Spine and Spinal Cord Trauma

Question 1

Extent of _____ amnesia correlates

with severity of injury

Answer 1

retrograde

Question 2

Every Patient with One or More of the
Following Signs or Symptoms should be
Placed in a C-Spine Collar

Answer 2

• Midline tenderness
• Neurological symptoms or signs
• Significant distracting injuries
• HI
• Intoxication
• Dangerous mechanism
• History of altered LOC

Question 3

Of the Spine investigations, the _____ x-ray is the single most important film; ____%
of radiologically visible abnormalities are
found on this film

Answer 3

lateral C-spine

95%

Question 4

Cauda Equina Syndrome can occur with

any spinal cord injury below ____vertebrae.

Answer 4

T10

Question 5

Cauda Equina Syndrome signs

Answer 5

incontinence, anterior thigh pain,
quadriceps weakness, abnormal sacral
sensation, decreased rectal tone, and
variable reflexes

Question 6

spine board must be maintained _________

Answer 6

during patient transport only

Question 7

what’s a spinal cord injury without radiologic abnormality

Answer 7

means that the cord may be injured despite normal C-spine x-ray

Question 8

Cord injuries can include:

Answer 8

: complete/incomplete transection, cord edema, spinal shock

Question 9

Clinical features

Answer 9

neck pain, paralysis/weakness, paresthesia

Question 10

Physical Exam abdominal

Answer 10

ecchymosis, tenderness

Question 11

Physical Exam spine

Answer 11

: maintain neutral position, palpate C-spine; log roll, then palpate T-spine and L-spine, assess rectal tone

Question 12

Physical Exam when palpating spine

Answer 12

assess for tenderness, muscle spasm, bony deformities, step-o, and spinous process malalignment

Question 13

Physical Exam extremities

Answer 13

check capillary refill, suspect thoracolumbar injury with calcaneal fractures

Question 14

imaging in C spine injury

Answer 14

full C-spine x-ray series for trauma (AP, lateral, odontoid)

Question 15

• thoracolumbar x-rays

Answer 15

■ AP and lateral views

Question 16

indications of thoracolumbar x-rays

Answer 16

◆ C-spine injury
◆ unconscious patients (with appropriate mechanism of injury)
◆ neurological symptoms or findings
◆ deformities that are palpable when patient is log rolled
◆ back pain
◆ bilateral calcaneal fractures (due to fall from height)
– concurrent burst fractures of the lumbar or thoracic spine in 10% (T11-L2)

Question 17

◆ consider CT (for_____ ), MRI (for ______)

Answer 17

subtle bony injuries

soft tissue injuries

Question 18

The Canadian C-Spine Rule.

high-risk factor that mandates radiography

Answer 18

Age≥65 yr

Dangerous mechanism*

Paresthesias in extremities

Question 19

the low-risk factor
that allows safe assessment
of ROM are:

Answer 19

Simple rear-end MVC†

Sitting position in ED

Ambulatory at any time

Delayed onset of neck pain§

Absence of midline C-spine tenderness

Question 20

T/F

Rx should be done even if low-risk factor spine injury are presents

Answer 20

F

Only if Pt can’t actively rotate neck

Question 21

Can Clear C-Spine if:

Answer 21

-oriented to person, place, time, and event
• no evidence of intoxication
• no posterior midline cervical tenderness
• no focal neurological deficits
• no painful distracting injuries (e.g. long bone fracture)

Question 22

Management of Cord Injury

Answer 22

• immobilize
• evaluate ABCs
• treat neurogenic shock (maintain sBP >100 mmHg)
• insert NG and Foley catheter
• complete imaging of spine and consult spine service if available
• continually reassess high cord injuries as edema can travel up cord

Question 23

if cervical cord lesion, watch for respiratory ______

Answer 23

insuciency

Question 24

■ low cervical transection (C__-___) produces _____ (_____innervation of diaphragm
still intact but loss of innervation of intercostals and other accessory muscles of breathing)

Answer 24

(C5-T1)
abdominal breathing
phrenic

Question 25

■ high cervical cord injury (above C____) may require ____

Answer 25

4

intubation and ventilation

Question 26

treatment

Answer 26

warm blanket, Trendelenburg position (occasionally), volume infusion, consider vasopressors

Question 27

Prevertebral soft tissue swelling is

_____ sensitive for injury

Answer 27

only 49%

Question 28

. lateral C1-T1 XR can be done alone or with

Answer 28

± swimmer’s view.

when c7-t1 junction is not vissible

Question 29

lateral C1-T1 XR is_____, identifies _____% of injuties

Answer 29

is best, identifies 90-95% of injuries

Question 30

Lateral C spine XR can show in children:

Answer 30

n <8 yr of age, can see physiologic subluxation of C2 on C3, and C3 on C4, but the spino-laminal line is maintained

Question 31

Fanning of spinous processes suggests :

Answer 31

posterior ligamentous disruption

Question 32

Line extending inferiorly from _____ should transect odontoid

Answer 32

clivus

Question 33

Atlanto-axial articulation, widening of predental space (normal:_ in adults, _ in children. Indicates injury of ___ or ___

Answer 33

3
5
C1
or C2

Question 34

Sequelae of C-Spine Fractures are define by two phases :

Answer 34

acute phase of SCI

chronic phase of SCI

Question 35

acute phase of SCI includes : (2)

Answer 35

spinal shock:
&
neurogenic shock:

Question 36

spinal shock:

Answer 36

absence of all voluntary and reflex activity below level of injury
◆ decreased reflexes, no sensation, flaccid paralysis below level of injury, lasting days to months

Question 37

neurogenic shock: meaning, clinical features, when does it occur?

Answer 37

: loss of vasomotor tone, SNS tone
◆ watch for: hypotension (lacking SNS), bradycardia (unopposed PNS), poikilothermia (lacking SNS so no shunting of blood from extremities to core)
◆ occurs within 30 min of SCI at level T6 or above, lasting up to 6 wk

Question 38

neurogenic shock Management

Answer 38

◆ provide airway support, fluids, atropine (for bradycardia), vasopressors for BP support

Question 39

• chronic phase of SCI can cause

Answer 39

■ autonomic dysreflexia: in patients with an SCI at level T6 or above

Question 40

■ autonomic dysreflexia:

signs and symptoms:

Answer 40

pounding headache, nasal congestion, feeling of apprehension or anxiety,
visual changes, dangerously increased sBP and dBP

Question 41

■ autonomic dysreflexia:

common triggers

Answer 41

GU causes: bladder distention, urinary tract infection, and kidney stones
– GI causes: fecal impaction or bowel distension

Question 42

■ autonomic dysreflexia: treatment

Answer 42

monitoring and controlling BP, prior to addressing causative issue