Flashcards in week 2 Deck (49):
what is autonomic dysreflexia?
- injury above T6 can get trigger of unchecked sympathic discharg.
- triggered by pain, infection, manythings
- Get HTN, diaphoresis, ALOC, seizures, bradycardia.
what is a wide predental space in adults in children?
Children >5 mm
soft tissue normals in adults and children
- C2 - 7 mm
- C3 - 5 mm
- C6 - 21 mm
C2 - 7 mm
C3- 5 mm
C6 - 14 mmm
what measurement helps diagnose atlantooccipital dissociation?
- Powers ratio. If >1 then suspect atlato-occipital dissociation injuries
- Measurement tip of basion to spinolaminar line over basion to anterior tubercle.
what is the pathophysiology of spinal shock and neurogenic shock?
spinal shock: peripheral neurons temporarily become non responsive to brain
- flaccid paralysis, bulbocavernosis reflex
neurogenic shock; disruption of autonomic sympathetic tone and get decreased SVR
- dx of exclusion, hypotn, brady, warm extremities.
What is the difference between flexion and ext tear drop #
flexion - more unstable, C5/6
Extension - C3, elderly, more stable, unstable in extension
what is clay shovelers #?
avulsion # of spinous process
Ddx of torticollis?
unilateral perched facet dislocation
If on c/s xr the distance between the lateral masses and odontoid are not equidistant what is ddx?
- Rotary subluxation c1 on c2
- C1 jefferson #
If the spinous process on AP done line up what dx to think?
unilateral perched facet
why do unilat perched facet happen more often in C/T spine?
- facets more horizontal and flat so can slip off where in L spine is more curved.
why is it uncommon to have a SC injury with hangmans #?
Spinal cord widest at C2 and # of both pedicles - splayed out doesnt impinge on SC
why would a # Lspine cause neuro deficits up to T4?
Artery of adamkiwics enters at L1 have branches that go up to T4. If there is descrepancy PE and known injury think vascular injury
Abn breathing in setting of spinal trauma - think what?
C3-5 - phrenic n. Diaphram
Horners syndrome - what is it and what level of SC injury would you see it?
- miosis, ptosis, anhidrosis
- C7-T2 - cervical sympathetic chain
what is the most common area of injury in the pharynoesophageal area?
cervical portion of esophagus
NG tubes in neck trauma?
not ideal, leave until intubated and can have direct viualisation - endoscopic guidence.
what imaging is needed if suspect esophageal injury?
Gastrogaffin study/contrast esophagraphy - water soluble contrast followed by barium study and then EGD (flexible endoscopy)
together 100% sn.
CTA not enough! sn 50% but would get initially anyway.
what is the most scary laryngeal injury?
fracture of cricoid cartilag - can lead to acute airway obstruction
massive SQ air is a hard sign why?
suggests larnygeal # and represents laryngealtracheal injury until proven otherwise
pain with tongue movement suggests what?
injury to hyoid b or larygneal cartilage
why is fiberoptic most ideal in suspected trachea injury?
can take a look down below the cords and see if disrupted.
- minimize completing a partial laryngeotracheal separation or creating a false passage.
what type of airway management is contraindicated in the suspected tracheal injury
- any supraglottic device.
- BVM, LMA,
what is the most common mechanism for blunt internal carotid a. injury?
- sudden forceful hyperextension and lateral rotation of the neck
- stretching of carotid a. overTP of upper cervical vert.
List 4 indications for CTA in neck trauma (blunt)
1. c spine #, c1-3 is strongest RF. transverse foramen # anywhere
2. Maxillary # - lefort II/III
3. Basilar skull #
4. Low GCS and no clear reason on CT - no TBI
get in all penetrating
what volume of pot void residual is concerning for neuro issues?
how sensitive is urinary retention for CES?
In transverse myelitis, the ____ cord region is affected in 60-70% of cases. The ____ spinal cord is rarely affected.
In transverse myelitis, the thoracic cord region is affected in 60-70% of cases. The Cervical spinal cord is rarely affected.
ddx transverse myelititis (TM)
- SEA (spinal epidural abcess)
- Epidural hematoma
- Primary or metastatic spinal neoplasm, spinal cord infarct
what is the yield of CSf analysis in TM?
normal in 40%
in 60% mild protein elevation
what disorder is assoc with Syringomyelia?
Arnold-Chiari I malformation (90%)
it may also result from SC trauma, compressive tumors or meningitis
what is the classic neurologic pattern of a syrinx?
- loss of pain temp
- preserved vibration, proprioception.
- "dissociative anesthesia" "capelike"
Syringomyelia may also cause a loss of the ability to feel extremes of hot or cold, especially in the hands. There is also a disorder that generally leads to a cape-like bilateral loss of pain and temperature sensation along the back and arms.:
neurologic deficits are the exception in ___
get fever, radicular symptoms/pain
pt comes in with back pain and you suspect cancer. approach to DI?
- XR and ESR.
- if abN then CT/MRI
MRI right away if neuro deficits but would still get XR
define Myelopathy, radiculopathy, neuropathy, myopathy
Myelopathy = spinal cord
Radiculopathy = nerve root
Neuropathy = peripheral nerve
Myopathy = muscle.
Why do neuropathies cause ascending weakness?
as conduction along the axon is disrupted, delay in transmission affects the the longer nerve axons resulting in ascending weakness.
What is the receptor at the NMJ? CNS?
NMJ = nicotinic receptors
CNS = muscarinic
what disease is the prototype for NMJ dieases?
What is a normal FVC?
What FVC (forced vital capacity) does ventilation have to happen?
NIF (negative inspiratory force) of less than ____ suggests need for intubation
15 cm H20
Dont rely on VBG. functional reserve can be severely dimished by time someone is hypercarbic or hypoxic
what is the prototypical motor neuron disease?
Amyotrophic lateral sclerosis
- has both upper and lower motor neuron dysfunction
what is the simplified pathophys of Myasthenia gravis, Botulism and organophosphates/cholinergic?
Myesthesnia = blockage of receptors by autoantibodies
Botulism - bind to pre-synaptic membrane prevent release of Ach --> decrease in amount of Ach released
Organophosphates - Bind acetylcholinesterase.
Accumulation of ACh at motor nerves causes overstimulation of nicotinic expression at the neuromuscular junction. eventually results in m. paralysis When there is an accumulation of ACh at autonomic ganglia this causes overstimulation of nicotinic expression in the sympathetic system.
Cholinergic drug = any of various drugs that inhibit, enhance, or mimic the action of the neurotransmitter acetylcholine, the primary transmitter of nerve impulses within the parasympathetic nervous system—i.e., that part of the autonomic nervous system that contracts smooth muscles, dilates blood vessels, increases bodily secretions, and slows the heart rate.
how is Lambert Eaton different than MG?
weakness is more pronounced at the beginning and then gets stronger as more Ach builds up in the synaptic cleft with each stimulation. MG gt weaker with more stimulation
what is the case of Lambert Eaton syndrom?
Paraneoplastic syndrome. 50% assc with sclc
Autoantibodies cause inadequte release from nerve terminals affecting both nicotinic and muscarinic receptors
Name 2 cholinesterase inhibitors
prevent breakdown of Ach and thus prolong activity at synaptic cleft
used as chronic Rx not in ED.
Test for MG is Edrophonium reversible acetylcholinesterase inhibitor.
what is the bacteria called that causes botulism?
toxin mediated or spores (infant or unclassified)
What is the mechanism of botulism toxin?
irreversibly binding to presynaptic membrane of peripheral and cranial nerves inhibiting the release of Ach at peripheral n. synapse