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