Spinal Flashcards
What mechanisms of injury should spinal care be considered in?
- Major trauma
- Multiple injuries
- High speed injuries
- Falls
- Sporing injuries
- Head injuries
- ?All unresponsive patients
What is the Three Column concept?
- Anterior
- Middle
- Posterior
What is transverse Spinal cord damage?
- Complete tearing of the spinal cord, no signals are getting through
Brown Sequard Syndrome
- Most common from penetrating injuries
- Can be caused by tumour and injection
- Contralateral loss of pain and temperature sensation
Anterior Cord syndrome
- Anterior section of the cord, causes occlusion of the artery
- Loss of motor control
- Sensations are maintained
- This is how your body knows where your limbs are, perception of them
Posterior cord syndrome
- Loss of touch and temperature.
Cauda Equina syndrome
- Numb bum
- Weakness of the legs
- Loss of bladder and bowl control
- Excluded from treat and refer guidelines must be transported
6 ps of spinal cord injury
- Paraesthesia
- Pain
- Paralysis
- Poikilothermia
- Priapism
o Uncontrolled erection - Paradoxical respirations
o Opposite respirations. So when they breath out chest looks inflated
What is Spinal shock?
- Temporal loss of sensation, pain, motor control.
Neurogenic shock
- Occurs when the nervous system is no longer functioning properly
- Causes
o Trauma to spinal cord
o Epidural goes wrong - It is the loss of vascular tone and the pooling of peripheral blood
o The loss of sympathetic tone
This sympathetic tone on blood vessels is there to maintain blood pressure and allow flow.
o The loss of tone means that as blood hits the artier of vein walls it will lose its momentum due to the loss of tone like a limp trampoline causing blood to pool and not move around the body as freely and not perfusing tissues and organs as needed. - All of this lack of perfusion will reduce cardiac output. As les return of blood to the heart = reduce SV = reduce C0.
- The sympathetic nervous system also controls HR, this means that a reduce in HR will also cause a further reduction in CO.
- This all leads to a shutdown in oxygen delivery.
- Symptoms would be as follows
o Alt conscious state
o Decrease urine output
o Organ dysfunction
o Bradycardia – key symptom of neurogenic shock
o Warm skin – due to the dilation of all blood vessels, this is diverting blood from vital organs
- Treatment for neurogenic shock
o Pressor that clamp back down the blood vessels
o IV fluids to maintain fluid volume to help push blood through the system
↑ Both help increase BP
o Atropine
Blocking parasympathetic nervous system increase fight or flight response
• This will cause an increase in HR to increase C0 to improve the pumping of blood throughout the cardiovascular system.
What are Cervical spine fractures a result of?
- Hyper flexion
- Hyperextension
- Flexion- rotation
- Vertebral compression
- Lateral flexion
- Distraction- pulled and stretched beyond normal limits.
• Compression fractures
o Most common type of vertebral fracture, partially seen in people with bone disease.
o Loss of height of the anterior part of the vertebral body with posterior cortex intact.
o Commonly results in a wedge fracture which is a subtype of compression.
• Burst fracture.
o Extreme Trauma
o Vertebrae is crushed involving anterior, middle and sometimes posterior column.
o Bony fragments spread out and cause spinal injury
• Distraction (flexion- distraction)
o Seen when the spine is made to flex forward placing excessive stress on the spine (e.g. MVA)
o Involves horizontal fractures of posterior and middle column
o Often includes separation of the posterior elements
High chance of cord injury.
• Dislocation
o Ligaments and/ or disc are stretched or torn
o Bones come out of alignment
o Occurs with compression of the body against a seat belt pulling apart the vertebrae.
o A dislocated vertebra can cause instability and spinal cord compression. Usually require stabilization surgery or a brace.
• Fracture dislocation.
o Very unstable and requires surgical repair
o Usually involves all there columns
o A fracture of any of the aforementioned with vertebral displacement.
• Spinal Cord Injury Without Radiological Abnormality (SCIWORA)
o Presents as a complete spinal cord injury (total loss of sensation and function below a lesion) or incomplete spinal cord injury (some sensation and/ or function is preserved.
o 90% of cases are children <18 years old.
o Typically involves the cervical spine, less commonly involves thoracolumbar spine.
o Can Occur in newborns following traumatic breech extraction
Other causes can be MVA and falls (most common).
o Central cord syndrome
Central part of the spinal cord is damaged while external part remains intact
Most common form of incomplete SCI
Cause by hyperextension especially in elderly
Motor and sensory functions in upper more than lower limbs. And reflexes are
