Spine and Spinal Cord Trauma Flashcards
Extent of _____ amnesia correlates
with severity of injury
retrograde
Every Patient with One or More of the
Following Signs or Symptoms should be
Placed in a C-Spine Collar
- Midline tenderness
- Neurological symptoms or signs
- Significant distracting injuries
- HI
- Intoxication
- Dangerous mechanism
- History of altered LOC
Of the Spine investigations, the _____ x-ray is the single most important film; ____%
of radiologically visible abnormalities are
found on this film
lateral C-spine
95%
Cauda Equina Syndrome can occur with
any spinal cord injury below ____vertebrae.
T10
Cauda Equina Syndrome signs
incontinence, anterior thigh pain,
quadriceps weakness, abnormal sacral
sensation, decreased rectal tone, and
variable reflexes
spine board must be maintained _________
during patient transport only
what’s a spinal cord injury without radiologic abnormality
means that the cord may be injured despite normal C-spine x-ray
Cord injuries can include:
: complete/incomplete transection, cord edema, spinal shock
Clinical features
neck pain, paralysis/weakness, paresthesia
Physical Exam abdominal
ecchymosis, tenderness
Physical Exam spine
: maintain neutral position, palpate C-spine; log roll, then palpate T-spine and L-spine, assess rectal tone
Physical Exam when palpating spine
assess for tenderness, muscle spasm, bony deformities, step-o, and spinous process malalignment
Physical Exam extremities
check capillary refill, suspect thoracolumbar injury with calcaneal fractures
imaging in C spine injury
full C-spine x-ray series for trauma (AP, lateral, odontoid)
• thoracolumbar x-rays
■ AP and lateral views
indications of thoracolumbar x-rays
◆ 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)
◆ consider CT (for_____ ), MRI (for ______)
subtle bony injuries
soft tissue injuries
The Canadian C-Spine Rule.
high-risk factor that mandates radiography
Age≥65 yr
Dangerous mechanism*
Paresthesias in extremities
the low-risk factor
that allows safe assessment
of ROM are:
Simple rear-end MVC†
Sitting position in ED
Ambulatory at any time
Delayed onset of neck pain§
Absence of midline C-spine tenderness
T/F
Rx should be done even if low-risk factor spine injury are presents
F
Only if Pt can’t actively rotate neck
Can Clear C-Spine if:
-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)
Management of Cord Injury
- 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
if cervical cord lesion, watch for respiratory ______
insuciency
■ low cervical transection (C__-___) produces _____ (_____innervation of diaphragm
still intact but loss of innervation of intercostals and other accessory muscles of breathing)
(C5-T1)
abdominal breathing
phrenic
■ high cervical cord injury (above C____) may require ____
4
intubation and ventilation
treatment
warm blanket, Trendelenburg position (occasionally), volume infusion, consider vasopressors
Prevertebral soft tissue swelling is
_____ sensitive for injury
only 49%
. lateral C1-T1 XR can be done alone or with
± swimmer’s view.
when c7-t1 junction is not vissible
lateral C1-T1 XR is_____, identifies _____% of injuties
is best, identifies 90-95% of injuries
Lateral C spine XR can show in children:
n <8 yr of age, can see physiologic subluxation of C2 on C3, and C3 on C4, but the spino-laminal line is maintained
Fanning of spinous processes suggests :
posterior ligamentous disruption
Line extending inferiorly from _____ should transect odontoid
clivus
Atlanto-axial articulation, widening of predental space (normal:_ in adults, _ in children. Indicates injury of ___ or ___
3
5
C1
or C2
Sequelae of C-Spine Fractures are define by two phases :
acute phase of SCI
chronic phase of SCI
acute phase of SCI includes : (2)
spinal shock:
&
neurogenic shock:
spinal shock:
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
neurogenic shock: meaning, clinical features, when does it occur?
: 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
neurogenic shock Management
◆ provide airway support, fluids, atropine (for bradycardia), vasopressors for BP support
• chronic phase of SCI can cause
■ autonomic dysreflexia: in patients with an SCI at level T6 or above
■ autonomic dysreflexia:
signs and symptoms:
pounding headache, nasal congestion, feeling of apprehension or anxiety,
visual changes, dangerously increased sBP and dBP
■ autonomic dysreflexia:
common triggers
GU causes: bladder distention, urinary tract infection, and kidney stones
– GI causes: fecal impaction or bowel distension
■ autonomic dysreflexia: treatment
monitoring and controlling BP, prior to addressing causative issue
