Spine Trauma, part 1 Flashcards
remarks on spine fractures
assume any spine fracture is unstable, and maintain appropriate precautions until expert consultation can be obtained from a spine surgeon
an patient with an injury at ______ should have the airway secured by endotracheal intubation
C5 or above
remarks on neck immobilization while intubating
maintain manual in-line stabilization while intubating
remarks on hypotension in spine injuries
presume blood loss as the cause of hypotension in spinal injury patients until proven otherwise
3 major incomplete spinal cord syndromes
anterior cord (poor prognosis)
central cord
brown-sequard
anterior cord syndrome
loss of motor function and pain and temperature distal to the lesion
only vibration, position, and tactile sensation are preserved
central cord syndrome
decreased strength and to a lesser degree,
decreased pain and temperature sensation, more in the upper than the lower extremities
brown sequard syndrome
ipsilateral spastic paresis
loss of proprioception and vibratory sensation
contralateral loss of pain and temperature sensation
spinal shock
temperature loss or depression of spinal reflex activity that occurs below a complete or incomplete spinal injury
presentation: flaccidity, loss of reflexes, and loss of voluntary movement
among the first to return as spinal shock resolves
delayed plantar and bulbocarvernosus reflexes
CCR’s dangerous mechanisms
fall of >3 feet
axial loading injury
high-speed MVC, rollover, or ejection
motorized recreational vehicle or bicycle collision
remarks on the use of CCR
the 3 assessments are asked in sequential order
to proceed to the next assessment, the answer to the previous assessment must be “yes”
if the answer to any assessments is “no”, then imaging is immediately performed
remarks on imaging in spine injuries
multidetector CT is more sensitive and specific than plain radiography for evaluating the cervical spine in trauma patients and can be performed quickly
what to do for findings of spinal column fractures or ligamentous injuries
obtain emergent consultation with a spine surgeon (neurosurgeon or orthopedic surgeon depending on the facility) on all spinal column fractures or ligamentous injuries, regardless of neurologic compromise
steroids in spinal cord injuries
high-dose methylprednisolone remains a controversial treatment in acute blunt spinal cord injury and should not be given routinely
the option to start corticosteroids should only be made in conjunction with the surgeon who will ultimately be caring for the patient and not given routinely
high-dose MP has NOT been found to be efficacious in penetrating spinal cord injury. corticosteroids are contraindicated in patients with any type of penetrating spinal injuries
