week 2 Flashcards
(49 cards)
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?
Adults >3mm
Children >5 mm
soft tissue normals in adults and children
Adults
- C2 - 7 mm
- C3 - 5 mm
- C6 - 21 mm
Child
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.