Spinal

Question 1

What mechanisms of injury should spinal care be considered in?

Answer 1

• Major trauma
• Multiple injuries
• High speed injuries
• Falls
• Sporing injuries
• Head injuries
• ?All unresponsive patients

Question 2

What is the Three Column concept?

Answer 2

• Anterior
• Middle
• Posterior

Question 3

What is transverse Spinal cord damage?

Answer 3

• Complete tearing of the spinal cord, no signals are getting through

Question 4

Brown Sequard Syndrome

Answer 4

• Most common from penetrating injuries
• Can be caused by tumour and injection
• Contralateral loss of pain and temperature sensation

Question 5

Anterior Cord syndrome

Answer 5

• Anterior section of the cord, causes occlusion of the artery
• Loss of motor control
• Sensations are maintained
• This is how your body knows where your limbs are, perception of them

Question 6

Posterior cord syndrome

Answer 6

• Loss of touch and temperature.

Question 7

Cauda Equina syndrome

Answer 7

• Numb bum
• Weakness of the legs
• Loss of bladder and bowl control
• Excluded from treat and refer guidelines must be transported

Question 8

6 ps of spinal cord injury

Answer 8

• Paraesthesia
• Pain
• Paralysis
• Poikilothermia
• Priapism
  o Uncontrolled erection
• Paradoxical respirations
  o Opposite respirations. So when they breath out chest looks inflated

Question 9

What is Spinal shock?

Answer 9

• Temporal loss of sensation, pain, motor control.

Question 10

Neurogenic shock

Answer 10

• Occurs when the nervous system is no longer functioning properly
• Causes
  o Trauma to spinal cord
  o Epidural goes wrong
• It is the loss of vascular tone and the pooling of peripheral blood
  o The loss of sympathetic tone
   This sympathetic tone on blood vessels is there to maintain blood pressure and allow flow.
  o The loss of tone means that as blood hits the artier of vein walls it will lose its momentum due to the loss of tone like a limp trampoline causing blood to pool and not move around the body as freely and not perfusing tissues and organs as needed.
• All of this lack of perfusion will reduce cardiac output. As les return of blood to the heart = reduce SV = reduce C0.
• The sympathetic nervous system also controls HR, this means that a reduce in HR will also cause a further reduction in CO.
• This all leads to a shutdown in oxygen delivery.
• Symptoms would be as follows
  o Alt conscious state
  o Decrease urine output
  o Organ dysfunction
  o Bradycardia – key symptom of neurogenic shock
  o Warm skin – due to the dilation of all blood vessels, this is diverting blood from vital organs

Question 11

• Treatment for neurogenic shock

Answer 11

o Pressor that clamp back down the blood vessels
o IV fluids to maintain fluid volume to help push blood through the system
 ↑ Both help increase BP
o Atropine
 Blocking parasympathetic nervous system increase fight or flight response
• This will cause an increase in HR to increase C0 to improve the pumping of blood throughout the cardiovascular system.

Question 12

What are Cervical spine fractures a result of?

Answer 12

• Hyper flexion
• Hyperextension
• Flexion- rotation
• Vertebral compression
• Lateral flexion
• Distraction- pulled and stretched beyond normal limits.

Question 13

• Compression fractures

Answer 13

o Most common type of vertebral fracture, partially seen in people with bone disease.
o Loss of height of the anterior part of the vertebral body with posterior cortex intact.
o Commonly results in a wedge fracture which is a subtype of compression.

Question 14

• Burst fracture.

Answer 14

o Extreme Trauma
o Vertebrae is crushed involving anterior, middle and sometimes posterior column.
o Bony fragments spread out and cause spinal injury

Question 15

• Distraction (flexion- distraction)

Answer 15

o Seen when the spine is made to flex forward placing excessive stress on the spine (e.g. MVA)
o Involves horizontal fractures of posterior and middle column
o Often includes separation of the posterior elements
 High chance of cord injury.

Question 16

• Dislocation

Answer 16

o Ligaments and/ or disc are stretched or torn
o Bones come out of alignment
o Occurs with compression of the body against a seat belt pulling apart the vertebrae.
o A dislocated vertebra can cause instability and spinal cord compression. Usually require stabilization surgery or a brace.

Question 17

• Fracture dislocation.

Answer 17

o Very unstable and requires surgical repair
o Usually involves all there columns
o A fracture of any of the aforementioned with vertebral displacement.

Question 18

• Spinal Cord Injury Without Radiological Abnormality (SCIWORA)

Answer 18

o Presents as a complete spinal cord injury (total loss of sensation and function below a lesion) or incomplete spinal cord injury (some sensation and/ or function is preserved.
o 90% of cases are children <18 years old.
o Typically involves the cervical spine, less commonly involves thoracolumbar spine.
o Can Occur in newborns following traumatic breech extraction
 Other causes can be MVA and falls (most common).

Question 19

o Central cord syndrome

Answer 19

 Central part of the spinal cord is damaged while external part remains intact
 Most common form of incomplete SCI
 Cause by hyperextension especially in elderly
 Motor and sensory functions in upper more than lower limbs. And reflexes are