Trauma - Vertebral Column & Spinal Cord

Question 1

descending spinal tracts

Answer 1

• motor tracts

- corticospinal

Question 2

ascending spinal tracts

Answer 2

• sensory
• dorsal columns (deep touch, proprioception, vibration)
• lateral spinothalamic tract (pain, temperature)
• ventral spinothalamic tract (light touch)

Question 3

incomplete cord injuries: anterior cord

Answer 3

• loss of bilateral motor function, pain, temperature

- supplied by one artery (great radicular artery of Adamkiewicz)

Question 4

incomplete cord injuries: posterior cord

Answer 4

• loss of bilateral proprioception

- supplied by two arteries

Question 5

incomplete cord injuries: central cord

Answer 5

-upper extremity weakness

Question 6

incomplete cord injuries: Brown-Sequard

Answer 6

-loss of unilateral motor(think penetrating injury), contralateral sensory

Question 7

spinal shock treatment

Answer 7

• direct vasoactive drugs
• temperature management
• invasive monitoring

Question 8

SCIWRA

Answer 8

• spinal cord injury without radiographic abnormalities

- need MRI to diagnose

Question 9

vertebral artery injury

Answer 9

• 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

Question 10

autonomic dysreflexia

Answer 10

-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

Question 11

muscle relaxants in spinal trauma patients

Answer 11

-okay to use succinylcholine for first 24-48 hours, avoid after that time due to up-regulation of receptors

Question 12

spinal trauma: blood pressure goals

Answer 12

• MAP: 85-90 mmHg

- SBP > 90 mmHg for 7 days

Question 13

diaphragm innervation

Answer 13

C-3, C-4, C-5

Question 14

intercostal innervation

Answer 14

T-2 to T-11

Question 15

enhanced EPM

Answer 15

• ketamine
• etomidate
• inhalation > 1 MAC

Question 16

location of spinal cord injuries

Answer 16

1/3 at the craniocervical junction (bw occiput & first two vertebrae.)

about 1/2 are cervical > lumbar> thoracic

Question 17

central cord

Answer 17

most common type

-UE weakness compared to LE (opposite of what you would see with transection)

Question 18

spinal shock symptoms

Answer 18

from sympathectomy that occurs. The higher the level of injury, the worse the manifestations

• hypotension
• bradycardia
• hypothermia
• can not shiver (poikilothermy)

Question 19

what to keep MAP after spinal cord injury

Answer 19

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

Question 20

a true c-spine film requires….

Answer 20

all 7 vertebrae viewable (C7 is the most common site of injury.)