Spinal Trauma Flashcards
Spinal Trauma Mechanisms of injury
Describe Hyperextension and give two examples
the head is forced back and the cervical vertebrae are placed in an overextended position
Examples whiplash and hangings
Spinal Trauma Mechanisms of injury
Describe Hyperflexion and give one example
the head is forced forward, and the cervical vertebrae are placed in an over flexed position
Examples driver hitting the windshield
Spinal Trauma Mechanisms of injury
Describe Axial loading and give two examples
a severe blow to the top of the head causes a blunt force on the vertebrae and spinal column.
- Falling from a height and landing on the heels transmits forces up the axial skeleton to the lumbar
- Examples of axial loading mechanisms of injury include diving head first and striking the head on the bottom surface
Spinal Trauma Mechanisms of injury
Describe compression and give two examples
forces from above and below compress the vertebrae
Examples of compression mechanisms of injury include falling down and landing on the buttocks
Spinal Trauma Mechanisms of injury
Describe Overrotation and distraction and give one example
the head turns to one side and the cervical vertebrae are forced beyond normal limits
Examples of overrotation include wrestling moves.
Spinal Trauma
Mechanisms of injury
name 5 types
Hyperextension Hyperflexion Axial loading Compression Overrotation and distraction
Spinal Trauma assessment should include evaluating the movement of what
all 4 extremities
Spinal Trauma assessment
Describe the Assessment of sensory status by testing dermatomes
beginning at the level of no reported sensation and proceeding up to the level in which feeling is intact
What is Sacral Sparing
Incomplete injury by definition includes a phenomenon known as sacral sparing: some degree of sensation is preserved in the sacral dermatomes, even though sensation may be more impaired in other, higher dermatomes below the level of the lesion.
What is a dermatome?
The area of skin innervated by a specific spinal nerve is called a dermatome
What is a myotome?
the group of muscles innervated by a single spinal nerve is called a myotome.
describe the grading system for ASIA Impairment Scale for classifying spinal cord injury
A B C D E
describe ASIA Impairment Scale Grade A
Complete injury. No motor or sensory function is preserved in the sacral segments S4 or S5.
describe ASIA Impairment Scale Grade B
Sensory incomplete. Sensory but not motor function is preserved below the level of injury, including the sacral segments.
describe ASIA Impairment Scale Grade C
Motor incomplete. Motor function is preserved below the level of injury, and more than half of muscles tested below the level of injury have a muscle grade less than 3 (see muscle strength scores, left).
describe ASIA Impairment Scale Grade D
Motor incomplete. Motor function is preserved below the level of injury and at least half of the key muscles below the neurological level have a muscle grade of 3 or more.
describe ASIA Impairment Scale Grade E
Normal. No motor or sensory deficits, but deficits existed in the past.
How should you assess for sacral sparing?
Assess for sacral or perineal sensation. If sacral sensation is present in a patient with focal deficits, the patient has sacral sparing, which should lead you to suspect an incomplete spinal cord injury.
Gently palpate the patients entire vertebral column to detect what? (4)
pain, tenderness, crepitus, and step off deformity.
NEXUS clearence without radiology for low risk patients if they meet all 5 criteria. Low probability for injury include;
No Midline cervical tenderness No focal neurologic deficit Normal alertness No intoxication No painful or distracting injury
A patient with a spinal injury at or above T6 may experience what?
hypotension, and bradycardia (neurogenic shock) because of loss of sympathetic vasomotor tone.
A patient with a spinal injury at or above T6 may experience hypotension, and bradycardia (neurogenic shock) because of loss of sympathetic vasomotor tone.
How should you rule out bleeding, and how should this be treated?
Rule out other sources of bleeding that could also rule out hypotension, such as hemothorax, tension pneumothorax, or intra-abdominal bleeding
Administer IV fluids if the cause of hypotension is not clear
If hypotension persists after fluid deficits have been corrected, administer vasopressor drugs
what is Poikilothermy, and how would you describe a patient who has this condition?
decreased temperature regulation. A patient with spinal trauma may have poikilothermy, adapting to the ambient temperature much like a reptile does.
Patients do not feel discomfort when the temperature changes and are unaware of having a problem.
Cervical traction
Cervical tongs; what are the two types commonly used?
Gardner-Wells tongs, which are compatible with MRI
Crutchfield tongs
This device provides the most rigid immobilization and may be used to stabilize C1, C2, and odontoid fractures.
Halo device
What is A type II odontoid fracture?
is a break that occurs through a specific part of C2, the second bone in the neck.
What are two contraindications for using a halo device?
Unstable skull fractures
Disrupted skin at the pin insertion site
Vertebral fractures are categorized into four major categories, what are they?
Simple fractures
Compression (wedge) fractures
Commuted (burst) Fx
Teardrop fracture
Vertebral fractures
Describe Simple fractures
linear fractures affect the spinous or transverse process, facets, or pedicles.
Compression is rare
The vertebral column remains aligned
Vertebral fractures Describe Compression (wedge) fractures
Fx affect the vertebral body but the posterior wall of the vertebral body remains intact (unlike a burst Fx.
Most common type of spinal fractures
Spinal cord compression may or may not be present
Vertebral fractures Describe Commuted (burst) Fx
these are multiple fractures of the vertebral body
These fractures are associated with axial loading, usually at the lumbar curve, then the patients falls over, resulting in bilateral Colles fractures.
These fracture may result in spinal cord injury
Vertebral fractures
Describe Teardrop fracture
a small fracture that affects the anterior of the vertebrae which may impinge the spinal cord.
It results from an upward direction force to the mandible or a force directed at the forehead.
Most common type of spinal fractures are
Compression (wedge) fractures
What is A Jefferson fracture?
is an example of a compression fracture that occurs at C1 and is extremely unstable
The injury location determines the effects of the spinal cord injury. What effects would you expect to find with an injury to the Cervical spine?
risk for pulmonary and ventilation problems
The injury location determines the effects of the spinal cord injury. What effects would you expect to find with an injury to the Lower thoracic spine?
Loss of abdominal muscle function, decreased respiratory reserves, and gastric distension.
The injury location determines the effects of the spinal cord injury. What effects would you expect to find with an injury to the Lumbosacral spine?
Loss of bowel and bladder function
Spinal shock - characterized by what?
Usually occurs ____, and the level of injury determines its intensity and duration. Patients with spinal shock usually exhibit (4)
the loss of reflexes and motor and sensory functions below the level of injury. immediately Flaccid paralysis Loss of sensation Loss of DTRs Bowel and bladder dysfunction
How long does spinal shock generally last?
Although spinal shock generally lasts less than 24 hours, it occasionally persists for several days.
Neurogenic shock - a form of ____ shock, may also occur with injuries above T__. may cause (3).
Treatment includes what?
distributive T6 Bradycardia Hypotension Warm, dry skin Begin treatment with a bolus of fluids, consider vasopressors.
What percentage of spinal cord injuries are complete?
50%
Complete spinal cord injury include total loss of what?
Total loss of motor function distal to spinal cord injury.
Along with motor function, Complete spinal cord injury causes the loss of what (2) and can cause these two conditions.
Loss of thermoregulation, bowel and bladder, paralytic ileus, priapism
With a complete spinal cord injury, Functional motor is rare in a patient with findings that last more than how long?
24 hours
Incomplete Spinal cord injury
____ cord syndrome - most common, results from hyperextension, greater deficits in the upper extremities than in the lower. “The patient can walk but can’t take a drink”.
Central cord syndrome
Incomplete Spinal cord injury
Has variable prognosis. More than 50% become ambulatory and regain B+B control and some hand function.
Central cord syndrome
Incomplete Spinal cord injury
Usually results from hyperflexion that causes cord contusion when a bony fragment or herniated disc protrudes into the spinal canal. Characterized by paralysis below the injury with preservation of the proprioception and touch.
Anterior cord syndrome
How is Anterior cord syndrome treated?
Warrants immediate neurosurgical evaluation, may be due to a correctable lesion. Offers a variable degree of recovery in the first 24 hours, but little improvement thereafter.
Incomplete Spinal cord injury
____ ____ syndrome - is rare, results from hyperextension that damages the dorsal column. Causes impairment of light touch and proprioception, but preservation of motor function and pain, temperature, crude touch, and pressure sensations.
Posterior cord syndrome
Incomplete Spinal cord injury
describe Brown-Sequard Syndrome
usually results from penetrating trauma that causes hemisection of the spinal cord. Is characterized by ipsilateral motor paralysis and contralateral sensory deficit.
what is the prognosis of Brown-Sequard Syndrome?
Allows most patients to maintain B+B function and become ambulatory.
Conus Medullaris Syndrome
Results from compression at the level of T__
Causes paralysis of the ____ with variable sensory deficits below the level of injury and loss of ____ ____ tone.
12
legs
rectal sphincter
how is Conus Medullaris Syndrome treated?
Requires surgery to relieve cord compression or repair disc herniation.
Cauda Equina (tail of the horse) Syndrome
Results in the nerve root compression below the level of __
Causes a typical triad of symptoms; such as (3)
Also causes loss of ____ tone
How is it treated?
L1
saddle paresthesia, bowel or bladder incontinence, and lower extremity weakness.
sphincter
Requires surgery to relieve cord compression or repair disc herniation.
