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Trauma and Trauma Systems > Spinal Cord > Flashcards

Spinal Cord Flashcards

1
Q

introduction to spinal injury

A

-Annually 15,000 permanent spinal cord injuries
-Commonly men 16-30 years old
-Mechanism of Injury
– Vehicle crashes: 48%
– Falls: 21%
– Penetrating trauma: 15%
– Sports injury: 14%
-Lifelong care for spinal cord injury victim exceeds $1 million.
-Best form of care is public safety and prevention programs.

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2
Q

vertebral column

A

-33 bones comprise the spine.
-Function:
– Skeletal support structure
– Major portion of axial skeleton
– Protective container for spinal cord
-Vertebral Body:
– Major weight-bearing component
– Anterior to other vertebrae components

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3
Q

components of vertebrae

A
  • spinal canal
  • pedicles
  • laminae
  • transverse process
  • spinous process
  • intervertebral disk
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4
Q

size of vertebrae

A

-C-1 and C-2:
-No vertebral body
-Support head
-Allow for turning of head
-Vertebral body size increases the more inferior they
become.
-Lumbar spine strongest and largest-> Bear weight of the body
-Sacral and coccyx vertebrae are fused -> No vertebral body

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5
Q

spinal canal

A

Opening in the vertebrae that the spinal cord passes through

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6
Q

pedicles

A

Thick, bony structures that connect the vertebral body to the
spinous and transverse processes

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7
Q

laminae

A

Posterior bones of vertebrae that make up foramen

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8
Q

transverse process

A
  • Bilateral projections from vertebrae

- Muscle attachment and articulation location with ribs

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9
Q

compo

A
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10
Q

spinous process

A

Posterior prominence on vertebrae

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11
Q

intervertebral disk

A
  • Cartilaginous pad between vertebrae

- Serves as shock absorber

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12
Q

Vertebral Ligaments: Anterior Longitudinal

A
  • Anterior surface of vertebral bodies
  • Provides major stability of the spinal column
  • Resists hyperextension
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13
Q

vertebral ligaments: Posterior Longitudinal

A
  • Posterior surface of vertebral bodies in spinal canal

* Prevents hyperflexion

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14
Q

cervical spine

A

-7 vertebrae
-Sole support for head
-Head weighs 16–22 pounds
-C-1 (Atlas)
• Supports head
• Securely affixed to the occiput
• Permits nodding
-C-2 (Axis)
• Odontoid process (dens) -> Projects upward and Provides pivot point so head can rotate
-C-7
• Prominent spinous process (vertebra prominens)

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15
Q

thoracic spine

A

-12 vertebrae
-1st rib articulates with T-1
-Attaches to transverse process and vertebral body
-Next nine ribs attach to the inferior and superior portion of
adjacent vertebral bodies
-Limits rib movement and provides increased rigidity
-Larger and stronger than cervical spine
-Larger muscles help to ensure that the body stays erect
-Supports movement of the thoracic cage during respirations

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16
Q

lumbar spine

A

– 5 vertebrae
– Bear forces of bending and lifting above the pelvis
– Largest and thickest vertebral bodies and
intervertebral disks

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17
Q

sacral spine

A
  • 5 fused vertebrae
    – Form posterior plate of pelvis
    – Help protect urinary and reproductive organs
    – Attach pelvis and lower extremities to axial
    skeleton
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18
Q

coccygeal spine

A

-3–5 fused vertebrae

– Residual elements of a tail

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19
Q

layers of spinal meninges

A

– Dura mater
– Arachnoid
– Pia mater
-Cover entire spinal cord and peripheral nerve roots
that exit
-Cerebrospinal fluid bathes spinal cord by filling the
subarachnoid space
–CSF Exchange of nutrients and waste products
–CSF Absorbs shocks of sudden movement

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20
Q

spinal cord function

A

-Transmits sensory input from body to the brain
-Conducts motor impulses from brain to muscles and
organs
-Reflex center- Intercepts sensory signals and initiates a reflex signal

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21
Q

growth of spinal cord

A

-Fetus- Entire cord fills entire spinal foramen
-Adult- Base of brain to L-1 or L-2 level
-adult Peripheral nerve roots pulled into spinal foramen at the distal end
(cauda equina)

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22
Q

axons

A

-Transmit signals upward to the brain and down to the
body
-Ascending tracts
– Axons that transmit signals to the brain
– Sensory tracts
-Descending tracts
– Axons that transmit signals to the body
– Motor tracts
» Voluntary and fine muscle movement

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23
Q

dermatomes

A 
-Topographical region of the body surface
innervated by one nerve root
-Key locations
• Collar region: C-3
• Little finger: C-7
• Nipple line: T-4
• Umbilicus: T-10 
• Small toe: S-1
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24
Q

myotomes

A 
-Muscle and tissue of the body innervated by
spinal nerve roots
-Key myotomes
• Arm extension: C-5
• Elbow extension: C-7
• Small finger abduction: T-1
• Knee extension: L-3
• Ankle flexion: S-1
25
Q

reflex pathways

A 
-Function
• Speed body’s response to stressors
• Reduce seriousness of injury
• Body stabilization
-Occur in special neurons
• Interneurons
• Examples:
-Touch hot stove.
-Severe pain sends intense impulse to brain.
-strong signal triggers interneuron in the spinal cord to direct a
signal to the flexor muscle.
-Limb withdraws without waiting for a signal from the brain.
26
Q

ANS: Parasympathetic, “Feed and Breed”

A 
• Controls rest and regeneration
• Peripheral nerve roots from the sacral and cranial
nerves
• Major Functions
-Slows heart rate
-Increases digestive system activity
-Plays a role in sexual stimulation
27
Q

ANS: Sympathetic, “Fight or Flight”

A

• Increases metabolic rate
• Branches from nerves in the thoracic and lumbar regions
• Major Functions
– Decreases organ and digestive system activity
» Vasoconstriction
– Release of epinephrine and norepinephrine
– Systemic vascular resistance
» Reduces venous blood volume
» Increases peripheral vascular resistance
– Increases heart rate
– Increases cardiac output

28
Q

mechanism of spinal injury

A
  • extremes of motion
  • hyperextension- head flings backward
  • hyperflexion- kiss the chest
  • excessive rotation
  • lateral bleeding
29
Q

axial stress

A

-Axial loading
-Compression common between T-12 and L-2
• Distraction
• Combination
-Distraction/rotation or compression/flexion
-pressure to the length of the spine
-you land feet first (or head) -> squish the spine

30
Q

other MOI spinal injuries

A
  • direct, blunt, or penetrating trauma

- electrocution

31
Q

flexion injury

A

-lumbar spine

32
Q

compression injury

A
  • axial loading injury

- landing on the feet or the head

33
Q

column injury

A
  • movement of vertebrae from normal position
  • subluxation or dislocation
  • fractures:
  • spinous process and transverse process
  • pedicle and laminae
  • vertebral body
  • ruptured intervertebral disks
  • common sites of injury:
  • C-1/C-2: delicate vertebrae
  • C-7: transition from flexible cervical spine to thorax
  • T-12/L-1: different flexibility between thoracic and lumbar regions
34
Q

cord injury: concussion

A
  • similar to cerebral concussion

- temporary and transient disruption of cord function

35
Q

cord injury: contusion

A
  • bruising of the cord

- tissue damage, vascular leakage, swelling

36
Q

cord injury: compression

A 
-Secondary to:
– Displacement of the vertebrae
– Herniation of intervertebral disk
– Displacement of vertebral bone fragment
– Swelling from adjacent tissue
37
Q

cord injury: laceration

A
  • causes:
  • bony fragments driven into the vertebral foramen
  • cord may be stretched to the point of tearing
  • hemorrhage into cord tissue, swelling, and disruption of impulses
38
Q

cord injury: hemorrhage

A

Associated with contusion, laceration, or stretching

39
Q

transection cord injury

A 
-Injury that partially or completely severs the
spinal cord
-can be incomplete or complete
-Complete:
-Cervical Spine damage:
-Quadriplegia
-Incontinence
-Respiratory paralysis
– Below T-1:
» Incontinence
» Paraplegia
40
Q

incomplete transection cord injury: anterior cord syndrome

A

-Anterior vascular disruption
-Loss of motor function and sensation of pain, light touch, and
temperature below injury site
-Retain motor, positional, and vibration sensation

41
Q

incomplete transection cord injury: central cord syndrome

A
  • Hyperextension of cervical spine
  • Motor weakness affecting upper extremities
  • Bladder dysfunction
42
Q

incomplete transection cord injury: brown-sequard’s syndrome

A
  • Penetrating injury that affects one side of the cord
  • Ipsilateral (same side) sensory and motor loss
  • Contralateral pain and temperature sensation loss
43
Q

general signs and symptoms of spinal injury

A 
– Extremity paralysis
– Pain with and without movement
– Tenderness along spine
– Impaired breathing
– Spinal deformity
– Priapism
– Posturing
– Loss of bowel or bladder control
– Nerve impairment to extremities
44
Q

spinal shock

A

-Temporary insult to the cord
-Affects body below the level of injury
-Affected area:
• Flaccid
• Without feeling
• Loss of movement (flaccid paralysis)
• Frequent loss of bowel and bladder control
• Priapism
• Hypotension secondary to vasodilation

45
Q

neurogenic shock

A
  • Spinal-Vascular Shock
  • Occurs when injury to the spinal cord disrupts the brain’s ability to control the body
  • Loss of sympathetic tone:
  • Dilation of arteries and veins -> Expands vascular space and results in relative hypotension
  • Reduced cardiac preload
  • Reduction of the strength of contraction -> Frank-Starling reflex
  • ANS loses sympathetic control over adrenal medulla
  • Unable to control release of epinephrine and norepinephrine -> Loss of positive inotropic and chronotropic effects
46
Q

signs and symptoms of neurogenic shock

A
  • Bradycardia
  • Hypotension
  • Cool, moist, and pale skin above the injury
  • Warm, dry, and flushed skin below the injury
  • Male: priapism
47
Q

Autonomic Hyperreflexia Syndrome

A

-Associated with the body’s resolution of the effects of
spinal shock
-Commonly associated with injuries at or above T-6
-Presentation
• Sudden hypertension
• Bradycardia
• Pounding headache
• Blurred vision
• Sweating and flushing of skin above the point of injury

48
Q

other causes of neurologic dysfunction

A 
-Any injury that affects the nerve impulse’s path of
travel:
• Swelling
• Dislocation
• Fracture
• Compartment syndrome
49
Q

scene size up of spinal injury pt

A

– Evaluate MOI.
– Consider spinal clearance protocol.
– Determine type of spinal trauma.
– Maintain suspicion with sports injuries.
– If unclear about MOI, take spinal precautions.

50
Q

initial assessment of spinal injury

A

-Consider spinal clearance protocol.
-Consider spinal precautions.
• Head injury
• Intoxicated patients
• Injuries above the shoulders
• Distracting injuries
-Maintain manual stabilization.
• Vest style versus rapid extrication
• Maintain neutral alignment
• Increase of pain or resistance, restrict movement in position found

– ABCs.
– Suction.
– Consider oral or digital intubation if required -> Maintain in-line manual c-spine control.

51
Q

rapid trauma assessment of spinal injury

A
  • Focused versus rapid assessment
  • Rapid Assessment
  • Suspected or likely spinal cord/column injury
  • Multi-system trauma patient
  • Evaluate for:
  • Neck deformity, pain, crepitus, warmth, tenderness
  • Bilateral extremities -> Finger abduction/adduction, push, pull, grips
  • Motor and sensory function:
  • > Dermatome and myotome evaluation
  • > Babinski’s sign test
  • > Hold-up position
52
Q

secondary assessment of spinal injury: vital signs

A

-Body temperature
-Above and below site of injury
– Pulse
– Blood pressure
– Respirations

53
Q

ongoing assessment of spinal injury

A

-Recheck elements of initial assessment.
– Recheck vital signs.
– Recheck interventions.
– Recheck any neurological deviations

54
Q

spinal alignment

A

-Move patient to a neutral, in-line position.
-Position of function.
-Hips and knees should be slightly flexed for maximum comfort and
minimum stress on muscles, joints, and spine.
-Place a rolled blanket under the knees
-ALWAYS support the head and neck.
-Contraindications to neutral position:
• Movement causes a noticeable increase in pain.
• Noticeable resistance met during procedure.
• Increase in neurological deficits occurs during movement.
• Gross deformity of spine.
– LESS MOVEMENT IS BEST.

55
Q

padding in order to keep body aligned with spinal injury

A
  • padding under shoulders for infant
  • child no padding necessary
  • padding under the head
  • elderly- look for lordosis, kyphosis
56
Q

movement of spinal injury patient

A

-Any movement MUST be coordinated.
-Move patient as a unit.
-NO LATERAL PUSHING.
-Move patient up and down to prevent lateral bending.
-Rescuer at the head “CALLS” all moves.
-ALL MOVES MUST be slowly executed and well coordinated.
-Consider the final positioning of the patient prior to
beginning move.

57
Q

emergency medical care of spinal injuries

A

-Follow standard precautions.
-Maintain the patient’s airway while keeping
the spine in the proper position.
-Assess respirations and give supplemental
oxygen.
-Managing the airway -> Perform the jaw-thrust maneuver.
-After you open the airway, consider inserting an oropharyngeal airway.
-Have a suctioning unit available.
-Provide high-flow oxygen.
-Stabilization of the cervical spine -> Restrict motion of the head and trunk so that bone fragments do not cause further damage.

58
Q

long backboards

A
  • Provide full body spinal motion restriction to the head, neck, torso, pelvis, and extremities
  • Used to move patients to a stretcher, then removed, while maintaining spinal motion restriction

Trauma and Trauma Systems (18 decks)

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