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ATLS > Spine and spinal cord trauma > Flashcards

Spine and spinal cord trauma Flashcards

1
Q

Signs of spinal shock

A

Hypotension
Bradycardia
Signs of high neurologic deficit (eg lack of limb movement)

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2
Q

Other injuries associated with C spine fractures

A

Brain injury

Another non-contiguous spine fracture in 10% pts

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3
Q

Level of spinal cord injury associated with neurogenic shock

A

T6 and higher

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4
Q

Mechanism of neurogenic shock

A

Distributive shock from lack of vasomotor tone

Injury to sympathetic fibres that maintain vascular tone and heart rate

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5
Q

Three spinal cord tracts that can be examined clinically

A

Dorsal column (gracile fasciculus, cuneate fasciculus )

Lateral corticospinal tract

Spinothalamic tract

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6
Q

Dermatome definition

A

Area of skin innervated by a particular nerve root

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7
Q

Sensory level definition

A

The lowest dermatome with normal sensory function

Can differ between sides of the body

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8
Q

How to document spinal cord injury assessment

A

ASIA worksheet

(American Spinal Injury Association)

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9
Q

Muscle strength grading score 5

A

Normal strength

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10
Q

Muscle strength grading score 4

A

Full ROM but less than normal strength

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11
Q

Muscle strength grading score 3

A

Full ROM against gravity but not against resistance

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12
Q

Muscle strength grading score 2

A

Full ROM with gravity eliminated

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13
Q

Muscle strength grading score 1

A

Palpable or visible contraction

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14
Q

Muscle strength grading score 0

A

Total paralysis

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15
Q

Muscle strength grading score NT

A

Not testable

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16
Q

Myotome C5

A

Deltoid abduction

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17
Q

Myotome C6

A

Biceps flexion

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18
Q

Myotome C7

A

Triceps extension

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19
Q

Myotome C8

A

Wrist extension (radial test)

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20
Q

Myotome T1

A

Finger abduction (ulnar test)

Or

Grip strength

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21
Q

Myotome L2

A

Hip flexion

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22
Q

Myotome L3 / L4

A

Knee extension

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23
Q

Myotome L5

A

Knee flexion

or

Big toe extension

24
Q

Myotome S2, S3, S4

A

Anal tone

25
Q

Neurogenic shock definition

A

Loss of vasomotor tone and sympathetic innervation to the heart
Causes hypotension and inability to mount tachycardic response

Physiologic effects NOT reversed with fluid resuscitation alone

26
Q

Spinal shock definition

A

Loss of muscle tone and reflexes immediately after spinal cord injury

Spasticity

27
Q

Consequences of spinal injury on other organ systems

A

Resp failure due to paralysis of respiratory muscles

Inability to perceive pain - masks other serious injuries

28
Q

Classification of spinal injuries

A

Level (Bony and neurological)
Severity of neuro deficit
Spinal cord syndromes
Morphology

29
Q

Bony level classification of spinal injury

A

Specific vertebral level at which bony damage has occurred

30
Q

Neurological level classification of spinal injury

A

The most caudal segment of spinal cord with:

  • Normal sensory function

AND

  • Motor function with muscle strength 3 or above
31
Q

Severity of neurological deficit classification of spinal injury

A

Paraplegia

Quadriplegia / Tetraplegia:
- Complete
- Incomplete

32
Q

Injuries associated with paraplegia

A

Thoracic spinal injuries

33
Q

Injuries associated with Quadriplegia / Tetraplegia

A

Cervical spinal injuries

34
Q

Spinal cord syndromes

A

Central cord syndrome
Anterior cord syndrome
Brown-Sequard syndrome

35
Q

Central cord syndrome

A

Disproportionate greater loss of motor strength in upper extremities than lower extremities

Varying sensory loss

36
Q

Anterior cord syndrome

A

Injury to motor and sensory pathways in anterior cord

Paraplegia and loss of pain / temperature sensation

37
Q

Brown-Sequard syndrome

A

(Often penetrating) injury to one side of the spinal cord

Ipsilateral motor loss and loss of proprioception

Contralateral loss of pain / temperature sensation 1 or 2 levels below injury level

38
Q

Morphology classification of spinal injuries

A

Fractures
Fracture-dislocations
SCIWORA
Penetrating injuries

All of above can be described as stable or unstable

39
Q

SCIWORA

A

Spinal Cord Injury Without Radiological Abnormalities

40
Q

C spine fracture mechanisms

A

Axial
Flexion
Extension
Rotation
Lateral bending
Distraction

41
Q

Most common level of C spine fracture

A

C5

42
Q

Most common level of C spine subluxation

A

C5 on C6

43
Q

Types of thoracic spine fractures

A

Anterior wedge compression
Burst
Chance fractures
Fracture-dislocations

44
Q

Mechanism of anterior wedge compression fractures

A

Axial loading with flexion

45
Q

Mechanism of burst fractures

A

Vertical axial compression

46
Q

Mechanism of Chance fractures

A

Flexion about an axis anterior to the vertebral column

Eg lap seat belts

Can be associated with abdo visceral / retroperitoneal injuries

47
Q

Mechanism of fracture-dislocations of the thoracic spine

A

Extreme flexion

OR

Severe blunt trauma to spine

48
Q

Level of Thoracolumbar junction

A

T11 through to L1

49
Q

Mechanism of Thoracolumbar junction fractures

A

Acute hyperflexion + rotation

50
Q

Considerations with Thoracolumbar junction fractures

A

Usually unstable

Highly vulnerable to rotational movement - careful with logroll

51
Q

Types of lumbar spine fractures

A

Similar to thoracic spine fractures

52
Q

Spinal injuries associated with blunt carotid and vertebral artery injury

A

C1-C3 fractures
C spine fracture with subluxation
Fractures involving foramen transversarium

53
Q

Potential complication of blunt carotid and vertebral artery injury

A

Stroke

54
Q

Indication for MRI C spine

A

Neurological deficit but no radiographic evidence of fracture

Look for soft tissue compressive lesions, contusions or ligamentous injury

55
Q

Spinal immobilisation method

A

Lay patient on firm surface
Rigid cervical collar
Head blocks

56
Q

When to suspect neurogenic shock

A

Persistent hypotension
Bradycardia
No active haemorrhage

57
Q

Management of neurogenic shock

A

Avoid overzealous IV fluid
Consider vasopressors

ATLS (14 decks)

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