Spinal Trauma Flashcards
If you suspect a cervical spine injury until you can prove otherwise you want to……
If you suspect a cervical injury of C5 or higher, which nerve is involved? For this you would want to intubate.
_______, __________, __________ keep the diaphragm alive.
Mantain BP- MAP goal of ____________ + pressors if needed
immobilize with a hard collar and oxygenate.
C3, 4, 5
phrenic nerve
> 85
Priapism is a sign of _______________. Why does this occur?
spinal shock.
due to sudden loss of sympathetic tone to the pelvic vasculature following SCI causes an increase in the parasympathetic tone and uncontrolled arterial blood flow into the penile sinusoidal spaces. When occurring immediately after an acute SCI, its generally self-limiting and settles within a few hours.
What is the significance of rectal tone?
if it winks- the sacrum may be spared.
What is the significance of bulbocavernosus reflex?
if absent may represent spinal shock and cant declare if this is a complete or incomplete SCI- can also be cauda equina syndrome.
What is the significance of cremasteric sign?
instrument run up thigh causes scrotum to rise
What is the significance of hoffmans sign?
flicking of finger causes contracture- sign of chronic cord compression
What is the significance of clonus?
look for off beats, associated with spinal cord compression - often more chronic finding
Why do we check for anal reflex, bulbocavernous reflex, priapism?
because it is innervated by S2,3,4 which keeps the penis off the floor, - pelvic floor
What is spinal shock?
immediate temporary loss of total power, sensation and reflexes below the level of injury
Spinal shock:
BP
Pulse
Bulbocavernosus reflex
motor
time
mechanism
hypotension
bradycardia
absent
flaccid paralysis
24-72 hrs immediate after SCI
peripheral neurons become temporarily unresponsive to brain stimuli
Neurogenic shock:
BP
Pulse
Bulbocavernosus reflex
motor
time
mechanism
hypotension
brady
variable
variable
24-72 hours
disruption of autonomic pathways > loss of sympathetic tone and vasodilation
Neurogenic shock occurs with SCI of _______________ and above this is due to the sympathetics coming out of the cord ________, __________, ____________.
Hypotension is due to ___________________.
Brady due to increase in the ____________________ of the heart
T2
C8, T1, T2
loss of sympathetic drive.
-lose the inotropic drive (contractility)
-vasodilation= BP drops
chronotropic effect (cant beat faster)
In the treatment of neurogenic shock, you need a ______________ to increase the BP. What is the most common one?Why is this not a good choice? Instead, you want a pressor with a ________________ such as ________________
PRESSOR- neosynephrine- alpha agonist ONLY. however not a good choice because it makes blood vessels contract but it increases vagal tone so youre asking a heart that cant squeeze and cant go faster to fight against resistance = BAD, more brady.
BETA AGONIST
LEVOPHED****
In the treatment of neurogenic shock, the goal is to maintain SBP _______________ with MAP __________________ typically for 7 days. There is also a need for DVT prophylaxis- what do you want to give?
> 90
> 85-90
high + SQH or Lovenox
What med is not recommended for a patient in neurogenic shock?
STEROIDS
What is the name of the grading scale used for characterizing spine injuries?
ASIA- american spinal cord injury association
In the spinal cord, ascending tracts are __________________ while descending tracts are __________________
sensory, motor
Central cord syndrome is most caused by _____________. There is greater loss of motor function in the ____________ compared to the ____________. There is variable degrees of ____________ loss. It is a hyperextension injury in the setting of stenosis. There is vascular compromise of the _________________. The _________ recovers before the ___________
extension.
UE
LE
sensory
anterior spinal artery
LE
UE
Anterior cord syndrome is loss of ___________ function, ____________ and _____________ below the lesion and preservation of ____________ and ______________ function.
motor
temp
pain
position, vibratory
What is the most common cause of anterior cord syndrome?
infarction of the cord in the territory of the anterior spinal artery
Posterior cord syndrome is impaired ______________ and loss of ______________ because of the lack of ____________. The patient has sensory ataxia meaning poor __________ and unsteady gait. These patients also present with impaired vibration and fine touch. These patients have preserved _________ AND _________.
voluntary movement
coordination
proprioception
balance
pain
temp
What is brown sequard syndrome?
half of the spinal cord is injured
- ipsilateral loss of motor, vibratory sense, proprioception,
- contralateral loss of pain and temperature- spinothalamic