Trauma - Vertebral Column & Spinal Cord Flashcards
descending spinal tracts
- motor tracts
- corticospinal
ascending spinal tracts
- sensory
- dorsal columns (deep touch, proprioception, vibration)
- lateral spinothalamic tract (pain, temperature)
- ventral spinothalamic tract (light touch)
incomplete cord injuries: anterior cord
- loss of bilateral motor function, pain, temperature
- supplied by one artery (great radicular artery of Adamkiewicz)
incomplete cord injuries: posterior cord
- loss of bilateral proprioception
- supplied by two arteries
incomplete cord injuries: central cord
-upper extremity weakness
incomplete cord injuries: Brown-Sequard
-loss of unilateral motor(think penetrating injury), contralateral sensory
spinal shock treatment
- direct vasoactive drugs
- temperature management
- invasive monitoring
SCIWRA
- spinal cord injury without radiographic abnormalities
- need MRI to diagnose
vertebral artery injury
- injury occurs with hyper-extension of neck
- put on anticoagulant to prevent formation of clot that can become dislodged and sent to brain
- responsible for cerebral monitoring
autonomic dysreflexia
-classically associated w t-6 injuries
- no inhibitory signals to sympathetic response below lesion
- takes weeks after injury to develop
- treatments: deepen anesthesia, remove stimulus (MAC BAR), treat hypertension
muscle relaxants in spinal trauma patients
-okay to use succinylcholine for first 24-48 hours, avoid after that time due to up-regulation of receptors
spinal trauma: blood pressure goals
- MAP: 85-90 mmHg
- SBP > 90 mmHg for 7 days
diaphragm innervation
C-3, C-4, C-5
intercostal innervation
T-2 to T-11
enhanced EPM
- ketamine
- etomidate
- inhalation > 1 MAC
location of spinal cord injuries
1/3 at the craniocervical junction (bw occiput & first two vertebrae.)
about 1/2 are cervical > lumbar> thoracic
central cord
most common type
-UE weakness compared to LE (opposite of what you would see with transection)
spinal shock symptoms
from sympathectomy that occurs. The higher the level of injury, the worse the manifestations
- hypotension
- bradycardia
- hypothermia
- can not shiver (poikilothermy)
what to keep MAP after spinal cord injury
MAP 85-90 and avoid SBP<90 for 5-7 days after SCI.
low thoracic injuries may need an alpha 1 agonist
high thoracic injuries need chronotropic support
vasopressin is useful in resistant hypotension
a true c-spine film requires….
all 7 vertebrae viewable (C7 is the most common site of injury.)