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Exam 9 > Spinal Trauma > Flashcards

Spinal Trauma Flashcards

1
Q

What is a classic example of an extension injury mechanism?

A

Rear-impact auto crash

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2
Q

Extremes of extension may cause?

A

Disk disruption, compression of interspinous ligaments,and fracture of the posterior vertebral elements

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3
Q

The result of a rotational spinal injury may include?

A

Stretching or tearing of ligaments
rotational subluxation or discoloration
Vertebral fracture

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4
Q

______ occurs as compressional stress is brought to bear along the axis of the spine.

A

Axial loading

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5
Q

What may occur when a person lifts a weight too great for the strength of the lumbar spine or when a person lands on their heels?

A

Axial loading

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6
Q

What are the most common sites of axial loading injuries?

A

Between T-12 and L-2

Cervical region

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7
Q

Axial loading injuries between T-12 and L-2 occur when?

A

For lifting injuries and heel-first falls

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8
Q

____ is the opposite of axial loading.

A

Distraction

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9
Q

The upper cervica region is most commonly affected by ______.

A

Distraction

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10
Q

What might hanging do to the victim?

A

Suspend the victim from the side of the head, causing injury from distraction and severe lateral bending direct at the C-1/C-2 region (causing hangman’s fracture)

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11
Q

The ___ region of the spinal column can be injured, and such injuries are usually related to ___ ___ trauma (i.e. failing on one’s tailbone).

A

coccygeal ; direct blunt

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12
Q

What forces may cause movement of the vertebrae from their normal position?

A

Subluxation (partial or complete dislocation) or dislocation

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13
Q

T or F. Trauma (especially axial loading) may damage the intervertebral disks and are always associated with injury to the spinal cord itself.

A

False - these injuries are to connective or skeletal tissue of the vertebral column and may or may not be associate with injury to the spinal cord itself

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14
Q

The ___ region accounts for over ___ of all spinal injuries, with the ___/___ (C-1/C-2) joint being most frequently involved.

A

cervical ; half ; atlas/axis

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15
Q

Why is C-7 also injured frequently?

A

Because it is located at the transition between the flexible cervical spine and the more rigid thoracic spine

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16
Q

The ___ area (L-5/S-1) is likewise injured because the ___ immobilizes the ___ spine.

A

lumbosacral ; pelvis ; sacral

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17
Q

The spinal cord ends at the ___/___ region.

A

L-1/L-2

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18
Q

What does a concussion of the cord cause?

A

Temporary and transient disruption of cord fuction

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19
Q

What is the resolution of a cord contusion and its associated S/S?

A

Likely to take longer than is the case with a concussion

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20
Q

When might spinal cord compression occur?

A

Secondary to the displacement of vertebra, through herniation of the intervertebral disk, from displacement of vertebral bone fragment, or from swelling of adjacent tissue.

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21
Q

What are cord lacerations likely to result in?

A
  • Hemorrhage into the cord tissue
  • Swelling due to the injury
  • Disruption of some portions of the cord and their associated communication pathways
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22
Q

What is a cord transection?

A

Injury that partially or completely severs the spinal cord

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23
Q

What are the results of transection injuries below the beginning of the thoracic spine?

A

Incontinence

Paraplegia

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24
Q

What are the results of transection injuries to the cervical spine?

A

Quadriplegia
Incontinence
Partial/complete respiratory paralysis

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25
Q

What is the condition caused by bony fragments or pressure compressing the arteries that perfuse the anterior cord?

A

Anterior cord syndrome

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26
Q

What do anterior cord syndrome injuries usually involve?

A

Loss of motor function

Sensation to pain, light touch, and temperature below the injury site

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27
Q

What is an anterior cord syndrome patient likely to retain?

A

Motion
Positional
Vibration sensation

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28
Q

What are the S/S of spinal injury?

A
  • Paralysis of the extremities
  • Pain with and without movement
  • tenderness along the spine
  • Impaired breathing
  • Spinal deformity
  • Priapism
  • Posturing
  • Loss of bowel or bladder control
  • Nerve impairment to extremities
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29
Q

What are the types of primary and secondary spinal cord injuries?

A
  • Concussion
  • Contusion
  • Compression
  • Laceration
  • Hemorrhage
  • Transection
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30
Q

What is the condition usually related to hyperextension of the cervical spine that results in motor weakness, usually in the upper extremities and possible bladder dysfunction?

A

Central cord syndrome

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31
Q

What is the conditional caused by partial cutting of one side of the spinal cord resulting in sensory and motor loss to that side of the body?

A

Brown-Sequard syndrome

32
Q

Why is pain and temperature perception lost on the opposite (contralateral) side of the body in Brown-Sequard syndrome?

A

Because of the switching of the associated nerves that occurs as they enter the spinal cord

33
Q

What condition occurs when nerve roots at the lower end of the spinal cord are compressed, interrupting sensation and movement?

A

Cauda equina syndrome

34
Q

What results when injury to the spinal cord disrupts the brain’s ability to exercise control over the body?

A

Neurogenic (or spinal-vascular) shock

35
Q

Lack of ___ tone permits the ___ and ___ to dilate, expanding the ___ space, resulting in a relative hypovolemia.

A

sympathetic ; arteries ; veins ; vascular

36
Q

How does a patient in neurogenic shock present?

A
  • Slow heart rate
  • Low BP
  • Shocklike symptoms (cool, moist, and pale skin) above the cord injury
  • Warm, dry, flushed skin below the injury
  • Priapism in male
37
Q

What is the treatment for neurogenic shock?

A

Bolus of isotonic solution 20 mL/kg (200 mL initially)
Atropine - 0.5 to 1 mg every 3 to 5 minutes
Dopamine - 2 to 20 mcg/kg

38
Q

What is the condition associated with the body’s adjustment ot the effects of neurogenic shock; presentation includes sudden hypertension, bradycardia, pounding headache, blurred vision, and sweating/flushing of the skin above point of injury?

A

Autonomic hyperreflexia syndrome

39
Q

Autonomic hyperreflexia syndrome is most commonly associated with injuries at or above ___.

A

T-6

40
Q

You should test ___ and ___ function for the lower extremities by (1) placing your hand against the ball of the patient’s foot and have him push firmly against it (plantar flexion, S-1, S-2) then (2) place your hand on top of the toes and have the patient ___ the toes and foot upwards (___, L-5)

A

motor ; sensory ; pull ; dorsiflexion

41
Q

How to you test for Bainski’s sign?

A

Stroke the lateral aspect of the bottom of the foot and watch for movement of the toes and great toe

42
Q

Fanning of the toes and ___ (lifting) of the great toe is a positive sign and suggest injury along the ___ (descinding spinal) tracts.

A

dorsiflexion ; pyramidal

43
Q

What might a patient with midcervical spine injury present with?

A

“Hold-up” position - patient’s arms rise to a position above the shoulders and head because the injury paralyzes the adductor and extensor muscles while the patient maintains control over the abductors and flexors

44
Q

What is the study that proposed, validated, and is used by emergency physicians to determine which patients need spinal x-rays and which do not?

A

National Emergency X-Radiography Utilization Study (NEXUS)

45
Q

What three conditions must be met to discontinue spinal precautions?

A
  • Patient is alert and fully oriented; not intoxicated or under the influence of drugs (including alcohol); has GCS of 15; and not significantly affected by the “fight-or-flight” response
  • Patient is free of significant distracting injuries or symptoms such as a fracture, joint injury, abdominal pain, or dyspnea
  • Patient is free of any S/S of spinal injury
46
Q

When should a helmet be removed?

A
  • Helmet does not immobilize the patient’s head within
  • Cannot securely immobilize the helmet to the long spine board
  • Helmet prevents airway care
  • Helmet prevent assessment of anticipated injuries
  • There are (or you anticipate) airway/breathing problems
  • Helmet removal will not cause further injury
47
Q

Routine use of ___ for spinal injury is no longer recommended.

A

steroids

48
Q

How is hypovolemia frequently treated?

A
  • Fluid challenge
  • Followed by careful use of vasopressor such as dopamine
  • Slow heart rate treated with atropine to reduce any parasympathetic stimulation
49
Q

The most common sites of axial loading for lifting injuries and heel-first falls are located between:

A

T-12 and L-2

50
Q

During a trauma assessment you notice that a patient has no sensation below the lower border of the rib cage. This would suggest spinal pathology between which vertebral areas?

A

T-4 and T-10

51
Q

Which of the following vital signs would most likely indicate a potential spinal cord injury?

A

Hypotension, bradycardia, and shallow respirations

52
Q

For which of the following patients would the anticholinergic agent atropine be best suited. A patient:

A

with an injury to the upper spinal cord

53
Q

The primary management objective in a patient with a suspected spinal cord injury is to:

A

maintain the patient in a neutral, in-line position

54
Q

Priapism is defined as:

A

A sustained erection of the penis

55
Q

Which of the following statements regarding cervical collars is true?

A

They serve as an adjunct to full cervical immobilization

56
Q

All of the following are S/S of spinal shock except:

a. priapism
b. hypertension
c. loss of bladder control
d. flaccid paralysis

A

b. hypertension

57
Q

Which of the following best defines spinal shock?

A

temporary insult to the cord that affects the body below the level of the injury

58
Q

When a neuromuscular blocker is to be given to a patient, a(n) ___ should be administered first.

A

sedative/hypnotic

59
Q

Feed or breed is which system?

A

Parasympathetic

60
Q

Fight or flight is which system?

A

Sympathetic

61
Q

C1 is also known as?

A

Atlas

62
Q

Which part of the spine allows for wide range of motion for head to move and pivot?

A

C1

63
Q

C2 is also known as?

A

Axis

64
Q

What is the odondoid process?

A

Rises through C1 to keep spine in line

65
Q

What does C6/7 control?

A

Fingers and hands

Biceps

66
Q

What does C3 and above control?

A

Respiratory

67
Q

What does C4 control?

A

Diaphragm - results in paralysis

68
Q

If paralyzed waist down, break might have occurred where?

A

T10

69
Q

If paralyzed waist up, break might have occurred where?

A

T4

70
Q

Where is T4 located?

A

Nipple line

71
Q

Where is T10 located?

A

Umbilicus

72
Q

Which shock usually resolves within 24 hours?

A

Neurogenic shock

73
Q

What is the presentation for neurogenic hypotension?

A

BP between 80-100

Warm, dry skin, bradycardia

74
Q

What is the proper way to secure a patient to back board?

A

Torso
Head
Legs
Arms

75
Q

What is methylprednisolone used for?

A

To reduce edema and inflammation within spine

Exam 9 (11 decks)

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