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EM Spine Trauma
| Question | Answer |
|---|---|
| Area of greastest Spinal Trauma | cervical (55%) |
| Immediate Management of Spinal trauma | ABCs, immobilization, IV fluids, consider vasopressors, Consider steroids if non-penetratin injury within first 8 hours to reduce pressure on spinal cord |
| Persistent hypotension and bradycardia should raise concern for | neurogenic shock |
| Difficulties of Immobilization | airway compromise, aspiration, increased ICP, cutaneous pressure ulcers, iatrogenic pain, increased difficulty of patient handling, combativeness in intoxicated pts |
| Neurogenic Shock | Impairment of the descending sympathetic pathways in the spinal cord. Loss of vasomotor tone, loss of sympathetic innervation to the heart. Vasodilation leading to hypotension |
| Neurologic assessment | May become bradycardic or fail to become tachycardic in response to hypovolemia. Need vasopressors with moderate fluid replacement |
| Spinal Shock | Flaccidity and loss of reflexes after a spinal cord injury, variable state |
| Central Cord Syndrome | Disproportionately greater loss of motor power in the upper extremities than in the lower extremities. Varying sensory loss. Ligamentum flavum buckles into spinal cord causing a concussion or contusion to central cord (cord intact) |
| Anterior Cord Syndrome: Paraplegia and dissociated sensory loss with loss of pain and temperature sensation. Postrior column (position, vibration, deep pressure) preserved. Causes: | Due to infarction of the cord in the region supplied by the anterior spinal arteryAlso the result of disc herniation, bony fragment protrusion, cord contusion from cervical hyperflexion. Poorest prognosis of the incomplete injuries |
| Brown-sequard syndrome | Hemisection of the cord from penetrating injuries. Rare. Ipsilateral motor loss with loss of vibration, pressure, all proprioception as well as contralateral loss of pinprick, pain, temperature sensations |
| SCIWORA | spinal cord injury without evidence of radiographic abnormality. diagnosis of exclusion. Acute traumatic myelopathy despite nl imaging studies. More frequent in peds. Transverse atlantal ligament injury. |
| NEXUS criteria is used to | determine what image to order. Posterior midline cervical spine tenderness, intoxication, alertness, focal neurologic deficit, painful distracting injuries |
| Clinical indications for Thoracic or Lumbar Imaging | High force mechanisms, GCS<15, Pain or tenderness along spine, local signs of injury, neurologic deficit, previously identified spinal injury |
| WNL | we never looked |
| CT imaging | Diagnostic option, especially in high energy blunt trauma. Better sensitivity than plain films. Disadvantage of higher doses of radiation. (x-rays in obese pts are not usually enough to clear a c-spine; limited by body habitus cannot r/o fx) |
| Offers the best evaluation of the biomechanical integrity of the spine’s supporting ligaments, disc interspace, and vertebral artery patency | MRI. |
| Provides the only evaluation of the spinal cord itself (best when considering ligamentous injury and SCIWORA) | MRI. |
| C-Spine plain films | Normal 3 views: AP, Lateral, Odontoid |
| Step by Step C films | 1)adequacy: see C1-T1? odontoid- see entire dens and lateral borders of c1/c2. 2)AP: alignment, intervertebral spacing, fx. 3)Lateral 4 lines. 4)Soft tissues (<7mm @C2, <5mm at C3/C4) |
| Lateral 4 C-spine lines | 1. Anterior longitudinal ligament line, 2. Posterior longitudinal ligament line, 3. Spinolaminar line, 4. Spinous process line |
| Vertebral Fractures | Compression fx, Hyperflexion injuries |
| Injury of C3 Vetebrae and above | Typically lose diaphragm function and require a ventilator to breathe. |
| Injury of C4 Vertebrae | May have some use of biceps and shoulders, but weaker |
| Injury of C5 Vertebrae | May retain the use of shoulders and biceps, but not of the wrists or hands. |
| Injury of C6 Vertebrae | Generally retain some wrist control, but no hand function |
| Injury of C7 and T1 | Can usually straighten their arms but still may have dexterity problems with the hand and fingers. C7 is generally the level for functional independence. |
| Weakness on one side of the body and loss of sensation on the opposite side of the body is consistent with what diagnosis? | Brown-Sequard Syndrome. Hemisection of the cord from penetrating injuries |
| Spinal cord injury without evidence of radiographic abnormality is AKA SCIWORA. It is more common in which population? Which tissue is injured? | More frequent in pediatric population. Transverse atlantal ligament injury. Diagnosis of exclusion. |
Created by:
ltm12