SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
Search
Test your basic knowledge |
Emergency Medicine: Spinal Trauma
Start Test
Study First
Subjects
:
health-sciences
,
emergency-medicine
Instructions:
Answer 44 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. Most damaging of all injuries - Compression - flexion - distraction - rotation - shearing forces -> failure of ALL 3 columns - Causes subluxation or dislocation - Grossly unstable spine T11 -> L2
L1 - L3
TLS fracture-dislocation
L4 - S2
C-Spine Xrays NOT needed if all 3 met:1. No high risk factors mandating x-rays (>65 years - dangerous MOI - presence of parasthesias) 2. Low risk factors allowing a safe assessment of ROM (simple rear-end MVC - patient able to sit up in ED - patient
2. Canadian C-Spine Criteria (3)
C-Spine Xrays NOT needed if all 3 met:1. No high risk factors mandating x-rays (>65 years - dangerous MOI - presence of parasthesias) 2. Low risk factors allowing a safe assessment of ROM (simple rear-end MVC - patient able to sit up in ED - patient
L4 - S2
Indications for C-Spine Xrays
C1 Fx - Atlas
3. Men:Women = 4:1 - Mean age 40 years - Occurs on weekends / holidays
Spinal Cord Injuries
PE Findings: Areflexia
L2 - L4
PE Findings: Respiratory Dysfunction
4. Most susceptable spinal region in MVA and falls from a height injuries
Thoraco-lumbar Junction
Indications for C-Spine Xrays
Compression Fracture
C1 Fx - Atlas
5. High speed MVC (>35 mph)- Fatal MVC- Ped vs Auto- Fall from >10 ft- Significant or serious closed head injury - Neuro signs/symptoms referable to C-Spine - Pelvic of multiple extremity injuries - ICH seen on CT
Central Cord Injury
Indications for C-Spine Xrays
PE Findings: Priapism
Complete Cord Injury
6. Serious spinal cord damage and disruption of tracts w/o a fx - Most common in children - Flexion - hyperextension - longitudinal distraction - and ischemia causing complete - severe - or partial cord lesions
S1 - S2
Spinal Shock
PE Findings: Areflexia
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
7. Gastrocnemius (Ankle plantar flexion)
S1 - S2
PE Findings: Areflexia
L4 - S2
MVA
8. Direct _____ compression - flexion of the cervical spine - Thrombosis of anterior spinal artery. - Complete paralysis below the lesion - loss of pain / temp sensation - Preservation of proprioception and vibratory function - Poor prognosis
Anterior cord injury
MVA
Spinal Cord Injuries
PE Findings: Sacral Sparing
9. The temporary loss or depression of spinal reflex activity that occurs below a complete or incomplete spinal cord injury - Loss of neuro function w/ this can cause an incomplete spinal cord injury to mimic a complete cord injury - Duration of days ->
Importance of ABDCE's in SCIs
Neurogenic shock
Spinal Shock
Complete Cord Injury
10. Persistent irrection - Implies a complete spinal cord injury
C5 - C6
PE Findings: Priapism
L4 - S2
Indications for C-Spine Xrays
11. Hamstrings (Knee flexion)
L4 - S2
C2 Fx - Axis
Anal Sphincter (voluntary rectal tone) Corticosteroid use
C8 - T1
12. Functional disturbance and/or pathological change in the spinal cord - Due to a spinal cord lesion - stenosis - or compression
C-Spine Xrays NOT needed if all 3 met:1. No high risk factors mandating x-rays (>65 years - dangerous MOI - presence of parasthesias) 2. Low risk factors allowing a safe assessment of ROM (simple rear-end MVC - patient able to sit up in ED - patient
C2 Fx - Axis
Myelopathy
Central Cord Injury
13. Transverse hemisection of the spinal cord - unilateral cord compression - Ipsilateral spastic paresis - loss of prorioception / vibratory senation - Contralateral loss of pain / temp sensations - Good prognosis
PE Findings: Areflexia
L5 - S1
C-Spine Xrays NOT needed if all 5 met: 1. Absence of midline cervical tenderness 2. Normal level of alertness and consciousness 3. No evidence of intoxication 4. Absence of focal neurologic deficit 5. Absence of painful distracting injury
Brown Sequard Injury
14. Controversial - ______ infusion with acute blunt SCI can improve both motor/sensory function if started right away
Anal Sphincter (voluntary rectal tone) Corticosteroid use
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
C-Spine Xrays NOT needed if all 3 met:1. No high risk factors mandating x-rays (>65 years - dangerous MOI - presence of parasthesias) 2. Low risk factors allowing a safe assessment of ROM (simple rear-end MVC - patient able to sit up in ED - patient
Central Cord Injury
15. Caused by seat belt-type injuries (particularly lap belt only) - Middle and Posterior column failure - Increased height and/or fx of posterior vertebral body - posterior opening of disc space - Chance fx - Unstable
Radiculopathy
TLS Flexion-distraction
Hangman's Fracture
Anal Sphincter (voluntary rectal tone) Corticosteroid use
16. Caused by significant external forces - frequently involve other C-spine injuries - Dens projection
C2 Fx - Axis
C6 - C7
C1 Fx - Atlas
T9 - T12
17. Bladder
PE Findings: Respiratory Dysfunction
S2 - S4
L2 - L4
Neurogenic shock
18. Hand intrinsics (Finger Abduction) Flexor Digitorum Profundus (Hand Grasp)
Compression Fracture
Myelopathy
C8 - T1
Clay-Shoveler's Fracture
19. NEXUS C-Spine Criteria (5)
Neurogenic shock
C6 - C7
Importance of ABDCE's in SCIs
C-Spine Xrays NOT needed if all 5 met: 1. Absence of midline cervical tenderness 2. Normal level of alertness and consciousness 3. No evidence of intoxication 4. Absence of focal neurologic deficit 5. Absence of painful distracting injury
20. Pain seeming to radiate from the spine to extend outward - Due to a single spinal nerve root irritation
Radiculopathy
Thoraco-lumbar Junction
C5 - C6
T2 - T7
21. Illiopsoas (Hip Flexion)
Thoraco-lumbar Junction
Compression Fracture
L1 - L3
S2 - S4
22. Triceps (Elbow extension)
C7 - C8
L4 - L5
Central Cord Injury
PE Findings: Priapism
23. Caused by direct blow to top of head - Outward displacement of lateral masses of ___
C1 Fx - Atlas
Cauda Equina Syndrome
Myelopathy
Anterior cord injury
24. Deltoid (Arm Abduction) Biceps (Elbow Flexion)
C5 - C6
L2 - L4
PE Findings: Respiratory Dysfunction
L4 - S2
25. Quadriceps (Knee extension)
Indications for C-Spine Xrays
Importance of ABDCE's in SCIs
L2 - L4
Complete Cord Injury
26. Any injury above C5 -> Intubation - Hypotension due to neurogenic/spinal shock - blood loss - cardiac injury - Blood loss should be presumed to be the caUse of hypotension until proven otherwise
27. Complete neurologic lesion as the absence of sensory and motor function below the level of injury - Minimal chance of recovery
Complete Cord Injury
Importance of ABDCE's in SCIs
C6 - C7
Compression Fracture
28. Abdominal Muscles
S1 - S2
T9 - T12
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
T2 - T7
29. Extensor Carpi Radialis (Wrist extension)
L5 - S1
Cauda Equina Syndrome
Brown Sequard Injury
C6 - C7
30. Extensor hallucis longus (Big toe extension)
C-Spine Xrays NOT needed if all 3 met:1. No high risk factors mandating x-rays (>65 years - dangerous MOI - presence of parasthesias) 2. Low risk factors allowing a safe assessment of ROM (simple rear-end MVC - patient able to sit up in ED - patient
L5 - S1
T9 - T12
Hangman's Fracture
31. Hyperextension injuries - disruption of blood flow to the spinal cord - cervical spinal stenosis - Quadriparesis (Upper > Lower) - Some loss of pain / temp - Good prognosis
Central Cord Injury
C2 Fx - Axis
Brown Sequard Injury
TLS Flexion-distraction
32. Caused by failure of the vertebral body under axial load - Both the anterior and middle columns fail - Retropulsion of bone/disc into canal -> Neuro damage - Unstable
TLS Axial burst fracture
L2 - L4
TLS Flexion-distraction
C8 - T1
33. Test anogenital reflexes -> ______ with preservation o fthe reflexes denotes an incomplete spinal cord level - even if patient has complete sensory/motor loss
MVA
L4 - L5
PE Findings: Sacral Sparing
Spinal Shock
34. Indicates spinal cord injury or nerve severing - No Bueno
PE Findings: Areflexia
C-Spine Xrays NOT needed if all 3 met:1. No high risk factors mandating x-rays (>65 years - dangerous MOI - presence of parasthesias) 2. Low risk factors allowing a safe assessment of ROM (simple rear-end MVC - patient able to sit up in ED - patient
Spinal Shock
PE Findings: Sacral Sparing
35. Fx of both pedicles of C2 - Body of C2 displaces anteriorly on C3
36. Chest Muscles
Importance of ABDCE's in SCIs
C5 - C6
Cervical Burst Fracture
T2 - T7
37. Peripheral nerve injury - Variable motor and sensory loss in the lower extremites - sciatica - bowel/bladder dysfunction - 'saddle anesthesia' - Good prognosis
Cauda Equina Syndrome
Spinal Shock
PE Findings: Areflexia
Neurogenic shock
38. roots of phrenic nerve (supplying diaphragm) emerges at C3-C5 - Intubate any injury above C5
PE Findings: Areflexia
Myelopathy
PE Findings: Priapism
PE Findings: Respiratory Dysfunction
39. Tibialis Anterior (Ankle dorsiflexion)
C-Spine Xrays NOT needed if all 3 met:1. No high risk factors mandating x-rays (>65 years - dangerous MOI - presence of parasthesias) 2. Low risk factors allowing a safe assessment of ROM (simple rear-end MVC - patient able to sit up in ED - patient
Neurogenic shock
L4 - L5
Radiculopathy
40. Caused by axial loading and flexion - with subsequent failure of the anterior column - Middle column remains intact - Stable unless > 50% decrease in vertebral height - unlikely to be directly responsible for neuro damage
Neurogenic shock
C5 - C6
Thoraco-lumbar Junction
Compression Fracture
41. Injury to C/T spinal cord -> Peripheral sympathetic denervation - Patients are warm - peripherally vasodilated - hypotensive - relative bradycardia
TLS Flexion-distraction
C6 - C7
C8 - T1
Neurogenic shock
42. 45% of Spinal Cord Injuries due to this
Brown Sequard Injury
Neurogenic shock
MVA
PE Findings: Respiratory Dysfunction
43. Caused by a direct axial blow - Vertebral fragments displaced in all directions
Cervical Burst Fracture
PE Findings: Respiratory Dysfunction
Compression Fracture
C8 - T1
44. Caused by intense flexion against a contracted posterior erector spinal muscle - Avulsion fx of the lower cervical spinous processes (C7 especially)