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Emergency Medicine: Spinal Trauma

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. Extensor hallucis longus (Big toe extension)
Anal Sphincter (voluntary rectal tone) Corticosteroid use
C6 - C7
C5 - C6
L5 - S1

2. 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
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Brown Sequard Injury
Indications for C-Spine Xrays
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

3. Hand intrinsics (Finger Abduction) Flexor Digitorum Profundus (Hand Grasp)
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
C8 - T1
PE Findings: Priapism
TLS Axial burst fracture

4. NEXUS C-Spine Criteria (5)
PE Findings: Respiratory Dysfunction
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
Neurogenic shock
S1 - S2

5. Caused by significant external forces - frequently involve other C-spine injuries - Dens projection
Compression Fracture
C8 - T1
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

6. 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
S1 - S2
TLS Axial burst fracture
PE Findings: Priapism
PE Findings: Areflexia

7. Peripheral nerve injury - Variable motor and sensory loss in the lower extremites - sciatica - bowel/bladder dysfunction - 'saddle anesthesia' - Good prognosis
Cauda Equina Syndrome
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
MVA

8. Triceps (Elbow extension)
Neurogenic shock
C7 - C8
C5 - C6
TLS Axial burst fracture

9. Most susceptable spinal region in MVA and falls from a height injuries
Thoraco-lumbar Junction
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Spinal Shock
T2 - T7

10. Functional disturbance and/or pathological change in the spinal cord - Due to a spinal cord lesion - stenosis - or compression
Spinal Cord Injuries
Complete Cord Injury
C8 - T1
Myelopathy

11. 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
L5 - S1
Complete Cord Injury
TLS Flexion-distraction
Anterior cord injury

12. 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

13. Persistent irrection - Implies a complete spinal cord injury
C6 - C7
TLS Flexion-distraction
PE Findings: Priapism
TLS Axial burst fracture

14. Controversial - ______ infusion with acute blunt SCI can improve both motor/sensory function if started right away
PE Findings: Respiratory Dysfunction
Anal Sphincter (voluntary rectal tone) Corticosteroid use
C5 - C6
S1 - S2

15. Abdominal Muscles
L4 - S2
L2 - L4
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
T9 - T12

16. Tibialis Anterior (Ankle dorsiflexion)
TLS Axial burst fracture
L4 - L5
Indications for C-Spine Xrays
T2 - T7

17. Hyperextension injuries - disruption of blood flow to the spinal cord - cervical spinal stenosis - Quadriparesis (Upper > Lower) - Some loss of pain / temp - Good prognosis
Hangman's Fracture
Central Cord Injury
Radiculopathy
Cervical Burst Fracture

18. Caused by a direct axial blow - Vertebral fragments displaced in all directions
Clay-Shoveler's Fracture
L2 - L4
Indications for C-Spine Xrays
Cervical Burst Fracture

19. 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
TLS Flexion-distraction
C5 - C6
PE Findings: Sacral Sparing
TLS fracture-dislocation

20. Men:Women = 4:1 - Mean age 40 years - Occurs on weekends / holidays
Spinal Cord Injuries
MVA
PE Findings: Priapism
Complete Cord Injury

21. 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
Compression Fracture
Clay-Shoveler's Fracture
C5 - C6
TLS fracture-dislocation

22. 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 ->
Thoraco-lumbar Junction
PE Findings: Priapism
Radiculopathy
Spinal Shock

23. Illiopsoas (Hip 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
L4 - L5
Brown Sequard Injury
L1 - L3

24. Hamstrings (Knee flexion)
L4 - S2
S1 - S2
Spinal Cord Injuries
Spinal Shock

25. Canadian C-Spine Criteria (3)
L2 - L4
C1 Fx - Atlas
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
Compression Fracture

26. 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
MVA
C7 - C8
S2 - S4
Indications for C-Spine Xrays

27. Extensor Carpi Radialis (Wrist extension)
Spinal Shock
T9 - T12
C6 - C7
L1 - L3

28. Fx of both pedicles of C2 - Body of C2 displaces anteriorly on C3

29. Chest Muscles
L4 - S2
T9 - T12
T2 - T7
C2 Fx - Axis

30. 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
Central Cord Injury
TLS fracture-dislocation
Compression Fracture
C6 - C7

31. Deltoid (Arm Abduction) Biceps (Elbow Flexion)
C5 - C6
S2 - S4
Hangman's Fracture
Neurogenic shock

32. roots of phrenic nerve (supplying diaphragm) emerges at C3-C5 - Intubate any injury above C5
Clay-Shoveler's Fracture
Cauda Equina Syndrome
PE Findings: Respiratory Dysfunction
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

33. Caused by direct blow to top of head - Outward displacement of lateral masses of ___
Brown Sequard Injury
C1 Fx - Atlas
S2 - S4
T2 - T7

34. Pain seeming to radiate from the spine to extend outward - Due to a single spinal nerve root irritation
PE Findings: Areflexia
Anal Sphincter (voluntary rectal tone) Corticosteroid use
C7 - C8
Radiculopathy

35. Test anogenital reflexes -> ______ with preservation o fthe reflexes denotes an incomplete spinal cord level - even if patient has complete sensory/motor loss
L4 - L5
L5 - S1
PE Findings: Sacral Sparing
C8 - T1

36. 45% of Spinal Cord Injuries due to this
Complete Cord Injury
MVA
Radiculopathy
Hangman's Fracture

37. Injury to C/T spinal cord -> Peripheral sympathetic denervation - Patients are warm - peripherally vasodilated - hypotensive - relative bradycardia
TLS Flexion-distraction
Neurogenic shock
Radiculopathy
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

38. Bladder
PE Findings: Respiratory Dysfunction
S2 - S4
PE Findings: Sacral Sparing
MVA

39. 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
L4 - L5
Anal Sphincter (voluntary rectal tone) Corticosteroid use
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
L5 - S1

40. Quadriceps (Knee extension)
Thoraco-lumbar Junction
S2 - S4
L2 - L4
C5 - C6

41. Caused by intense flexion against a contracted posterior erector spinal muscle - Avulsion fx of the lower cervical spinous processes (C7 especially)

42. Indicates spinal cord injury or nerve severing - No Bueno
C6 - C7
PE Findings: Priapism
PE Findings: Areflexia
SCIWORA Spinal Cord Injury Without Radiologic Abnormality

43. Gastrocnemius (Ankle plantar flexion)
Radiculopathy
S1 - S2
Cervical Burst Fracture
PE Findings: Priapism

44. Complete neurologic lesion as the absence of sensory and motor function below the level of injury - Minimal chance of recovery
Central Cord Injury
S1 - S2
Complete Cord Injury
PE Findings: Respiratory Dysfunction