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M6 13-005
Exam 15: Spinal cord Injuries
| Question | Answer |
|---|---|
| Major causes of spinal cord injury: | Automobile Motorcycle Diving Surfing Other athletic accidents Gunshot wounds |
| Flexion injury | seen with rapid deceleration injuries, whiplash. |
| Extension injury | seen with rapid deceleration injuries, whiplash |
| Flexion rotation injury | twisting of the spinal cord. |
| Compression injury | Stacked down |
| Pathophysiological changes: | Damage to the spinal cord ranges from transient concussion, contusion, laceration, compression to complete transection of the cord |
| Complete cord injury or total transaction (Symptoms) | All voluntary movement below the level of injury is lost. |
| Incomplete or partial transaction (Symptoms) | Symptoms will vary. |
| If the spinal cord is completely transected | there is total sensory loss and motor paralysis below level of the injury. If damage is minimal some function may be maintained: |
| Cervical spinal cord injuries will produce | tetraplegia--loss of function of all four extremities. |
| Injuries to the thoracic spinal cord below the level of T1 will produce | paraplegia; paralysis of the lower extremities. |
| Loss of sweating and vasomotor tone below the level of the | cord lesion |
| areflexia (Spinal shock) | sudden depression of reflex activity below the level of injury. |
| areflexia (Spinal shock) happens | A complete loss of motor, sensory, reflex and autonomic activity below the level of the lesion. Usually occurs within 30-60 minutes of injury. |
| Autonomic dysreflexia: (Hyperreflexia) | an exaggerated sympathetic nervous system response. Occurs in patients with cord injuries at T6 and above. It can occur suddenly at any time after spinal shock subsides. |
| Factors that will precipitate autonomic dysreflexia | Impacted feces. Full bladder. Labor and delivery. |
| Areflexia resolves | itself |
| Dysreflexia resolves | Spontaneously |
| Dysreflexia Clinical Signs | Severe Bradycardia. Hypertension (systolic pressure up to 300mm Hg). Severe pounding headache. Flushed skin with gooseflesh (Piloerection). |
| Uncontrolled autonomic dysreflexia is a | medical emergency that requires immediate treatment to prevent a stroke, seizures, or death. |
| Methods used to evaluate spinal cord injuries: Dx Tests | History of trauma. Neurological exam. X-ray of the spinal column--possible MRI, CT scan. Spinal tap or myelogram may be done to detect occlusion. |
| Cervical spine (Injury associated manifestations) | tetraplegia with residual function depending on involvement of specific cervical segments. |
| C1-C3 | movement in neck and above: |
| Injury to C1-C3 results in | 1) Loss of innervations to diaphragm. 2) Absence of independent respiratory function. |
| Above C4 | complete quadriplegia, complete dependence. |
| Injury above C4 results in | 1) Sensation and movement in neck and above. 2) May be able to breathe without a ventilator. |
| C4-C5 | some shoulder movement possible, requires respiratory support. |
| Injury to C4-C5 results in | 1) C5: full neck, partial shoulder, back, biceps; gross elbow. 2) Inability to roll over or use hands; decreased respiratory reserve. |
| C6 / C7 / C8 | incomplete quadriplegia- some elbow, arm and wrist movement. No sensation below midchest. |
| C6 | shoulder and upper back abduction and rotation at shoulder. |
| C7 - C8 | all triceps to elbow extension, finger extensors and flexors. |
| C6 injury results in | a) Full biceps to elbow flexion, wrist extension, weak grasp of thumb. b) Decreased respiratory reserve. |
| C7 - C8 | all triceps to elbow extension, finger extensors and flexors. |
| C7 - C8 injury results in | a) Good grasp with some decreased strength. b) Decreased respiratory reserve. |
| Cervical Spine | C1-C8 |
| Thoracic Spine | T1-T12 |
| T1-T6 | paralysis below the waist with control of hands |
| T1-T6 injury results in | 1) Abdominal breathing: decreased respiratory reserve. 2) Full innervations of upper extremities, back. 3) Essential intrinsic muscles of hand; full strength and dexterity of grasp. 4) Decreased trunk stability. |
| T7 - T12 | full, stable thoracic muscles and upper back. |
| T7 - T12 injury results in | 1) Functional intercostals resulting in increased respiratory reserve. |
| Lumbar spine | L1-L5 |
| L 1-2 | Hip abduction impaired. No sensation below lower abdomen. |
| L 3-5 | Knee and ankle movement impaired. No sensation below upper thigh. |
| S 1-5 | bowel/bladder dysfunction, variable motor and sensory loss in lower extremities and perineum. |
| Foremost priority in spinal injury | Airway, breathing, Circulation. |
| Crutchfield tongs | burr in the skull holes are required for insertion. |
| Gardner-Wells tongs | burr holes not needed |
| Halo traction | burr holes are required for insertion. |
| A turning frame (Stryker or Foster) | is used to change the patient's position without changing alignment. |
Created by:
jtzuetrong
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