SPINAL INJURIES Flashcards
Vertebral fractures occur most commonly in what part of the spine?
Cervical – 55%
If a patient has a fracture, dislocation, of disruption of the disc – what type of injury is this?
Primary
If a patient has tearing of the ligaments in the c-spine is it a primary or secondary injury?
Primary
What type of spinal cord injury will affect proprioception or vibration on the SAME side at the injury?
Dorsal column injury
What type of spinal cord injury involves impairment to sensation on the OPPOSITE side of the injury?
Anterior column injury
Where do we begin with evaluating a patient with a potential spinal cord injury?
ABCD!
Then look at gross motor, sensation, and reflexes
A biker comes in with his helmet still on, with a collar on the spine board, what do you do about the headgear?
Leave it on! You might need to remove/cut clothing
After you have completed ABCD, what do you do?
Secondary survey – with the patient off the board
Walk me through the log-roll process to maintain spinal immobilization & complete your secondary survey?
Person at the head calls out 1, 2, 3 – then simultaneous roll the patient onto their side
When on side = Evaluate back, palpate thoracic, lumbar, and sacral spine. Look for injuries!
Move the patient back into the supine position on the board → now removal the collar and palpate along the spinous processes, make sure there’s no pain
According to the Canadian c-spine rules, there are 3 major steps with subsequent questions to rule in/out the need for radiographs. What are the questions?
- High-Risk Factors – Age >65; dangerous mechanism; paresthesia in extremities
- Low-Risk Factors – Simple MVA; Sitting position; Ambulatory at any time; Delayed onset of neck pain***; Absence of midline c-spine tenderness.
- Able to Actively Rotate Neck – 45 degrees to right & left
If a patient has a loss of spontaneous breathing – what level?
C4
If a patient can’t flex their fingers – what level?
C8/T1
If a patient can’t flexion at the elbows/biceps – what level?
C6
If a patient has a loss of intercostal muscle & abdominal muscle use – what level?
T1/T2
If a patient can’t shrug their shoulders – what level?
C5
Do normal radiographs rule out significant injury?
Nope; best for “low risk” patients
If a patient has a c-spine fracture with a mechanism of diving – what vertebrae is most likely involved, what is it called?
C1 = Jefferson fracture
Will a patient have sxs with a Jefferson fracture?
Not really (ring gets huge & spreads out)
What c-spine fracture accounts for more than ½ of all cervical fractures and is extremely unstable?
C2 = Odontoid fracture
What other type of fracture occurs at C2? What is the mechanism?
Hangman’s fracture
- Forced hyperextension
Will fractures of C2 (hangman’s or odontoid) have symptoms?
Most likely not
- Especially Hangman’s
What type of complication can arise with a Hangman’s fracture?
Central cord syndrome (more weakness in the UE than LE)
What type of cervical fracture often presents with the patient hearing a pop, followed by sudden pain between the shoulder blades?
Clay shoveler’s fracture
What is the NEXUS criteria for spine trauma?
- Absence of midline cervical tenderness
- Normal level of alertness and consciousness
- No evidence of intoxication
- Absence of focal neurological deficit
- Absence of painful distracting injury
- A no in any one of the 5 indicates no need for plain c-spine imagine
If a patient has complete paralysis below a certain level with loss of pain & temperature sensation, however, vibration, position, and tactile sensation are preserved – what diagnosis? What are the most likely MOI’s?
Anterior cord syndrome (damage to the corticospinal & spinothalamic pathways, with preservation of the posterior column function)
MOI = Direct anterior cord compression, flexion of c-spine, or thrombosis of anterior spinal artery
If a patient presents with decreased strength and only mild decreased pain & temperature sensation in the UE more than the LE; with vibratory & position sensation preserved along with bowel/bladder control – what diagnosis? What MOI?
Central cord syndrome
MOI = hyperextension, disruption to blood flow in the spinal cord, and cervical spinal stenosis (these have a good prognosis)
If a patient presents after a trauma with ipsilateral loss of motor function (spastic paresis), loss of proprioception and vibratory sensation; contralateral loss of pain and temperature sensations – what diagnosis? What MOI?
Brown-Sequard syndrome
MOI = Penetrating injury! Transverse hemisection of the spinal cord, unilateral cord compression (disc protrusion, hematoms, spine fracture, infections, or tumors)
If a patient presents with sxs of bowel/bladder dysfunction, decreased rectal tone, and saddle anesthesia – what diagnosis?
Cauda equina syndrome
If a patient presents with motor & sensory loss in the LE, with decreased LE reflexes, and sciatica – what diagnosis?
Cauda equina syndrome
