Spinal Cord Injuries Flashcards

1
Q

What are the mechanisms of spinal injury

A
Hyperflexion
Hyper extension 
Lateral stress 
Rotation 
Compression 
Distraction
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2
Q

What are common causes of spinal injuries

A

Trauma: car accidents, contact sports, falls, alcohol

Head injuries: 20% have c spine injury

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3
Q

Where are common sites of spinal injury

A

C6/7 (50%)
C2 (30%)

C1/2 in children (heavy head + lax ligaments)

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4
Q

What are the types of spinal cord injuries

A
Complete transection 
Hemisection 
Anterior cord injury 
Central cord injury 
Posterior cord injury
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5
Q

What are the causes of complete transection

A
Trauma
Infarction 
Transverse myelitis
Abscess
Tumour (metastasis)
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6
Q

What are the clinical features of complete transection

A

Spinal shock
Neurological shock
Bilateral paralysis below level of injury
Bilateral sensory loss of all modalities below level of injury
Priapism

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7
Q

What is spinal shock

A

Paralysis of bladder and rectum

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8
Q

What is neurological shock

A

Hypotension and bradycardia due to loss of sympathetics in cervical spine lesions

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9
Q

What is priapism

A

Prolonged sustained erection due to unopposed parasympathetic activity

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10
Q

What are the causes of spinal cord hemisection

A
Penetrating trauma
Fractured vertebrae
Tumour
Abscess
Multiple sclerosis
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11
Q

What are the features in Brown Sequard Syndrome

A

Ipsilateral loss of proprioception at+below level of lesion
Ipsilateral loss of motor function at+below level of lesion
Contralateral loss of pain sensation below level of lesion

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12
Q

What are the causes of anterior cord injury

A

Flexion injury: fracture, dislocation, herniation

Anterior spinal artery injury: atherosclerosis, iatrogenic (clamping, dissection)

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13
Q

What are the clinical features of anterior cord injury

A

Complete paralysis at+below lesion
Complete loss of pain sensation below lesion
Sparing of proprioception, fine touch, vibration
Autonomic dysfunction: bladder, bowel, sexual

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14
Q

What are the causes of central cord injuries

A
Trauma: hyperextension (elderly), hyperflexion (young) 
Disruption to spinal blood flow 
Cervical spinal stenosis 
Degenerative spinal disease 
Syringomyelia 
Central canal ependymoma
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15
Q

What are the clinical features of central cord injury

A

Initial Loss of pain + temp in cape like distribution
Followed by paralysis in cape like distribution
Motor>sensory
Upper extremity > Lower extremity
Distal>proximal

Bladder dysfunction
Sparing of proprioception, fine touch, vibration

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16
Q

What are the causes of posterior cord injury

A
Chronic pathological processes: 
Spondylosis
Spinal stenosis 
Infection 
Vitamin B12 deficiency 

Posterior spinal arteries occlusion

17
Q

What are the clinical features of posterior cord injury

A

Loss of proprioception, fine touch, vibration
Sparing of motor function
Sparing of pain + temp sensation

18
Q

What are the principles of management of spinal injuries

A
Intubation + icu admission 
Early c spine immobilisation 
C spine restriction for 6 weeks
PT/OT long term
Surgery - progressive neurological deficit, unstable fractures
19
Q

What is the initial management of spinal cord injuries

A
ABCDE assessment 
Intubation 
Log-roll and Backboard
Rigid C collar 
Manual stabilisation 
Treat: hypoxia, shock, hypothermia 
Catheterise
20
Q

Why is intubation important

A

Spinal injuries above C5 loss of diaphragm innervation, intercostal muscle’s will tire out

21
Q

When do you assume spinal injury

A

Head injury present
Focal neurological deficit
Altered level of consciousness/GCS
Spinal tenderness

22
Q

What is log roll

A

Manoeuvre to transfer patient onto backboard as a team

23
Q

What is a backboard

A

Board to transport patients in pre-hospital trauma setting in supine position

24
Q

What is manual stabilisation

A

Technique used to minimise movement of head and neck

25
What are the methods of manual stabilisation
Place hands on patients mastoid processes from above the patient Place hands on sides of head from patients side with elbows on their chest
26
In what position do you place patients head in manual stabilisation
ANY position comfortable for patient | You must not apply traction
27
Why is catheterisation important
Possible bladder dysfunction and retention
28
How do you “clear” spinal injuries
Communication: Alert and oriented No language barrier Not intoxicated Examination: No focal neurological deficits No posterior midline tenderness No painful distracting injuries