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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. 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
Importance of ABDCE's in SCIs
MVA
Cervical Burst Fracture
2. Injury to C/T spinal cord -> Peripheral sympathetic denervation - Patients are warm - peripherally vasodilated - hypotensive - relative bradycardia
Neurogenic shock
L5 - S1
C8 - T1
C1 Fx - Atlas
3. 45% of Spinal Cord Injuries due to this
T2 - T7
C1 Fx - Atlas
MVA
Thoraco-lumbar Junction
4. Hamstrings (Knee flexion)
PE Findings: Respiratory Dysfunction
L4 - S2
PE Findings: Priapism
Importance of ABDCE's in SCIs
5. Fx of both pedicles of C2 - Body of C2 displaces anteriorly on C3
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6. 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
TLS fracture-dislocation
Anterior cord injury
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
Clay-Shoveler's Fracture
7. Pain seeming to radiate from the spine to extend outward - Due to a single spinal nerve root irritation
S2 - S4
MVA
Radiculopathy
Cauda Equina Syndrome
8. 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
S2 - S4
Importance of ABDCE's in SCIs
TLS Axial burst fracture
PE Findings: Priapism
9. Indicates spinal cord injury or nerve severing - No Bueno
PE Findings: Areflexia
Brown Sequard Injury
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
PE Findings: Respiratory Dysfunction
10. Test anogenital reflexes -> ______ with preservation o fthe reflexes denotes an incomplete spinal cord level - even if patient has complete sensory/motor loss
S2 - S4
PE Findings: Sacral Sparing
Anterior cord injury
Myelopathy
11. Gastrocnemius (Ankle plantar flexion)
S2 - S4
C2 Fx - Axis
PE Findings: Sacral Sparing
S1 - S2
12. 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 ->
Spinal Shock
T2 - T7
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
Complete Cord Injury
13. roots of phrenic nerve (supplying diaphragm) emerges at C3-C5 - Intubate any injury above C5
C1 Fx - Atlas
L2 - L4
Radiculopathy
PE Findings: Respiratory Dysfunction
14. 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
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
TLS fracture-dislocation
Clay-Shoveler's Fracture
15. Deltoid (Arm Abduction) Biceps (Elbow Flexion)
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
Hangman's Fracture
C5 - C6
C6 - C7
16. Persistent irrection - Implies a complete spinal cord injury
PE Findings: Priapism
MVA
Hangman's Fracture
Spinal Shock
17. 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
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18. Men:Women = 4:1 - Mean age 40 years - Occurs on weekends / holidays
Central Cord Injury
L1 - L3
Importance of ABDCE's in SCIs
Spinal Cord Injuries
19. Bladder
PE Findings: Sacral Sparing
Indications for C-Spine Xrays
Central Cord Injury
S2 - S4
20. Canadian C-Spine Criteria (3)
S2 - S4
PE Findings: Sacral Sparing
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
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
21. Abdominal Muscles
MVA
Cauda Equina Syndrome
T9 - T12
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
22. Tibialis Anterior (Ankle dorsiflexion)
L5 - S1
L4 - L5
PE Findings: Sacral Sparing
L2 - L4
23. 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
Importance of ABDCE's in SCIs
MVA
Brown Sequard Injury
Complete Cord Injury
24. Extensor hallucis longus (Big toe extension)
C7 - C8
C8 - T1
L2 - L4
L5 - S1
25. NEXUS C-Spine Criteria (5)
L1 - L3
Anal Sphincter (voluntary rectal tone) Corticosteroid use
Clay-Shoveler's Fracture
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
26. Chest Muscles
T2 - T7
PE Findings: Areflexia
Cervical Burst Fracture
T9 - T12
27. Caused by intense flexion against a contracted posterior erector spinal muscle - Avulsion fx of the lower cervical spinous processes (C7 especially)
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28. 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
Spinal Cord Injuries
Compression Fracture
PE Findings: Areflexia
C8 - T1
29. Caused by significant external forces - frequently involve other C-spine injuries - Dens projection
TLS Axial burst fracture
Anterior cord injury
C2 Fx - Axis
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
30. Caused by a direct axial blow - Vertebral fragments displaced in all directions
Neurogenic shock
Cervical Burst Fracture
Hangman's Fracture
Central Cord Injury
31. Caused by direct blow to top of head - Outward displacement of lateral masses of ___
PE Findings: Sacral Sparing
C6 - C7
C1 Fx - Atlas
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
32. Most susceptable spinal region in MVA and falls from a height injuries
Thoraco-lumbar Junction
Spinal Cord Injuries
L4 - L5
Central Cord Injury
33. 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
L5 - S1
Indications for C-Spine Xrays
L4 - L5
C2 Fx - Axis
34. Extensor Carpi Radialis (Wrist extension)
TLS Flexion-distraction
TLS fracture-dislocation
PE Findings: Sacral Sparing
C6 - C7
35. 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
Compression Fracture
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
PE Findings: Areflexia
T9 - T12
36. Controversial - ______ infusion with acute blunt SCI can improve both motor/sensory function if started right away
Anal Sphincter (voluntary rectal tone) Corticosteroid use
Importance of ABDCE's in SCIs
PE Findings: Areflexia
Thoraco-lumbar Junction
37. Hand intrinsics (Finger Abduction) Flexor Digitorum Profundus (Hand Grasp)
C8 - T1
Brown Sequard Injury
S1 - S2
L2 - L4
38. Triceps (Elbow extension)
Indications for C-Spine Xrays
C7 - C8
L4 - S2
TLS Axial burst fracture
39. Functional disturbance and/or pathological change in the spinal cord - Due to a spinal cord lesion - stenosis - or compression
Compression Fracture
Myelopathy
C8 - T1
Indications for C-Spine Xrays
40. Complete neurologic lesion as the absence of sensory and motor function below the level of injury - Minimal chance of recovery
S2 - S4
Complete Cord Injury
PE Findings: Areflexia
Spinal Shock
41. Illiopsoas (Hip Flexion)
L4 - L5
S1 - S2
Brown Sequard Injury
L1 - L3
42. Peripheral nerve injury - Variable motor and sensory loss in the lower extremites - sciatica - bowel/bladder dysfunction - 'saddle anesthesia' - Good prognosis
Thoraco-lumbar Junction
Spinal Shock
Cauda Equina Syndrome
Central Cord Injury
43. Quadriceps (Knee extension)
L2 - L4
Brown Sequard Injury
TLS fracture-dislocation
Hangman's Fracture
44. 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
Indications for C-Spine Xrays
Myelopathy
Central Cord Injury
TLS Flexion-distraction