SPINAL INJURY

Question 1

Cervical Spine Injury Types

Answer 1

• Hyperflexion
• Hyperextension
• Flexion-rotation
• Vertebral compression
• Lateral Flexion
• Distraction

Question 2

Structure of the Vertebraes

Answer 2

7 Cervical 
12 Thoracic 
5 Lumbar 
5 Fused sacral 
5 Fused Coccyx

Question 3

Signs and Symptoms of SCI

Answer 3

Pain
Paraethesia
Paralysis
Priapism
Paradoxical respirations (diaphragm takes over)
Polikilothermia (loss of ability to sweat)

Also consider:

• Bradycardia
• Hypotension
• Bladder distension

Question 4

What is Neurogenic Shock?

Answer 4

Shock caused by loss of sympathetic stimulation to vascular smooth muscle resulting in vasodilation caused by a defect in the vasomotor control centre in the brain stem or due to transection of the spinal cord (failure of vasoconstriction)

- Imbalance between sympathetic and parasympathetic stimulation 
↓ 
Massive vasodilation 
↓
Decreased vagal tone 
↓ 
Decreased systematic vascular resistance 
↓ 
Inadequate Cardiac Output  
↓ 
Decreased Tissue Perfusion 
↓
Impaired cellular metabolism

Question 5

What nerve supplies C3, C4, C5?

Answer 5

Phrenic nerve is the motor nerve to the diaphragm - loss of this nerve results in respiratory arrest

Question 6

Spinal CPG- The Patient have either:

• Major Trauma criteria after blunt force trauma to head or trunk
• Neurological deficit or changes?

YES.. whats next

Answer 6

Suspected SCI or Major Trauma

• Apply cervical collar
• Extricate on combi-carrier if necessary
• Immobilise on vacuum mattress or stretcher
• Tx without delay as per trauma TC

Isolated Spinal Cord Injury
If BP <90mmHG
- Normal Saline 10mL/kg IV

Question 7

Spinal CPG- The Patient have either:

• Major Trauma criteria after blunt force trauma to head or trunk
• Neurological deficit or changes?

NO.. whats next

Answer 7

Assess modified NEXUS Criteria

Increased Injury Risk

• Age >65
• Hx of bone or muscle weakening disease/injury

Difficult Patient Assessment

• Altered Conscious State
• Intoxication
• Significant distracting injury

Actual evidence of structural injury
-Midline pain/tenderness on palpation of the vertebrae

Neck range of motion
-Patient is unable to actively rotate neck 45 degrees left to right without pain

Question 8

What happens if any ONE of the Nexus criteria are present

Answer 8

c-spine NOT cleared

• Apply collar
• Consider self-extrication where the patient is:
  
  • Conscious and Co-operative
  • Not intoxicated
  • Not prevented from doing so by injury
• immobilise on vacuum mattress or stretcher

Question 9

What happens if NONE of the Nexus criteria are present

Answer 9

No spinal immobilisation required

Question 10

What is the Spinal Injury Neurological Examination

Answer 10

Motor function- any weakness when asked to:

• Arms: push, pull and grasp
• Legs: Push, plantar flex, pull/dorsiflex and leg raise

Sensory Function- reduced or no sensation when applying light touch to the following:

• Arms: Palms and back of hand
• Legs: lateral aspects of calcaneus
• Superasternal Notch

If ANY of the above criteria are present the patient should not be spinally cleared