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Clinical Medicine Lecture - Professor Kramer > Spinal Cord trauma > Flashcards

Spinal Cord trauma Flashcards

1
Q

Arm abduction ?

A

C5, C6, deltoid

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2
Q

Elbow flexion ?

A

C5, C6, biceps

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3
Q

Wrist extension ?

A

C6, C7, extensor carpi radialis

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4
Q

Elbow extension ?

A

C7, C8, triceps

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5
Q

Finger abduction and Hand grasp ?

A

C8, T1,

hand intrinsics,

flexor digitorum profundus

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6
Q

Chest muscles ?

A

T2-T7

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7
Q

Abdominal muscles ?

A

T9-T12

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8
Q

Hip flexion ?

A

L1, L2, L3,

Iliopsoas

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9
Q

Knee extension ?

A

L2, L3, L4

Quads

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10
Q

Knee flexion ?

A

L4, L5,S1, S2

hamstrings

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11
Q

Ankle dorsiflexion ?

A

L4, L5

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12
Q

Great toe extension ?

A

L5, S1

extensor hallicus longus

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13
Q

Ankle Plantar flexion ?

A

S1, S2

gastrocnemius

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14
Q

Voluntary rectal tone ?

A

S2, S3, S4

bladder /anal sphincter

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15
Q

SC Anatomy and physiology own notes ?

A

C - it is above the bone

T - it is below the bone

know where the injury is and what it can cause here

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16
Q

Two main phases of spinal cord injury ?

A

Direct mechanical injury

Tissue degeneration phase

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17
Q

Direct mechanical injury facts ?

A

hemorrhage into the cord

formation of edema at the injured site

vasospasm and thrombosis of the small arterioles
–Local spinal cord blood flow is decreased.

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18
Q

Tissue degeneration phase

facts ?

A

begins within hours of injury

release of membrane-destabilizing enzymes and mediators of inflammation

disruption of calcium channel pathways

Lipid peroxidation and hydrolysis

inflammatory phase causes more injury so steroid!

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19
Q

lesion types ?

A

Spinal shock

Complete

incomplete

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20
Q

Spinal shock definition ?

A

initial loss of all reflex activities below the area of injury

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21
Q

Complete definition ?

A

absence of sensory and motor function below the level of injury

lesions cannot be deemed complete until spinal shock has resolved

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22
Q

Incomplete definition ?

A

sensory, motor, or both functions are partially present below the neurologic level of injury

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23
Q

Spinal cord trauma patho own notes ?

A

warm shock cause massive vasodilation, warm and the BP drops and they have a bradycardia

no sympathetic innervation

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24
Q

Determination of acute unstable injuries ?

A

Any C1-C2 injury (atlas and axis - connection site to the skull)

Disruption of at least two columns

Degree of vertebral body compression

neuro deficits

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25
Q

Degree of vertebral body compression to be considers unstable ?

A

> 25% for the third to seventh cervical

> 50% in the thoracic or lumbar

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26
Q

Anterior cord etiology ?

A

Direct anterior cord compression

flexion of C-spine

Thrombosis of anterior spinal artery

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27
Q

Anterior cord sxs. ?

A

Complete paralysis below the lesion w/ loss of pain and temp sensation

Preservation of proprioception and vibration

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28
Q

Central cord etiology ?

A

Hyperextension injuries

Disruption of blood flow in the spinal cord

C-spine stenosis

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29
Q

Central cord sxs. ?

A

Quadriparesis

greater in the UE than the LE

some loss of pain and temp sensation, also greater in the UE

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30
Q

Brown-Sequard etiology ?

A

Transverse hemisection of the SC

Unilateral cord compression

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31
Q

Brown-Sequard sxs. ?

A

Ipsilateral Spastic paresis

loss of proprioception and vibratory sensation and

contralateral loss of pain and temp.

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32
Q

Cauda Equina etiology ?

A

Peripheral nerve injury

33
Q

cauda equina sxs. ?

A

Variable motor and sensory loss in the LE

sciatica, bowel, bladder dysfunction

saddle anesthesia

34
Q

Spinal cord trauma prevalence ?

A

40 cases per million

more frequently on weekends, holidays, and during summer months

35
Q

Spinal cord trauma demographic ?

A

mean age of 40 years old

male-to-female ratio 4 to 1

36
Q

Spinal cord trauma etiology ?

A

MVA 42%

Falls 27%

Violence 15% (primarily gunshot wounds)
Sports 8%
Other 8%

37
Q

Spinal cord trauma: Prehospital immobilization type ?

A

Cervical spine (hard collar and/or bilateral blocks)

Backboard

38
Q

Spinal cord trauma: Prehospital immobilization indications ?

A

Tenderness

Neurologic complaints

High risk mechanism

39
Q

Spinal cord trauma Hx. ?

A

Mechanism

Pain

Weakness

  • Focal
  • Paralysis

Paresthesias

Incontinence

40
Q

Spinal cord trauma PE ?

A

Neurogenic shock

Vertebral tenderness

Motor loss

Reflex loss

Sensory loss

41
Q

Neurogenic shock

sxs. ?

A

warm, peripherally
vasodilated

hypotensive

relative bradycardia

Caution
**hypotension in the trauma patient can never be presumed to be caused by neurogenic shock until other possible sources of hypotension have been excluded

42
Q

SC trauma: Reflex loss - anogenital indicates complete SC damage ?

A

Bulbocavernosus

Cremasteric

Anal wink

43
Q

Reflex: Biceps ?

A

C5, C6

44
Q

Reflex: Brachioradialis ?

A

C6

45
Q

Reflex: Triceps ?

A

C7

46
Q

Reflex: Patellar ?

A

L4

47
Q

Reflex: Achilles tendon ?

A

S1

48
Q

SC trauma: C-spine - low risk ?

A

X-ray cervical spine

49
Q

SC trauma: C-spine - high risk ?

A

CT cervical spine

50
Q

You dont need to get a C-spine XR if they meet what criteria ?

A

NEXUS

51
Q

NEXUS criteria ?

A

National Emergency X-Radiography Utilization Study Criteria

52
Q

C-spine XR Unnecessary if meet each criteria ?

A

Absence of midline cervical tenderness

Normal level of alertness and consciousness

No evidence of intoxication

Absence of focal neurologic deficit

Absence of painful distracting injury

**what you can use to clear someone of cervical spine ijurt **

53
Q

Canadian cervical spine rule also used ?

A

Goal is “clinically important” injuries

54
Q

SC trauma: if you get a C-spine XR what views ?

A

lateral, anteroposterior, and odontoid performed

single lateral cervical spine film will identify approximately 90% of injuries to bone and ligaments

55
Q

Cervical spine xray

you can find what ?

A

Poor for identifying C1-C2 injuries

Column disruption

Compressions

56
Q

What imaging is better for SC trauma ?

A

Cervical spine CT

Better imaging than plain films

More sensitive and specific

57
Q

Thoracic or lumbar spine

initial imaging ?

A

XR

58
Q

Thoracic or lumbar spine

if abd. or major trauma ?

A

CT

59
Q

Thoracic or lumbar spine

ID nerve damage?

A

MRI

60
Q

Thoracic or lumbar spine x-ray ?

A

initial imaging of these spinal levels

Anterior and lateral films are generally obtained

61
Q

Thoracic or lumbar CT

indications ?

A

Proven bony spinal injury

neurologic deficits (with normal plain films)

severe neck or back pain (with normal plain films)

62
Q

Thoracic or lumbar CT

for multisystem trauma ?

A

Thoracic and abdominal CT scans reformatted

reconstruct images of the thoracic and lumbar spine

63
Q

Thoracic or lumbar CT

purpose and findings ?

A

Anatomy of an osseous injury

Grade canal impingement

Assess stability

64
Q

Thoracic or lumbar MRI

indications ?

A

Test of choice for anatomy of nerve injury

Helpful for identifying herniated disks or spinal cord contusions

65
Q

Thoracic or lumbar MRI

limitations ?

A

Not as sensitive as CT for detecting bone injuries

66
Q

SC trauma complications ?

A

Neurogenic shock

67
Q

SC trauma goals of tx. ?

A

prevent secondary injury

alleviate cord compression

establish spinal stability

68
Q

SC trauma: all spine trauma tx. ?

A
  • Airway considerations
  • Make sure cervical spine stabilized

Remove from backboard

Order appropriate imaging

69
Q

SC trauma: If neurologic deficit or unstable tx. ?

A

Consult spinal surgery immediately

70
Q

SC trauma: If blunt trauma

tx. ?

A

High dose corticosteroids (methylprednisolone)

71
Q

SC trauma: Neurogenic shock tx. ?

A

Stabilization cervical spine

IV crystalloid
-mean arterial blood pressure at 85 to 90 mm Hg

If insufficient
-inotropic pressor (atropine, dobutamine)

Identify possible other causes

72
Q

SC trauma: airway considerations ?

A

any patient with an injury at C5 or above should have his or her airway secured via endotracheal intubation

**above C5 careful of phrenic nerve injury - it innervates the diaphragm

73
Q

SC trauma: Operative management ?

A

Determined by spinal surgeon

74
Q

SC trauma: Nonoperative stabilization choices ?

A

Philadelphia collar

Miami J collar
-May have thoracic extension

Halo vest

  • Gold standard
  • Very invasive
75
Q

Operative management

common indications ?

A

Neurologic deterioration– URGENT SURGERY

Instability

76
Q

SC trauma: Thoracic and lumbar spine injury

- Nonoperative patients ?

A

Usually not immobilized, very difficult

Educate to restrict movements

77
Q

LeFort I description ?

A

maxilla only

78
Q

LeFort II description ?

A

maxilla and zygomatic

79
Q

LeFort III description ?

A

zygomatic and orbits

Clinical Medicine Lecture - Professor Kramer (28 decks)

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