Spinal Injuries

Question 1

Signs and Symptoms of Spinal Cord Injury

Answer 1

Central neck or back pain
Deformity of spinal column
Paralysis
Numbness
Heaviness of limbs
Tingling/paraesthesia
Neurogenic shock
Respiratory difficulty
Diaphragmatic breathing
Respiratory arrest
Priapism

Question 2

If the head is not in a neutral position, it should be carefully moved into that position unless what contraindications?

Answer 2

Increased pain
Increased muscle spasm
Resistance to movement
Onset or worsening of neurological deficit
Crepitus

Question 3

Neurogenic Shock ? and why of concern?

Answer 3

Damage to the sympathetic nervous system causes a loss of vascular tone. This results in the pooling of blood in the peripheral circulation, leading to hypotension, usually with warm extremities. The body would normally compensate by increasing the heart rate, but because this would normally be mediated via the sympathetic nervous system, this does not occur. Patients with neurogenic shock therefore have a low blood pressure with a low pulse rate.

Question 4

on-pitch baseline observation of the neurological status

Answer 4

ACVPU

Spinal pain or tenderness. This is midline pain/tenderness.
Tenderness isolated to the paravertebral muscles is not spinal.

Sensory: ask about loss of sensation, or paraesthesia. Check sensation to light touch in selected dermatomes i.e. C5, C8, T4, T10, L2, and L5.

Motor: check selected myotomes that do not cause movement of the trunk i.e. elbow flexion, hand andfinger movements, and ankle movement.

Question 5

Steps to clearing the C-spine ?

Answer 5

No suspicious mechanism of injury
No reduction in conscious level (GCS 15)
No neurological signs or symptoms
No distracting injury
No midline cervical spine tenderness
No intoxication with alcohol or drugs
Able to voluntary rotate neck > 45° R & L
Able to flex and extend neck

Question 6

What a Stinger ?

Answer 6

An intense painful, unilateral, neurological event due to an acute traumatic nerve injury affecting the upper roots or trunks of the brachial plexus.

Question 7

What is the mechanism of injury for a stinger, and its assessment?

Answer 7

The mechanism of injury is usually:
Lateral flexion of neck causing compression of the nerve
Lateral flexion of the neck causing traction of the nerve
Depression of shoulder causing traction of the nerve

Resisted testing of:
Shoulder abduction
Shoulder external rotation
Elbow flexion

Question 8

On field stinger red flags ?

Answer 8

Bilateral signs or symptoms
Midline neck pain
Painful neck movement
Blocked neck movement
Persistent sensory symptoms – pain or dysaesthesia
Significant persistent weakness

Question 9

Log-roll Procedure?

Answer 9

Requires a minimum of 5 people
Patients arms by the side or folded across the chest
Team leader at head: in-line immobilisation
Tallest holding outer shoulder & elbow
Next tallest holding pelvis with one hand & other hand scooped under the outer thigh
Smallest with both hands scooped, one under the outer knee & the other hand under the lower leg
The roles are in unison, controlled by the team leader
Back inspection can be performed by a fifth person

Question 10

When to suspect a c-spine injury?

Answer 10

MOI
REDUCED ACVPU
NEUROLOGICAL SIGNS
OTHER DISTRACTING INJURY
MIDLINE TENDERNESS
NO VOLONTARY ROATION ABOVE 45D