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Trauma and Trauma Systems > Spinal Cord > Flashcards

Spinal Cord Flashcards

(58 cards)

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1
Q

introduction to spinal injury

A

-Annually 15,000 permanent spinal cord injuries
-Commonly men 16-30 years old
-Mechanism of Injury
– Vehicle crashes: 48%
– Falls: 21%
– Penetrating trauma: 15%
– Sports injury: 14%
-Lifelong care for spinal cord injury victim exceeds $1 million.
-Best form of care is public safety and prevention programs.

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2
Q

vertebral column

A

-33 bones comprise the spine.
-Function:
– Skeletal support structure
– Major portion of axial skeleton
– Protective container for spinal cord
-Vertebral Body:
– Major weight-bearing component
– Anterior to other vertebrae components

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3
Q

components of vertebrae

A
  • spinal canal
  • pedicles
  • laminae
  • transverse process
  • spinous process
  • intervertebral disk
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4
Q

size of vertebrae

A

-C-1 and C-2:
-No vertebral body
-Support head
-Allow for turning of head
-Vertebral body size increases the more inferior they
become.
-Lumbar spine strongest and largest-> Bear weight of the body
-Sacral and coccyx vertebrae are fused -> No vertebral body

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5
Q

spinal canal

A

Opening in the vertebrae that the spinal cord passes through

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6
Q

pedicles

A

Thick, bony structures that connect the vertebral body to the
spinous and transverse processes

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7
Q

laminae

A

Posterior bones of vertebrae that make up foramen

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8
Q

transverse process

A
  • Bilateral projections from vertebrae

- Muscle attachment and articulation location with ribs

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9
Q

compo

A
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10
Q

spinous process

A

Posterior prominence on vertebrae

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11
Q

intervertebral disk

A
  • Cartilaginous pad between vertebrae

- Serves as shock absorber

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12
Q

Vertebral Ligaments: Anterior Longitudinal

A
  • Anterior surface of vertebral bodies
  • Provides major stability of the spinal column
  • Resists hyperextension
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13
Q

vertebral ligaments: Posterior Longitudinal

A
  • Posterior surface of vertebral bodies in spinal canal

* Prevents hyperflexion

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14
Q

cervical spine

A

-7 vertebrae
-Sole support for head
-Head weighs 16–22 pounds
-C-1 (Atlas)
• Supports head
• Securely affixed to the occiput
• Permits nodding
-C-2 (Axis)
• Odontoid process (dens) -> Projects upward and Provides pivot point so head can rotate
-C-7
• Prominent spinous process (vertebra prominens)

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15
Q

thoracic spine

A

-12 vertebrae
-1st rib articulates with T-1
-Attaches to transverse process and vertebral body
-Next nine ribs attach to the inferior and superior portion of
adjacent vertebral bodies
-Limits rib movement and provides increased rigidity
-Larger and stronger than cervical spine
-Larger muscles help to ensure that the body stays erect
-Supports movement of the thoracic cage during respirations

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16
Q

lumbar spine

A

– 5 vertebrae
– Bear forces of bending and lifting above the pelvis
– Largest and thickest vertebral bodies and
intervertebral disks

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17
Q

sacral spine

A
  • 5 fused vertebrae
    – Form posterior plate of pelvis
    – Help protect urinary and reproductive organs
    – Attach pelvis and lower extremities to axial
    skeleton
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18
Q

coccygeal spine

A

-3–5 fused vertebrae

– Residual elements of a tail

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19
Q

layers of spinal meninges

A

– Dura mater
– Arachnoid
– Pia mater
-Cover entire spinal cord and peripheral nerve roots
that exit
-Cerebrospinal fluid bathes spinal cord by filling the
subarachnoid space
–CSF Exchange of nutrients and waste products
–CSF Absorbs shocks of sudden movement

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20
Q

spinal cord function

A

-Transmits sensory input from body to the brain
-Conducts motor impulses from brain to muscles and
organs
-Reflex center- Intercepts sensory signals and initiates a reflex signal

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21
Q

growth of spinal cord

A

-Fetus- Entire cord fills entire spinal foramen
-Adult- Base of brain to L-1 or L-2 level
-adult Peripheral nerve roots pulled into spinal foramen at the distal end
(cauda equina)

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22
Q

axons

A

-Transmit signals upward to the brain and down to the
body
-Ascending tracts
– Axons that transmit signals to the brain
– Sensory tracts
-Descending tracts
– Axons that transmit signals to the body
– Motor tracts
» Voluntary and fine muscle movement

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23
Q

dermatomes

A 
-Topographical region of the body surface
innervated by one nerve root
-Key locations
• Collar region: C-3
• Little finger: C-7
• Nipple line: T-4
• Umbilicus: T-10 
• Small toe: S-1
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24
Q

myotomes

Study These Flashcards
A 
-Muscle and tissue of the body innervated by
spinal nerve roots
-Key myotomes
• Arm extension: C-5
• Elbow extension: C-7
• Small finger abduction: T-1
• Knee extension: L-3
• Ankle flexion: S-1
25
reflex pathways
``` -Function • Speed body’s response to stressors • Reduce seriousness of injury • Body stabilization -Occur in special neurons • Interneurons • Examples: -Touch hot stove. -Severe pain sends intense impulse to brain. -strong signal triggers interneuron in the spinal cord to direct a signal to the flexor muscle. -Limb withdraws without waiting for a signal from the brain. ```
26
ANS: Parasympathetic, “Feed and Breed”
``` • Controls rest and regeneration • Peripheral nerve roots from the sacral and cranial nerves • Major Functions -Slows heart rate -Increases digestive system activity -Plays a role in sexual stimulation ```
27
ANS: Sympathetic, “Fight or Flight”
• Increases metabolic rate • Branches from nerves in the thoracic and lumbar regions • Major Functions – Decreases organ and digestive system activity » Vasoconstriction – Release of epinephrine and norepinephrine – Systemic vascular resistance » Reduces venous blood volume » Increases peripheral vascular resistance – Increases heart rate – Increases cardiac output
28
mechanism of spinal injury
- extremes of motion - hyperextension- head flings backward - hyperflexion- kiss the chest - excessive rotation - lateral bleeding
29
axial stress
-Axial loading -Compression common between T-12 and L-2 • Distraction • Combination -Distraction/rotation or compression/flexion -pressure to the length of the spine -you land feet first (or head) -> squish the spine
30
other MOI spinal injuries
- direct, blunt, or penetrating trauma | - electrocution
31
flexion injury
-lumbar spine
32
compression injury
- axial loading injury | - landing on the feet or the head
33
column injury
- movement of vertebrae from normal position - subluxation or dislocation - fractures: - spinous process and transverse process - pedicle and laminae - vertebral body - ruptured intervertebral disks - common sites of injury: - C-1/C-2: delicate vertebrae - C-7: transition from flexible cervical spine to thorax - T-12/L-1: different flexibility between thoracic and lumbar regions
34
cord injury: concussion
- similar to cerebral concussion | - temporary and transient disruption of cord function
35
cord injury: contusion
- bruising of the cord | - tissue damage, vascular leakage, swelling
36
cord injury: compression
``` -Secondary to: – Displacement of the vertebrae – Herniation of intervertebral disk – Displacement of vertebral bone fragment – Swelling from adjacent tissue ```
37
cord injury: laceration
- causes: - bony fragments driven into the vertebral foramen - cord may be stretched to the point of tearing - hemorrhage into cord tissue, swelling, and disruption of impulses
38
cord injury: hemorrhage
Associated with contusion, laceration, or stretching
39
transection cord injury
``` -Injury that partially or completely severs the spinal cord -can be incomplete or complete -Complete: -Cervical Spine damage: -Quadriplegia -Incontinence -Respiratory paralysis – Below T-1: » Incontinence » Paraplegia ```
40
incomplete transection cord injury: anterior cord syndrome
-Anterior vascular disruption -Loss of motor function and sensation of pain, light touch, and temperature below injury site -Retain motor, positional, and vibration sensation
41
incomplete transection cord injury: central cord syndrome
- Hyperextension of cervical spine - Motor weakness affecting upper extremities - Bladder dysfunction
42
incomplete transection cord injury: brown-sequard's syndrome
- Penetrating injury that affects one side of the cord - Ipsilateral (same side) sensory and motor loss - Contralateral pain and temperature sensation loss
43
general signs and symptoms of spinal injury
``` – Extremity paralysis – Pain with and without movement – Tenderness along spine – Impaired breathing – Spinal deformity – Priapism – Posturing – Loss of bowel or bladder control – Nerve impairment to extremities ```
44
spinal shock
-Temporary insult to the cord -Affects body below the level of injury -Affected area: • Flaccid • Without feeling • Loss of movement (flaccid paralysis) • Frequent loss of bowel and bladder control • Priapism • Hypotension secondary to vasodilation
45
neurogenic shock
- Spinal-Vascular Shock - Occurs when injury to the spinal cord disrupts the brain’s ability to control the body - Loss of sympathetic tone: - Dilation of arteries and veins -> Expands vascular space and results in relative hypotension - Reduced cardiac preload - Reduction of the strength of contraction -> Frank-Starling reflex - ANS loses sympathetic control over adrenal medulla - Unable to control release of epinephrine and norepinephrine -> Loss of positive inotropic and chronotropic effects
46
signs and symptoms of neurogenic shock
* Bradycardia * Hypotension * Cool, moist, and pale skin above the injury * Warm, dry, and flushed skin below the injury * Male: priapism
47
Autonomic Hyperreflexia Syndrome
-Associated with the body’s resolution of the effects of spinal shock -Commonly associated with injuries at or above T-6 -Presentation • Sudden hypertension • Bradycardia • Pounding headache • Blurred vision • Sweating and flushing of skin above the point of injury
48
other causes of neurologic dysfunction
``` -Any injury that affects the nerve impulse’s path of travel: • Swelling • Dislocation • Fracture • Compartment syndrome ```
49
scene size up of spinal injury pt
– Evaluate MOI. – Consider spinal clearance protocol. – Determine type of spinal trauma. – Maintain suspicion with sports injuries. – If unclear about MOI, take spinal precautions.
50
initial assessment of spinal injury
-Consider spinal clearance protocol. -Consider spinal precautions. • Head injury • Intoxicated patients • Injuries above the shoulders • Distracting injuries -Maintain manual stabilization. • Vest style versus rapid extrication • Maintain neutral alignment • Increase of pain or resistance, restrict movement in position found – ABCs. – Suction. – Consider oral or digital intubation if required -> Maintain in-line manual c-spine control.
51
rapid trauma assessment of spinal injury
- Focused versus rapid assessment - Rapid Assessment - Suspected or likely spinal cord/column injury - Multi-system trauma patient - Evaluate for: - Neck deformity, pain, crepitus, warmth, tenderness - Bilateral extremities -> Finger abduction/adduction, push, pull, grips - Motor and sensory function: - > Dermatome and myotome evaluation - > Babinski’s sign test - > Hold-up position
52
secondary assessment of spinal injury: vital signs
-Body temperature -Above and below site of injury – Pulse – Blood pressure – Respirations
53
ongoing assessment of spinal injury
-Recheck elements of initial assessment. – Recheck vital signs. – Recheck interventions. – Recheck any neurological deviations
54
spinal alignment
-Move patient to a neutral, in-line position. -Position of function. -Hips and knees should be slightly flexed for maximum comfort and minimum stress on muscles, joints, and spine. -Place a rolled blanket under the knees -ALWAYS support the head and neck. -Contraindications to neutral position: • Movement causes a noticeable increase in pain. • Noticeable resistance met during procedure. • Increase in neurological deficits occurs during movement. • Gross deformity of spine. – LESS MOVEMENT IS BEST.
55
padding in order to keep body aligned with spinal injury
- padding under shoulders for infant - child no padding necessary - padding under the head - elderly- look for lordosis, kyphosis
56
movement of spinal injury patient
-Any movement MUST be coordinated. -Move patient as a unit. -NO LATERAL PUSHING. -Move patient up and down to prevent lateral bending. -Rescuer at the head “CALLS” all moves. -ALL MOVES MUST be slowly executed and well coordinated. -Consider the final positioning of the patient prior to beginning move.
57
emergency medical care of spinal injuries
-Follow standard precautions. -Maintain the patient’s airway while keeping the spine in the proper position. -Assess respirations and give supplemental oxygen. -Managing the airway -> Perform the jaw-thrust maneuver. -After you open the airway, consider inserting an oropharyngeal airway. -Have a suctioning unit available. -Provide high-flow oxygen. -Stabilization of the cervical spine -> Restrict motion of the head and trunk so that bone fragments do not cause further damage.
58
long backboards
- Provide full body spinal motion restriction to the head, neck, torso, pelvis, and extremities - Used to move patients to a stretcher, then removed, while maintaining spinal motion restriction

Trauma and Trauma Systems (18 decks)

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