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