Spinal Trauma Flashcards by Misty Short

What is a classic example of an extension injury mechanism?

Rear-impact auto crash

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Extremes of extension may cause?

Disk disruption, compression of interspinous ligaments,and fracture of the posterior vertebral elements

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The result of a rotational spinal injury may include?

Stretching or tearing of ligaments
rotational subluxation or discoloration
Vertebral fracture

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______ occurs as compressional stress is brought to bear along the axis of the spine.

Axial loading

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What may occur when a person lifts a weight too great for the strength of the lumbar spine or when a person lands on their heels?

Axial loading

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What are the most common sites of axial loading injuries?

Between T-12 and L-2

Cervical region

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Axial loading injuries between T-12 and L-2 occur when?

For lifting injuries and heel-first falls

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____ is the opposite of axial loading.

Distraction

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The upper cervica region is most commonly affected by ______.

Distraction

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What might hanging do to the victim?

Suspend the victim from the side of the head, causing injury from distraction and severe lateral bending direct at the C-1/C-2 region (causing hangman’s fracture)

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The ___ region of the spinal column can be injured, and such injuries are usually related to ___ ___ trauma (i.e. failing on one’s tailbone).

coccygeal ; direct blunt

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What forces may cause movement of the vertebrae from their normal position?

Subluxation (partial or complete dislocation) or dislocation

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T or F. Trauma (especially axial loading) may damage the intervertebral disks and are always associated with injury to the spinal cord itself.

False - these injuries are to connective or skeletal tissue of the vertebral column and may or may not be associate with injury to the spinal cord itself

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The ___ region accounts for over ___ of all spinal injuries, with the ___/___ (C-1/C-2) joint being most frequently involved.

cervical ; half ; atlas/axis

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Why is C-7 also injured frequently?

Because it is located at the transition between the flexible cervical spine and the more rigid thoracic spine

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The ___ area (L-5/S-1) is likewise injured because the ___ immobilizes the ___ spine.

lumbosacral ; pelvis ; sacral

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The spinal cord ends at the ___/___ region.

L-1/L-2

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What does a concussion of the cord cause?

Temporary and transient disruption of cord fuction

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What is the resolution of a cord contusion and its associated S/S?

Likely to take longer than is the case with a concussion

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When might spinal cord compression occur?

Secondary to the displacement of vertebra, through herniation of the intervertebral disk, from displacement of vertebral bone fragment, or from swelling of adjacent tissue.

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What are cord lacerations likely to result in?

Hemorrhage into the cord tissue
Swelling due to the injury
Disruption of some portions of the cord and their associated communication pathways

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What is a cord transection?

Injury that partially or completely severs the spinal cord

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What are the results of transection injuries below the beginning of the thoracic spine?

Incontinence

Paraplegia

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What are the results of transection injuries to the cervical spine?

Quadriplegia
Incontinence
Partial/complete respiratory paralysis

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What is the condition caused by bony fragments or pressure compressing the arteries that perfuse the anterior cord?

Anterior cord syndrome

What do anterior cord syndrome injuries usually involve?

Loss of motor function | Sensation to pain, light touch, and temperature below the injury site

What is an anterior cord syndrome patient likely to retain?

Motion Positional Vibration sensation

What are the S/S of spinal injury?

- Paralysis of the extremities - Pain with and without movement - tenderness along the spine - Impaired breathing - Spinal deformity - Priapism - Posturing - Loss of bowel or bladder control - Nerve impairment to extremities

What are the types of primary and secondary spinal cord injuries?

- Concussion - Contusion - Compression - Laceration - Hemorrhage - Transection

What is the condition usually related to hyperextension of the cervical spine that results in motor weakness, usually in the upper extremities and possible bladder dysfunction?

Central cord syndrome

What is the conditional caused by partial cutting of one side of the spinal cord resulting in sensory and motor loss to that side of the body?

Brown-Sequard syndrome

Why is pain and temperature perception lost on the opposite (contralateral) side of the body in Brown-Sequard syndrome?

Because of the switching of the associated nerves that occurs as they enter the spinal cord

What condition occurs when nerve roots at the lower end of the spinal cord are compressed, interrupting sensation and movement?

Cauda equina syndrome

What results when injury to the spinal cord disrupts the brain's ability to exercise control over the body?

Neurogenic (or spinal-vascular) shock

Lack of ___ tone permits the ___ and ___ to dilate, expanding the ___ space, resulting in a relative hypovolemia.

sympathetic ; arteries ; veins ; vascular

How does a patient in neurogenic shock present?

- Slow heart rate - Low BP - Shocklike symptoms (cool, moist, and pale skin) above the cord injury - Warm, dry, flushed skin below the injury - Priapism in male

What is the treatment for neurogenic shock?

Bolus of isotonic solution 20 mL/kg (200 mL initially) Atropine - 0.5 to 1 mg every 3 to 5 minutes Dopamine - 2 to 20 mcg/kg

What is the condition associated with the body's adjustment ot the effects of neurogenic shock; presentation includes sudden hypertension, bradycardia, pounding headache, blurred vision, and sweating/flushing of the skin above point of injury?

Autonomic hyperreflexia syndrome

Autonomic hyperreflexia syndrome is most commonly associated with injuries at or above ___.

T-6

You should test ___ and ___ function for the lower extremities by (1) placing your hand against the ball of the patient's foot and have him push firmly against it (plantar flexion, S-1, S-2) then (2) place your hand on top of the toes and have the patient ___ the toes and foot upwards (___, L-5)

motor ; sensory ; pull ; dorsiflexion

How to you test for Bainski's sign?

Stroke the lateral aspect of the bottom of the foot and watch for movement of the toes and great toe

Fanning of the toes and ___ (lifting) of the great toe is a positive sign and suggest injury along the ___ (descinding spinal) tracts.

dorsiflexion ; pyramidal

What might a patient with midcervical spine injury present with?

"Hold-up" position - patient's arms rise to a position above the shoulders and head because the injury paralyzes the adductor and extensor muscles while the patient maintains control over the abductors and flexors

What is the study that proposed, validated, and is used by emergency physicians to determine which patients need spinal x-rays and which do not?

National Emergency X-Radiography Utilization Study (NEXUS)

What three conditions must be met to discontinue spinal precautions?

- Patient is alert and fully oriented; not intoxicated or under the influence of drugs (including alcohol); has GCS of 15; and not significantly affected by the "fight-or-flight" response - Patient is free of significant distracting injuries or symptoms such as a fracture, joint injury, abdominal pain, or dyspnea - Patient is free of any S/S of spinal injury

When should a helmet be removed?

- Helmet does not immobilize the patient's head within - Cannot securely immobilize the helmet to the long spine board - Helmet prevents airway care - Helmet prevent assessment of anticipated injuries - There are (or you anticipate) airway/breathing problems - Helmet removal will not cause further injury

Routine use of ___ for spinal injury is no longer recommended.

steroids

How is hypovolemia frequently treated?

- Fluid challenge - Followed by careful use of vasopressor such as dopamine - Slow heart rate treated with atropine to reduce any parasympathetic stimulation

The most common sites of axial loading for lifting injuries and heel-first falls are located between:

T-12 and L-2

During a trauma assessment you notice that a patient has no sensation below the lower border of the rib cage. This would suggest spinal pathology between which vertebral areas?

T-4 and T-10

Which of the following vital signs would most likely indicate a potential spinal cord injury?

Hypotension, bradycardia, and shallow respirations

For which of the following patients would the anticholinergic agent atropine be best suited. A patient:

with an injury to the upper spinal cord

The primary management objective in a patient with a suspected spinal cord injury is to:

maintain the patient in a neutral, in-line position

Priapism is defined as:

A sustained erection of the penis

Which of the following statements regarding cervical collars is true?

They serve as an adjunct to full cervical immobilization

All of the following are S/S of spinal shock except: a. priapism b. hypertension c. loss of bladder control d. flaccid paralysis

b. hypertension

Which of the following best defines spinal shock?

temporary insult to the cord that affects the body below the level of the injury

When a neuromuscular blocker is to be given to a patient, a(n) ___ should be administered first.

sedative/hypnotic

Feed or breed is which system?

Parasympathetic

Fight or flight is which system?

Sympathetic

C1 is also known as?

Atlas

Which part of the spine allows for wide range of motion for head to move and pivot?

C2 is also known as?

Axis

What is the odondoid process?

Rises through C1 to keep spine in line

What does C6/7 control?

Fingers and hands | Biceps

What does C3 and above control?

Respiratory

What does C4 control?

Diaphragm - results in paralysis

If paralyzed waist down, break might have occurred where?

T10

If paralyzed waist up, break might have occurred where?

Where is T4 located?

Nipple line

Where is T10 located?

Umbilicus

Which shock usually resolves within 24 hours?

Neurogenic shock

What is the presentation for neurogenic hypotension?

BP between 80-100 | Warm, dry skin, bradycardia

What is the proper way to secure a patient to back board?

Torso Head Legs Arms

What is methylprednisolone used for?

To reduce edema and inflammation within spine

Spinal Trauma Flashcards

(75 cards)