week 6: spinal trauma

Question 1

what is clinically clearing the c-spine

Answer 1

a careful clinical assessment ewiuth a conscious and co-op patient leading to the removal of c-spine collar

Question 2

history required to clear the c-spine

Answer 2

no history of loss of consciousness
GCS 15 + no bev 
no significant distracting injury 
no neuro symptoms in limbs 
no midline tenderness upon palpation of c-spine 
no pain on gentle active neck movement

Question 3

if there is doubt, c–spine cannot be cleared, collar must stay on. next step

Answer 3

further imaging
x-rays
CT required

Question 4

examination of patient with usspected c-spine shd include

Answer 4

full trauma assessment (ABCD) 
full neuro exam incld
-peripheral motor
- touch
-limb reflexes
-cranial nerve evaluation 
-rectal exam
-bulbocavernous reflex assessment  (checks sacral nerves)

Question 5

stable c-spine injjury trearted with

Answer 5

firm cervical collar

Question 6

unstable c-spine injjuries may require immobilisation in ___ ___ (external fixator, with 4 pins into skull) Some unstable injuries require surgical stabilization including____, ___ ___ . Subluxations and dislocations may require traction for _____ halo application or operative stabilization whilst burst fractures with neurologic deficits may require traction to ____ the spinal canal.

Answer 6

halo vest
fusions, wiring or internal fixation
reduction
decompress

Question 7

most thoracolumbar spine fractures are due to

Answer 7

motor accidents or falls from a heigh t

Question 8

if its an elderly patient, it is likely to be ___ ___ ‘wedge’ ____,, which only requires symptomatic treatment

Answer 8

osteoporosis osteoporotic insufficiency

Question 9

if the injuries stbale (not a burst) of the thoracic spine they may be treated with a brace, why

Answer 9

limits flexion

prevents kyphosis

Question 10

indications for surgery in spinal fractures

Answer 10

neuro dieficit
unstable injury pattern, substantial loss of vertebral height/displacement
involvement of posterior ligamentous structures

Question 11

SPINAL SHOCK

Answer 11

physiologic response to injury

complete loss of sensation and motor function and loss of reflexes below the level of injjry

Question 12

spinal shock resolves within 24hrs t/f

Answer 12

true

depends on severity tho

Question 13

what signals the end of spinal shock

Answer 13

regain of function of bulbocavernous reflex - reflex contraction of anal sphincter

Question 14

neurogenic shock occurs after damage to CNS, leads to low bp, bradycardia. how does it occur after spinal injjry

Answer 14

sympathetic outflow from cord (t1 - l2) is shutdown

priapism - painful boner - due to unstoppable para righteousness

Question 15

how is neurogenic shock treated

Answer 15

iv fluid

Question 16

central cord syndrome

Answer 16

most common injury pattern
hyperextension injjury in cervical spine with OA
Spinal COrd Injury Without Radiographic Abnormality SCIWORA

Question 17

in central cord syndome, lower limbs are usually affected tf

Answer 17

false
usually upper
corticospinal (motor) tracrs are more central

Question 18

t/f sacral sparing is typically present in central cord syndrome

Answer 18

true

Question 19

anterior cord syndome results in in loss of motor function due to the impact on the corticospinal tracts. However, loss of touch pain and temp is evident, whihc tract is affected by this? the doral columns is unaffected, what do these do

Answer 19

lateral spinothalamic tract

proprioception
vibration sense and light touch

Question 20

syndome in which there is a loss of dorsal column function (proprioception, light touch and vibration)

Answer 20

posterior cord syndome

rare

Question 21

brown-sequard syndrome leads to one side of body lossing the sensation of pain, tempt, ligght touch, whilst the other side loses motor functon, vibration, position, deep touch sensation, how tf

Answer 21

hemisection of the cord (usually from prenetrating injury)

ipsilateral paralysis and loss of dorsal column sensation occurs (so opp site of impact loses pain/temp ect)