertebral body to collide with one below fracturing anterior wedge
What is an extension tear drop fracture?
ALL pulls anterioinferior corner from vertebral body when there is abrupt neck extension
What is a compression fracture?
fracture of the anterior portion of vertebral body
doesn’t usually cause neurological damage
solution- vertebroplasty
What is a wedge fracture?
fracture wedge shaped from anterior portion of vertebral body
more damage than normal compression fracture
patient put in brace that prevents flexion
What is a burst fracture?
vertebral body fractures into pieces
increased vertical compression force
increased risk of neurological damage
decompress fracture and stabilize spine
What is a chance fracture?
transverse fracture of vertebral body
increase forced deceleration injury
usually from wearing only lap belt
What are the indications for use of spinal orthoses?
spinal immobilization surgery spinal immobilization needed after trauma compression fracture management pain relief mechanical unloading of a joint kinesthetic reminder to avoid movement
What are the characteristics of orthoses you need to take into consideration?
weight, adjustability, functional use, cosmesis, durability, ease of don/doff, access to: trach tube, drain sites and surgical sites, aeration
What is the Halo brace?
most drastic way of stabilizing C-spine
4 steel screws into skull attached to body jacket
allows early mobilization and upright posture
applied bedside with local anesthetic
What are some complications of the Halo brace?
moves COG superiorly drastically
pins could loosen or become infected
