Question 1

Major causes of spinal cord injury:

Accepted Answer

Automobile
Motorcycle
Diving
Surfing
Other athletic accidents
Gunshot wounds

Question 2

Flexion injury

Accepted Answer

seen with rapid deceleration injuries, whiplash.

Question 3

Extension injury

Accepted Answer

seen with rapid deceleration injuries, whiplash

Question 4

Flexion rotation injury

Accepted Answer

twisting of the spinal cord.

Question 5

Compression injury

Accepted Answer

Stacked down

Question 6

Pathophysiological changes:

Accepted Answer

Damage to the spinal cord ranges from transient concussion, contusion, laceration, compression to complete transection of the cord

Question 7

Complete cord injury or total transaction (Symptoms)

Accepted Answer

All voluntary movement below the level of injury is lost.

Question 8

Incomplete or partial transaction (Symptoms)

Accepted Answer

Symptoms will vary.

Question 9

If the spinal cord is completely transected

Accepted Answer

there is total sensory loss and motor paralysis below level of the injury.  If damage is minimal some function may be maintained:

Question 10

Cervical spinal cord injuries will produce

Accepted Answer

tetraplegia--loss of function of all four 
extremities.

Question 11

Injuries to the thoracic spinal cord below the level of T1 will produce

Accepted Answer

paraplegia; paralysis of the lower extremities.

Question 12

Loss of sweating and vasomotor tone below the level of the

Accepted Answer

cord lesion

Question 13

areflexia (Spinal shock)

Accepted Answer

sudden depression of reflex activity below the level of injury.

Question 14

areflexia (Spinal shock) happens

Accepted Answer

A complete loss of motor, sensory, reflex and autonomic activity below the level of the lesion. Usually occurs within 30-60 minutes of injury.

Question 15

Autonomic dysreflexia: (Hyperreflexia)

Accepted Answer

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.

Question 16

Factors that will precipitate autonomic dysreflexia

Accepted Answer

Impacted feces. 
Full bladder.
Labor and delivery.

Question 17

Areflexia resolves

Accepted Answer

itself

Question 18

Dysreflexia resolves

Accepted Answer

Spontaneously

Question 19

Dysreflexia Clinical Signs

Accepted Answer

Severe Bradycardia.
Hypertension (systolic pressure up to 300mm Hg).
Severe pounding headache.
Flushed skin with gooseflesh (Piloerection).

Question 20

Uncontrolled autonomic dysreflexia is a

Accepted Answer

medical emergency that requires immediate treatment to prevent a stroke, seizures, or death.

Question 21

Methods used to evaluate spinal cord injuries: Dx Tests

Accepted Answer

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.

Question 22

Cervical spine (Injury associated manifestations)

Accepted Answer

tetraplegia with residual function depending on involvement of specific 
cervical segments.

Question 23

C1-C3

Accepted Answer

movement in neck and above:

Question 24

Injury to C1-C3 results in

Accepted Answer

1) Loss of innervations to diaphragm.
2) Absence of independent respiratory function.

Question 25

Above C4

Accepted Answer

complete quadriplegia, complete dependence.

Question 26

Injury above C4 results in

Accepted Answer

1) Sensation and movement in neck and above.
2) May be able to breathe without a ventilator.

Question 27

C4-C5

Accepted Answer

some shoulder movement possible, requires respiratory support.

Question 28

Injury to C4-C5 results in

Accepted Answer

1) C5:  full neck, partial shoulder, back, biceps; gross elbow.
2) Inability to roll over or use hands; decreased respiratory reserve.

Question 29

C6 / C7 / C8

Accepted Answer

incomplete quadriplegia- some elbow, arm and wrist movement.  No sensation below midchest.

Question 30

C6

Accepted Answer

shoulder and upper back abduction and rotation at shoulder.

Question 31

C7 - C8

Accepted Answer

all triceps to elbow extension, finger extensors and flexors.

Question 32

C6 injury results in

Accepted Answer

a) Full biceps to elbow flexion, wrist extension, weak grasp of thumb. 
b) Decreased respiratory reserve.

Question 33

C7 - C8

Accepted Answer

all triceps to elbow extension, finger extensors and flexors.

Question 34

C7 - C8 injury results in

Accepted Answer

a) Good grasp with some decreased strength.
b) Decreased respiratory reserve.

Question 35

Cervical Spine

Accepted Answer

C1-C8

Question 36

Thoracic Spine

Accepted Answer

T1-T12

Question 37

T1-T6

Accepted Answer

paralysis below the waist with control of hands

Question 38

T1-T6 injury results in

Accepted Answer

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.

Question 39

T7 - T12

Accepted Answer

full, stable thoracic muscles and upper back.

Question 40

T7 - T12 injury results in

Accepted Answer

1) Functional intercostals resulting in increased respiratory reserve.

Question 41

Lumbar spine

Accepted Answer

L1-L5

Question 42

L 1-2

Accepted Answer

Hip abduction impaired. No sensation below lower abdomen.

Question 43

L 3-5

Accepted Answer

Knee and ankle movement impaired.  No sensation below upper thigh.

Question 44

S 1-5

Accepted Answer

bowel/bladder dysfunction, variable motor and sensory loss in lower extremities and perineum.

Question 45

Foremost priority in spinal injury

Accepted Answer

Airway, breathing, Circulation.

Question 46

Crutchfield tongs

Accepted Answer

burr in the skull holes are required for insertion.

Question 47

Gardner-Wells tongs

Accepted Answer

burr holes not needed

Question 48

Halo traction

Accepted Answer

burr holes are required for insertion.

Question 49

A turning frame (Stryker or Foster)

Accepted Answer

is used to change the patient's position without changing alignment.

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.

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