Spinal Trauma Flashcards
Who? Cause?
- DUDES!!! Males (life of adventure…)
- MC auto-accident
- blunt trauma
- often PREVENTABLE
Long-term spinal injury effects
- less employment
- divorce
- shorter life expectancy
how many vertebrae?
33
Fracture through cervical vertebral foramen?
Order
CT w/ contrast = spinal cord injury
*blunt force
Thoracic vertebral fracture?
Investigate
Spleen/liver lac, etc.
*HUGE force needed
Lumbar vertebral fracture
MC?
Compression
Spinal Injury
Initial Management
*ABCs
*Immobilization (C-spine collar, etc.)
*High cervical Injury = Early Intubation
Jaw thrust - NO HEAD tilt/chil lift
*Transport
Spinal immobilization
*Rigid cervical collar
*supportive blocks
*backboard w/ straps
(Exam b/f and after)
Focused Neuro / Spine exam
- Palpate spine (tenderness, stepoffs)
- Motor level assess
- Neurosurgery rectal (Tone, Sensation, Contraction, Blood)
- sensory : light touch + pinprick
- reflexes = MC initially absent
- ASIA score
ASIA score
A = nothing B= Sensory , NO MOTOR C= Sensory/Motor, WEAKNESS +1/2 D= Sensory/Motor, WEAKNESS -1/2 E = normal
REVIEW OTHERS
Spinal Imaging
NEXUS Criteria
NO IMAGE if:
NO
- midline cervical tenderness
- focal neuro s/s
- abnormal alertness
- intoxication
- painful distracting injury
Minimum Required Imaging
1st = thin cut axial C from OCCIPITAL –> T1 + sag/coronal reconstructions
- w/ pan-scan of body w/ reformatting =all 3 planes
- also MRI, CT Myelogram, Flexion/Extension
Types of Injury
- Blunt Injury
- Falls
- Sports Injury
- Penetrating Trauma
ANY Cervical Spine fracture =
- Compression Fracture
- Burst fracture
- Flexion-distraction (seatbelt)
- Fracture dislocation
Surgery?
SURGERY REQUIRED
Minor injuries
Transverse,spinal, articulating processes
4 point burst fracture of ring of C1
Jefferson Fracture
- Bilateral Pars fractures = C2
- Traumatic sublixation of C2 on C3
?
Hangman’s Fracture
Odontoid fracture
where in spine?
Cervical fracture
Injuries w/ foramen transversarium
Consider…
Vascular injury
Assess Injury Morphology, Neuro status, PLC Integrity
TLICS score
<3 = Non-OP 4 = Grey Zone 5< = Surgical
Compression fracture
possible surgery?
Fusion
W/ corpectomy
Don Juan fracture
Double calcaneal fracture
Check back!
Car crash
Spine flexes, damaging facet/ligs/ etc.
Flexion-distraction
Spinal Injury
Long-term care = must refer to
Spinal Rehab PT/OT
PT OT Speech language Case manager Psyc/Social Worker Therapeutic recreation Transportation specialist Pastoral care Peer mentor
Spinal injury ancillary report
Spinal Injury RED ALERTS
Send to SCAN
- Ankylosing Spondylitis (DISH) - bamboo CT/fusing
- Osteoporosis
- Steroid use
Initial Hospital Assessment
- ABCs
- Trauma team activation
- Focused Neuro assess
- Other injuries = ATLS
