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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. Indicates spinal cord injury or nerve severing - No Bueno
TLS Axial burst fracture
Thoraco-lumbar Junction
Central Cord Injury
PE Findings: Areflexia

2. Functional disturbance and/or pathological change in the spinal cord - Due to a spinal cord lesion - stenosis - or compression
C8 - T1
Myelopathy
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
Indications for C-Spine Xrays

3. 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
L5 - S1
PE Findings: Sacral Sparing
TLS Axial burst fracture

4. Test anogenital reflexes -> ______ with preservation o fthe reflexes denotes an incomplete spinal cord level - even if patient has complete sensory/motor loss
Neurogenic shock
PE Findings: Sacral Sparing
Indications for C-Spine Xrays
Anal Sphincter (voluntary rectal tone) Corticosteroid use

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

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
Central Cord Injury
Anterior cord injury
L1 - L3
L4 - S2

7. Controversial - ______ infusion with acute blunt SCI can improve both motor/sensory function if started right away
Anterior cord injury
Anal Sphincter (voluntary rectal tone) Corticosteroid use
S2 - S4
L4 - S2

8. Chest Muscles
C8 - T1
C7 - C8
T2 - T7
Anterior cord injury

9. Caused by significant external forces - frequently involve other C-spine injuries - Dens projection
C2 Fx - Axis
C1 Fx - Atlas
TLS Flexion-distraction
Anal Sphincter (voluntary rectal tone) Corticosteroid use

10. Gastrocnemius (Ankle plantar flexion)
S2 - S4
Cervical Burst Fracture
C8 - T1
S1 - S2

11. Quadriceps (Knee extension)
S1 - S2
L2 - L4
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

12. Complete neurologic lesion as the absence of sensory and motor function below the level of injury - Minimal chance of recovery
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
PE Findings: Respiratory Dysfunction
C6 - C7
Complete Cord Injury

13. Triceps (Elbow extension)
C7 - C8
PE Findings: Respiratory Dysfunction
Thoraco-lumbar Junction
SCIWORA Spinal Cord Injury Without Radiologic Abnormality

14. Tibialis Anterior (Ankle dorsiflexion)
MVA
Myelopathy
L4 - L5
PE Findings: Sacral Sparing

15. Injury to C/T spinal cord -> Peripheral sympathetic denervation - Patients are warm - peripherally vasodilated - hypotensive - relative bradycardia
T2 - T7
Indications for C-Spine Xrays
C5 - C6
Neurogenic shock

16. 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
S2 - S4
T9 - T12
Brown Sequard Injury

17. 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
Indications for C-Spine Xrays
L4 - S2
Thoraco-lumbar Junction
TLS fracture-dislocation

18. 45% of Spinal Cord Injuries due to this
C6 - C7
S2 - S4
Compression Fracture
MVA

19. 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
Anal Sphincter (voluntary rectal tone) Corticosteroid use
PE Findings: Sacral Sparing

20. Extensor Carpi Radialis (Wrist extension)
C6 - C7
Spinal Shock
C8 - T1
Spinal Cord Injuries

21. roots of phrenic nerve (supplying diaphragm) emerges at C3-C5 - Intubate any injury above C5
C7 - C8
L1 - L3
PE Findings: Respiratory Dysfunction
T2 - T7

22. Abdominal Muscles
T9 - T12
TLS fracture-dislocation
Anal Sphincter (voluntary rectal tone) Corticosteroid use
Brown Sequard Injury

23. Bladder
TLS Axial burst fracture
S2 - S4
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
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

24. 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
Thoraco-lumbar Junction
S2 - S4
L4 - L5

25. 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
Brown Sequard Injury
S1 - S2
TLS Flexion-distraction
Myelopathy

26. 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
Brown Sequard Injury
Indications for C-Spine Xrays
Compression Fracture
Radiculopathy

27. Hamstrings (Knee flexion)
L4 - S2
Cervical Burst Fracture
S1 - S2
Importance of ABDCE's in SCIs

28. 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
L1 - L3
Clay-Shoveler's Fracture
Myelopathy

29. Canadian C-Spine Criteria (3)
L4 - L5
Complete Cord Injury
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: Priapism

30. Caused by direct blow to top of head - Outward displacement of lateral masses of ___
PE Findings: Respiratory Dysfunction
Spinal Shock
Complete Cord Injury
C1 Fx - Atlas

31. Peripheral nerve injury - Variable motor and sensory loss in the lower extremites - sciatica - bowel/bladder dysfunction - 'saddle anesthesia' - Good prognosis
C7 - C8
Compression Fracture
Cauda Equina Syndrome
TLS Axial burst fracture

32. 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

33. Hyperextension injuries - disruption of blood flow to the spinal cord - cervical spinal stenosis - Quadriparesis (Upper > Lower) - Some loss of pain / temp - Good prognosis
T2 - T7
Central Cord Injury
C1 Fx - Atlas
L4 - S2

34. 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 ->
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
Spinal Shock
C1 Fx - Atlas
Spinal Cord Injuries

35. Persistent irrection - Implies a complete spinal cord injury
PE Findings: Areflexia
TLS Flexion-distraction
PE Findings: Priapism
Neurogenic shock

36. Caused by a direct axial blow - Vertebral fragments displaced in all directions
Cervical Burst Fracture
Hangman'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
Complete Cord Injury

37. Most susceptable spinal region in MVA and falls from a height injuries
Myelopathy
Importance of ABDCE's in SCIs
S2 - S4
Thoraco-lumbar Junction

38. Men:Women = 4:1 - Mean age 40 years - Occurs on weekends / holidays
Spinal Cord Injuries
PE Findings: Areflexia
L4 - L5
C6 - C7

39. Pain seeming to radiate from the spine to extend outward - Due to a single spinal nerve root irritation
Radiculopathy
TLS fracture-dislocation
C2 Fx - Axis
C7 - C8

40. Extensor hallucis longus (Big toe extension)
L4 - S2
TLS fracture-dislocation
L5 - S1
Radiculopathy

41. 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
Cervical Burst Fracture
TLS fracture-dislocation
C5 - C6

42. Illiopsoas (Hip Flexion)
Spinal Cord Injuries
L1 - L3
T2 - T7
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

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

44. Deltoid (Arm Abduction) Biceps (Elbow Flexion)
Central Cord Injury
S2 - S4
Neurogenic shock
C5 - C6