Unit 10a - Spinal and head

Question 1

spinal cord

Answer 1

• exit thru foramen magnum
• 2 pairs of spinal cords exit each vertebrae
• sever cord/nerve cause damage below injured area
• C3, 4, 5 control diaphragm (phrenic nerve)

Question 2

spinal injuries

Answer 2

• simple as ligament sprain or muscle strain
• extreme such as death or paralysis
• 5mm displacement cause internal decapitation
• can cause bowel mvmnts/urination

C4: paralyzed below neck
C6: partial paralysis of hands/arm and all of lower body
T6: paralysis below chest
L1: paralysis below waist

Question 3

dangerous MOIs

Answer 3

• unresponsive (unknown case)
• fall > 3.3ft / 5 stairs / 1m
• MVA (pedestrian, driver, passenger)
• helmet is damaged or came off
• blunt force to head or neck
• penetration to head or neck
• axial loading (ex: diving)
• electrocution

Question 4

motions of injury

Answer 4

hyper extension
hyper flexion
hyper rotation
whiplash
axial loading

Question 5

hyper flexion injuries

Answer 5

Force to occiput = rotate head fwd ; flexion follows
- stretch posterior structures
- fracture vertebral bodies
- spinal cord compressed
- discs herniated

Question 6

hyper extension injuries

Answer 6

neck is forced into backward rotation
- spinous processes injured (palpate in PA)
- stretch anterior neck muscles
- compression of posterior structures
- can pinch off vertebral artery

Question 7

axial load injuries

Answer 7

straightened neck (remove the natural lordosis)
- anterior muscles loose / contract
- posterior muscles extended
- Intervertebral disks shock absorbers but will curve to the front if over stressed (flexion)

Question 8

Whiplash

Answer 8

symptoms caused by sudden, uncontrolled extension and flexion of the neck, often in an automobile accident
- lateral and rotary factors
- head should sit mid head rest or higher

Question 9

rotation injuries

Answer 9

caused by turning the head beyond the normal range
- vertebral artery on opp side is stretched = decrease blood flow = change in LOR
- get back to neutral

Question 10

s/s of head and neck injury

Answer 10

• change in LOR
• severe pain/pressure in head or spine
• persistent head ache
• N/T, total/partial paralysis
• skull deformity
• CSF/blood from nose or ears
• seizures
• bowel movement or urination
• bilateral periorbital ecchymosis
• periauricular ecchymosis
• nausea, vomit
• unequal pupils or not pearl
• respiratory and circulatory changes
• lose balance

Question 11

canadian c-spine rule (CCR)

Answer 11

used to determine if SMR is needed
- high risk (older than 65, paresthesia in extremities, dangerous MOI), yes = SMR

• safe to assess ROM (sitting, ambulatory, deferred onset neck injury, no midline c spine pain), no = SMR
• actively rotate head (45 L and R), no = SMR

Question 12

Simple rear-end MVC excludes

Answer 12

-pushed into oncoming traffic
-hit by bus/large truck
-rollover
-hit by high speed vehicle

Question 13

when to apply CCR

Answer 13

• trauma patient
• patient is alert; GCS = 15
• stable vitals
• over 16 years old
• no acute paralysis
• no vertebral disease
• no previous c-spine injury

Question 14

c-spine management (conscious)

Answer 14

no tingling, complete sensation, normal extremity strength, improving = walk them off field
- if in doubt, treat as severe and call EMS

Question 15

c-spine management

Answer 15

• EAP in place and rehearsed
• recruit responsible personnel

neutral alignment contraindications:
- severe pain
- spasm
- neurochanges
- resistance or blockage
- airway/ventilation compromised
- malalignment of head and shoulders

Question 16

spinal motion restriction

Answer 16

• only use rigid collars
• slight mvmnt is inevitable but try to minimize it all
• flexion reduced to 75-80 degrees
• too tight of collar = pressure on internal jugular vein
• too big = separation of c spine and skull

Question 17

general head/neck care

Answer 17

minimize head and neck movement
maintain open airway
control bleeding
SMR if appropriate
monitor LOR, ABCs, vitals
maintain normal body temp
oxygen if needed
more medical care if needed
head to toe assessment (PA)
get npa or opa in (no contradictions)

Question 18

spinal shock

Answer 18

an autodestructive process initiated w/in the spinal cord
- occur 30-60 min after trauma
- mechanical, biochemical , hemodynamic changes make ischemic or hypoxic state in cells
- neural tissue intact
- decrease LOR, necrosis, respiratory arrest

primary and secondary phases

Question 19

spinal shock primary stage

Answer 19

• actual structural damage to neural tissues
• MOI: mechanical insult
• initial response is hemorrhage and swell of cap endo
• zone of injury: neural injury affect where MOI struck
• bradycardia, hypotension, lose reflexes

Question 20

spinal shock secondary phase

Answer 20

• pathophysiological cascade of injury after primary phase
• progression of edema and autodestructive biochemical processes

decrease autoregulatory response of natural vasculature > significant decrease blood flow to spinal cord in 2 hours > ischemia, necrosis, permanent damage, death