the nervous system has two major functions:
communication and control
consists of the brain and the spinal cord
CNS
consists of nerves located outside of the brain and spinal cord
peripheral nervous system
the bulky portion of a vertebra that faces anteriorly in the spinal column
body
the posterior aspect of a vertebra
spinous process
there are three main types of tracts within the spinal cord that are tested in the assessment to determine if spinal cord injuries exist.
motor tracts
pain tracts
light touch tracts
the spine is particularly susceptible to injury from the following mechanisms: 1 2 3 4 5 6 7
compression flexion extension rotation lateral bending distraction penetration
spinal injury when the weight of the body is driven against the head. this is common in falls, diving accidents, motor vehicle crashes, or other accidents where a person impacts an object face first.
compression
spinal injury when there is severe forward movement of the head in which the chin meets the chest, or when the torso is excessively curled forward
flexion
spinal injury when there is severe backward movement of the head in which the neck is stretched, or when the torso is severely arched backward.
extension
spinal injury when there is lateral movement of the head or spine beyond its normal rotation
rotation
spinal injury when the body or neck is bent severely from the side
lateral bending
spinal injury when the vertebrae and spinal cord are stretched and pulled apart. this is common in hangings
distraction
spinal injury when there is injury from gunshots, stabbings, or other types of penetrating trauma that involve the cranium or spinal column.
penetration
results when an area of the spinal cord has been completely transected (cut crossways) either physically or physiologically
complete spinal cord injury
a temporary concussion like insult to the spinal cord that causes effect below the level of injury. such an injury usually occurs high in the cervical region.
spinal cord shock
condition associated with injury to the spinal cord that results in vasodilation and relative hypovolemia
neurogenic hypotension
injury to the spinal cord that does not affect all spinal cord tracts: motor, light, touch, and pain. may produce conflicting and confusing assessment findings as some motor and sensory functions remain intact while others do not.
incomplete spinal cord injury
the three most common types of incomplete spinal cord injury:
central cord syndrome
anterior cord syndrome
brown sequard syndrome
loss of function in upper extremities caused by injury to the middle portion of the spinal cord
central cord syndrome
loss of most function below the site of injury to the anterior portion of the spinal cord
anterior cord syndrome
loss of different functions on opposite sides of the body from injury to one side of the spinal cord
brown sequard syndrome
the medial (inner) aspects of the motor and pain tracts control the ________ extremities
upper
the lateral (outer) portions of the tracts control the ________ extremities
lower
motor function assessment - upper extremities: 1 2 3 4
flex your arms (bend arms at the elbow) across chest
(tests function at C6)
extend your arms (straighten arms to the side of the body)
(tests function at C7)
spread your fingers out on both hands and don’t let me squeeze them together
(tests function at T1)
hold out both arms and dont let me push your hand down (done while you support the hand under the wrist)
(tests function at C7)
motor function assessment - lower extremities:
1
2
push down against my hands with your feet (place hands under feet)
(tests motor function at S1 and S2)
pull up against my hands with your feet (place your hands on the tops of the feet)
(tests motor function at the level of L5)
three situations in which you will have to move a patient with a suspected spine injury before immobilizing him to a long board or short spinal device:
scene is not safe
pt condition is so unstable that you need to move and transport immediately
pt blocks access to a second or more seriously injured pt
when the time saved by immediate extrication between life and death- a _______ is performed.
rapid extrication
there are only two circumstances in which a melmet should be premoved:
if it does not adequately secure the head because it is too large for the pt
if you cannot gain access to the airway