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Emergency Medicine: Spinal Trauma

Subjects : health-sciences, emergency-medicine

Instructions:

Answer 44 questions in 15 minutes.
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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. Hand intrinsics (Finger Abduction) Flexor Digitorum Profundus (Hand Grasp)
Anal Sphincter (voluntary rectal tone) Corticosteroid use
Spinal Cord Injuries
Spinal Shock
C8 - T1

2. Tibialis Anterior (Ankle dorsiflexion)
Cauda Equina Syndrome
Compression Fracture
L4 - L5
T2 - T7

3. Triceps (Elbow extension)
TLS Flexion-distraction
C7 - C8
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
Compression Fracture

4. 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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5. Most susceptable spinal region in MVA and falls from a height injuries
S1 - S2
Spinal Shock
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
Thoraco-lumbar Junction

6. Complete neurologic lesion as the absence of sensory and motor function below the level of injury - Minimal chance of recovery
Cervical Burst Fracture
Complete Cord Injury
C2 Fx - Axis
Compression Fracture

7. Quadriceps (Knee extension)
C5 - C6
L2 - L4
T9 - T12
C7 - C8

8. 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
S2 - S4
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Spinal Shock
Indications for C-Spine Xrays

9. 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
L4 - L5
C8 - T1
Anterior cord injury
L4 - S2

10. Caused by direct blow to top of head - Outward displacement of lateral masses of ___
T9 - T12
Complete Cord Injury
C1 Fx - Atlas
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

11. Canadian C-Spine Criteria (3)
Complete Cord Injury
L5 - S1
T2 - T7
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

12. 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
C8 - T1
Brown Sequard Injury
Anal Sphincter (voluntary rectal tone) Corticosteroid use
TLS Flexion-distraction

13. Men:Women = 4:1 - Mean age 40 years - Occurs on weekends / holidays
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
S1 - S2
Compression Fracture

14. Persistent irrection - Implies a complete spinal cord injury
L1 - L3
TLS Axial burst fracture
S1 - S2
PE Findings: Priapism

15. Bladder
S2 - S4
S1 - S2
C2 Fx - Axis
Radiculopathy

16. Test anogenital reflexes -> ______ with preservation o fthe reflexes denotes an incomplete spinal cord level - even if patient has complete sensory/motor loss
C2 Fx - Axis
Indications for C-Spine Xrays
TLS Flexion-distraction
PE Findings: Sacral Sparing

17. Injury to C/T spinal cord -> Peripheral sympathetic denervation - Patients are warm - peripherally vasodilated - hypotensive - relative bradycardia
C7 - C8
Compression Fracture
Neurogenic shock
C8 - T1

18. Peripheral nerve injury - Variable motor and sensory loss in the lower extremites - sciatica - bowel/bladder dysfunction - 'saddle anesthesia' - Good prognosis
Compression Fracture
Cauda Equina Syndrome
TLS Flexion-distraction
SCIWORA Spinal Cord Injury Without Radiologic Abnormality

19. Deltoid (Arm Abduction) Biceps (Elbow Flexion)
Spinal Shock
Indications for C-Spine Xrays
C5 - C6
PE Findings: Priapism

20. Extensor hallucis longus (Big toe extension)
S2 - S4
Spinal Cord Injuries
L2 - L4
L5 - S1

21. Illiopsoas (Hip Flexion)
C2 Fx - Axis
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
L1 - L3

22. Caused by a direct axial blow - Vertebral fragments displaced in all directions
C6 - C7
C5 - C6
PE Findings: Priapism
Cervical Burst Fracture

23. Gastrocnemius (Ankle plantar flexion)
S1 - S2
L1 - L3
Importance of ABDCE's in SCIs
C7 - C8

24. 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
C7 - C8
Cervical Burst Fracture
Anal Sphincter (voluntary rectal tone) Corticosteroid use
Brown Sequard Injury

25. 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
Clay-Shoveler's Fracture
PE Findings: Sacral Sparing
Radiculopathy

26. Functional disturbance and/or pathological change in the spinal cord - Due to a spinal cord lesion - stenosis - or compression
PE Findings: Areflexia
Myelopathy
Brown Sequard 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

27. 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 - L5
C7 - C8
Cervical Burst Fracture

28. Indicates spinal cord injury or nerve severing - No Bueno
Thoraco-lumbar Junction
PE Findings: Areflexia
Spinal Cord Injuries
Indications for C-Spine Xrays

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

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30. roots of phrenic nerve (supplying diaphragm) emerges at C3-C5 - Intubate any injury above C5
PE Findings: Respiratory Dysfunction
Anal Sphincter (voluntary rectal tone) Corticosteroid use
C2 Fx - Axis
S1 - S2

31. Extensor Carpi Radialis (Wrist extension)
Compression Fracture
S2 - S4
MVA
C6 - C7

32. 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
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
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Clay-Shoveler's Fracture

33. 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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34. 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
C7 - C8
Thoraco-lumbar Junction
Complete Cord Injury
TLS fracture-dislocation

35. 45% of Spinal Cord Injuries due to this
Cauda Equina Syndrome
C5 - C6
L4 - L5
MVA

36. Hyperextension injuries - disruption of blood flow to the spinal cord - cervical spinal stenosis - Quadriparesis (Upper > Lower) - Some loss of pain / temp - Good prognosis
C6 - C7
SCIWORA Spinal Cord Injury Without Radiologic Abnormality
Brown Sequard Injury
Central Cord Injury

37. Hamstrings (Knee flexion)
Compression Fracture
PE Findings: Areflexia
C6 - C7
L4 - S2

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 ->
C8 - T1
Hangman's Fracture
L5 - S1
Spinal Shock

39. 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
Myelopathy
Importance of ABDCE's in SCIs
PE Findings: Areflexia

40. Caused by significant external forces - frequently involve other C-spine injuries - Dens projection
Importance of ABDCE's in SCIs
Complete Cord Injury
Myelopathy
C2 Fx - Axis

41. Abdominal Muscles
T9 - T12
Cervical Burst Fracture
Spinal Shock
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

42. Controversial - ______ infusion with acute blunt SCI can improve both motor/sensory function if started right away
Cauda Equina Syndrome
Anal Sphincter (voluntary rectal tone) Corticosteroid use
Importance of ABDCE's in SCIs
TLS Axial burst fracture

43. Pain seeming to radiate from the spine to extend outward - Due to a single spinal nerve root irritation
C2 Fx - Axis
TLS fracture-dislocation
Radiculopathy
S1 - S2

44. Chest Muscles
T2 - T7
PE Findings: Sacral Sparing
Radiculopathy
Anal Sphincter (voluntary rectal tone) Corticosteroid use

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Emergency Medicine: Spinal Trauma

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