Spinal injury and polytrauma (Garcia)

Question 1

Differentiate from other acute events (5)

Answer 1

1. Seizures
2. Toxicities
3. Saddle Thrombus
4. IVDD
   - Hansen type I & II
   - Type III vs. ANNPE
5. Non-traumatic inj
   - vasc events
   - orthopedic dz

Question 2

Confirmed Traumatic event (4)

Answer 2

Assess major body systems

1. Cardiovasc status
2. Resp status
3. Neuro - brain/spine
4. orthopedic assess

Question 3

Bedside testing

Answer 3

1. art blood gas-lactate; PCV/TS; Electrolytes
2. AFAST/TFAST
3. ECG

Question 4

In polytrauma first things first (4)

Answer 4

1. Stabilize major body systems first
2. Suspect spinal trauma based on primary survey
3. Characterize trauma based on neuro exam and imaging
4. Decided surgical vs non
   Timing of surgery
   -Degree of instability
   -Concurrent injuries and trauma burden
   -Ease of management of unstable spine-patient size

Question 5

Base prognosis off of

Answer 5

neuro exam, not rads

Question 6

Medical management an option for

Answer 6

Calm, small animals with minimal deficits and stable fractures

Question 7

Surgery best for (4)

Answer 7

1. Two compartment or
2. ventral compartment fractures
3. Animals that won’t tolerate external coaptation
4. Uncontrollable pain

Question 8

Patterns of injury for spinal trauma (3)

Answer 8

1. High impact-HBC, Projectiles
2. Falls from height
3. Big dog little dog bite wounds

Question 9

Flexion w/axial loading

Answer 9

ventral fracture, facets ok

Question 10

Extension forces

Answer 10

Facets take the hit

Question 11

Compression fx

Answer 11

shortened vertebrae

Question 12

Non-ambulatory after trauma DDX (8)

Answer 12

1. Hemorrhagic/hypovolemic shock
2. Long bone fractures
3. Pelvic fractures
4. Exacerbation OA/DJD
5. Brachial plexus injury, avulsion
6. Spinal fx/lux
7. Spinal contusion
8. Traumatic IVDD

Question 13

Neurologic assessment before correcting shock

Answer 13

Is not accurate

Question 14

Standard IV fluid resuscitation (2)

Answer 14

1. Isotonic crystalloids 20-30 ml/kg IV bolus, repeat PRN

2. Shock dose represents blood volume of patient

Question 15

Low volume IV fluid resuscitation (2)

Answer 15

1. Hypertonic saline 2-4 ml/kg, repeated once

2. Sometimes combined with artificial colloids at 5-10 ml/kg

Question 16

Hemostatic IV fluid resuscitation (3)

Answer 16

1. Replace what is lost
2. Blood products
3. Use only in MASSIVE HEMORRHAGE

Question 17

End points of resuscitation (7)

Answer 17

1. normal HR
2. Normal MM color
3. Normal mentation
4. BP > 100 systolic if sig CNS trauma
5. Pulse quality
6. Urine output
7. Lactate

Question 18

Common thoracic injuries (5)

Answer 18

1. Pneumothorax
2. Hemothorax
3. Pulmonary contusions-time frame
4. Diaphragmatic hernia
5. Rib fractures

Question 19

Thoracic interventions (3)

Answer 19

1. Supplemental O2 SpO2 90-95
2. Thoracocentesis
3. Thoracostomy tube

Question 20

Images show where the vertebrae are now, not

Answer 20

where they were at time of injury

Question 21

On rads assess (4)

Answer 21

1. Shape
2. Obvious fractures
3. Continuity of spinal cord
4. Articulation of facets and disc space

Question 22

MRI good for (3)

Answer 22

1. Spinal contusion
2. Hematoma
3. Tramatic discs

Question 23

Analgesia and sedation in confirmed spinal fx

Answer 23

Use caution

Question 24

ANNPE

Answer 24

Acute nucleus pulposis extrusion (looks like the FCE)

Question 25

Prognostic pointers (5)

Answer 25

1. Deep pain presence/absence 2. Trauma burden 3. Motor function 4. Imaging 5. Concurrent injuries

Question 26

Deep pain response not required

Answer 26

in dogs with good voluntary motor function

Question 27

Three compartment theory

Answer 27

Disruption of more than one compartment or ventral compartment alone compromises stability of vertebral column

Question 28

PMMA

Answer 28

Pins or screws (I think) and putty stuff

Question 29

Paperclip / MSF

Answer 29

some sort of vertebral fx stabilization....

Question 30

Locking plate

Answer 30

hard to get in, may disrupt nerve roots in lumbar spine

Question 31

Ex-fix

Answer 31

pain in the ass

Question 32

Cervical Traumas be worried about

Answer 32

Respiratory paralysis-phrenic nerve