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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. Men:Women = 4:1 - Mean age 40 years - Occurs on weekends / holidays
PE Findings: Sacral Sparing
Spinal Cord Injuries
C8 - T1
TLS Flexion-distraction

2. Deltoid (Arm Abduction) Biceps (Elbow Flexion)
PE Findings: Sacral Sparing
Radiculopathy
C5 - C6
T9 - T12

3. Hand intrinsics (Finger Abduction) Flexor Digitorum Profundus (Hand Grasp)
Thoraco-lumbar Junction
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
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

4. roots of phrenic nerve (supplying diaphragm) emerges at C3-C5 - Intubate any injury above C5
PE Findings: Areflexia
PE Findings: Respiratory Dysfunction
L2 - L4
Central Cord Injury

5. Abdominal Muscles
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
PE Findings: Sacral Sparing
Cauda Equina Syndrome
T9 - T12

6. Tibialis Anterior (Ankle dorsiflexion)
Spinal Cord Injuries
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
C7 - C8

7. Persistent irrection - Implies a complete spinal cord injury
S1 - S2
PE Findings: Priapism
TLS Flexion-distraction
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

8. 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
T9 - T12
L2 - L4
L1 - L3

9. 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
C6 - C7
Cauda Equina Syndrome
Myelopathy

10. Pain seeming to radiate from the spine to extend outward - Due to a single spinal nerve root irritation
Radiculopathy
Compression Fracture
PE Findings: Respiratory Dysfunction
Cauda Equina Syndrome

11. 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
C8 - T1
L4 - S2
Cervical Burst Fracture
TLS fracture-dislocation

12. Canadian C-Spine Criteria (3)
MVA
Indications for C-Spine Xrays
L4 - L5
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

13. Bladder
Compression Fracture
Indications for C-Spine Xrays
C1 Fx - Atlas
S2 - S4

14. Injury to C/T spinal cord -> Peripheral sympathetic denervation - Patients are warm - peripherally vasodilated - hypotensive - relative bradycardia
Thoraco-lumbar Junction
L4 - S2
Neurogenic shock
MVA

15. 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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16. 45% of Spinal Cord Injuries due to this
L4 - L5
T9 - T12
MVA
L4 - S2

17. Most susceptable spinal region in MVA and falls from a height injuries
Cauda Equina Syndrome
L5 - S1
C7 - C8
Thoraco-lumbar Junction

18. Indicates spinal cord injury or nerve severing - No Bueno
C8 - T1
PE Findings: Areflexia
S1 - S2
Clay-Shoveler's Fracture

19. 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
Myelopathy
PE Findings: Priapism
Anterior cord injury
C2 Fx - Axis

20. Functional disturbance and/or pathological change in the spinal cord - Due to a spinal cord lesion - stenosis - or compression
C8 - T1
Myelopathy
C2 Fx - Axis
Spinal Cord Injuries

21. Controversial - ______ infusion with acute blunt SCI can improve both motor/sensory function if started right away
TLS Axial burst fracture
C8 - T1
Anterior cord injury
Anal Sphincter (voluntary rectal tone) Corticosteroid use

22. 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
MVA
Thoraco-lumbar Junction
Radiculopathy
TLS Flexion-distraction

23. Caused by direct blow to top of head - Outward displacement of lateral masses of ___
TLS Flexion-distraction
C7 - C8
C1 Fx - Atlas
PE Findings: Respiratory Dysfunction

24. Complete neurologic lesion as the absence of sensory and motor function below the level of injury - Minimal chance of recovery
TLS fracture-dislocation
Central 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
Complete Cord Injury

25. Extensor hallucis longus (Big toe extension)
Radiculopathy
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
L5 - S1
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

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

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27. Gastrocnemius (Ankle plantar flexion)
PE Findings: Respiratory Dysfunction
S1 - S2
Importance of ABDCE's in SCIs
L4 - L5

28. Hyperextension injuries - disruption of blood flow to the spinal cord - cervical spinal stenosis - Quadriparesis (Upper > Lower) - Some loss of pain / temp - Good prognosis
T9 - T12
PE Findings: Sacral Sparing
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Central Cord Injury

29. Test anogenital reflexes -> ______ with preservation o fthe reflexes denotes an incomplete spinal cord level - even if patient has complete sensory/motor loss
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
PE Findings: Sacral Sparing
Spinal Cord Injuries
C6 - C7

30. NEXUS C-Spine Criteria (5)
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
C5 - C6
Myelopathy
L2 - L4

31. 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
PE Findings: Respiratory Dysfunction
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
S1 - S2

32. 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
Brown Sequard Injury
Anal Sphincter (voluntary rectal tone) Corticosteroid use
PE Findings: Respiratory Dysfunction
Hangman's Fracture

33. Triceps (Elbow extension)
L1 - L3
C7 - C8
Importance of ABDCE's in SCIs
Central Cord Injury

34. Caused by a direct axial blow - Vertebral fragments displaced in all directions
Cervical Burst Fracture
PE Findings: Respiratory Dysfunction
Hangman's Fracture
MVA

35. Illiopsoas (Hip Flexion)
PE Findings: Priapism
L1 - L3
TLS fracture-dislocation
L5 - S1

36. Chest Muscles
T2 - T7
Anterior cord injury
L2 - L4
Spinal Shock

37. Caused by significant external forces - frequently involve other C-spine injuries - Dens projection
C2 Fx - Axis
Indications for C-Spine Xrays
TLS fracture-dislocation
PE Findings: Respiratory Dysfunction

38. 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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39. Quadriceps (Knee 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
C1 Fx - Atlas
Thoraco-lumbar Junction
L2 - L4

40. 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
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Brown Sequard Injury
L5 - S1
TLS Flexion-distraction

41. Peripheral nerve injury - Variable motor and sensory loss in the lower extremites - sciatica - bowel/bladder dysfunction - 'saddle anesthesia' - Good prognosis
Cauda Equina Syndrome
TLS Axial burst fracture
Thoraco-lumbar Junction
TLS Flexion-distraction

42. 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
Hangman's Fracture
Indications for C-Spine Xrays
Radiculopathy
PE Findings: Sacral Sparing

43. Hamstrings (Knee flexion)
Brown Sequard Injury
L4 - S2
TLS Flexion-distraction
Spinal Cord Injuries

44. Extensor Carpi Radialis (Wrist extension)
C6 - C7
Importance of ABDCE's in SCIs
PE Findings: Sacral Sparing
Cauda Equina Syndrome