Spinal Anatomy Review
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| The musculoskeletal system | The musculoskeletal system is a complex system of muscles, bones, joints, ligaments, and tendons that work together to move the body. |
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| Smooth muscle | Smooth muscle is under the control of the autonomic nervous system and can relax or contract to alter the inner lumen diameter. |
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| Skeletal muscle | Skeletal muscle, which constitutes the major muscle mass of the body, is under conscious control and allows mobility. In addition, muscles provide support for the skeleton in coordination with tendons, cartilage, and ligaments. |
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| Tendons | Tendons are bands of connective tissue binding muscles to bones. Tendons allow for power of movement across the joints. |
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| Cartilage | Cartilage is the connective tissue covering the epiphysis. It acts as a surface for articulation and allows for smooth movement at the joints. |
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| Ligaments | Ligaments are the connective tissues which support joints. Ligaments attach to bone ends and allow for stable range of motion. |
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| Bones | Bones act as a structural form for the body and protect the vital organs. |
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| Cervical spine | The cervical spine is comprised of 7 vertebrae and supports the head, which typically weighs 16-25 pounds. This region of the spinal column is extremely flexible. In splinting, the cervical spine is considered the "joint above". |
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| Thoracic spine | The thoracic spine consists of 12 vertebrae. It is this part of the spinal column to which the ribs are connected and which provides the rigid framework of the thorax |
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| Lumbar spine | The lumbar spine is comprised of 5 vertebrae and constitutes the largest vertebral body. This part of the spine is flexible, carries most of the body weight, and enables the torso to balance on the sacrum. |
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| Sacrum | The sacrum is 5 fused vertebrae that are common to the spine and pelvis. The sacrum forms the “joint below" with the pelvis for splinting. |
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| Coccyx | The coccyx is also known as the tailbone and is comprised of 4 fused vertebrae. |
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| The anterior longitudinal ligament | The anterior longitudinal ligament runs along the anterior portion of the body. This ligament is a major source of stability and protects against hyperextension. |
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| The posterior longitudinal ligament | The posterior longitudinal ligament runs along the posterior body within the vertebral canal. This ligament prevents hyperflexion and can be a major source of injury. |
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| The cruciform ligament and accessory atlantoaxial ligament | The cruciform ligament and the accessory atlantoaxial ligament add to the strength, stability, and articulation of the spinal column. It is important to note that injury to the ligaments may cause excess movement of vertebrae. |
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| The vertebral foramen | The vertebral foramen is an opening for the spinal cord that is formed when all vertebrae are in place. |
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| The spinous process | The spinous process is the posterior aspect of the vertebrae formed by the laminae. The spinous process is the attachment site for muscles and ligaments. |
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| The transverse process | The transverse process runs from between the pedicles and laminae in most vertebrae and projects laterally and posteriorly. This is the attachment site for various muscles and ligaments. |
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| The intervertebral foramen | The intervertebral foramen is formed by the lower surfaces of the vertebrae and creates a “notch" for spinal nerves. This allows nerves to connect to the spinal cord. |
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| The Inter-vertebral disks | Each vertebra is separated by a mass of fibrocartilage known as intervertebral disks. The disks are connected together by ligaments and act as shock absorbers for the spinal column, reducing bone wear and protecting against compression. |
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| The cervical spine consists of _____ vertebrae. | 7 |
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| Spinal Nerves | Thirty-one pairs of nerves originate from the spinal cord. These nerves carry signals for both sensation and motor function and provide two-way communication between the spinal cord and body parts. |
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| The nerves are named according to the level of spine from which they arise: | Cervical 1-8 Thoracic 1-12 Lumbar 1-5 Sacral 1-5 Coccygeal (1 set of nerves) |
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| Each spinal nerve emerges from the cord and has two branches or roots. | Dorsal roots carry sensory impulses to the cord and ventral roots carry motor impulses from the cord to the body. |
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| The dermatome | The dermatome is the particular area in which the spinal nerves travels. Dermatomes are mapped out by the level of the spinal nerve and can be useful for the assessment of a specific level of spinal cord injury |
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| How many pairs of nerves originate from the spinal cord? | 31 |
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| What are the four most common causes of SCI's "Spinal cord injury" | Motor vehicle crashes - 2.1 million per year Falls Penetrating injuries Sports injuries |
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| What percentage of will have temporary or permanent SCI? | Forty percent of trauma patients with neurological deficit will have temporary or permanent SCI. |
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| What percentage of of SCI may be caused by improper handling? | It is important to note that 25% of SCI may be caused by improper handling. Education in proper handling and transportation can decrease spinal cord injuries. |
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| SCI often results from mechanisms of injury such as: | Compression Falls Diving accidents Motor vehicle accidents Excessive flexion, extension, rotation Lateral bending Distraction Pulling apart of the spine Hangings |
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| Maintain a high index of suspicion when responding to calls related to: | Motor vehicle crashes Pedestrian - vehicle collisions Falls Blunt trauma Penetrating trauma to head, neck, or torso Motorcycle crashes Hangings Diving accidents Unconscious trauma victims |
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| The most common cause of spinal cord injuries is | motor vehicle crashes. |
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| The first step in assessing spinal injuries is? | The first step in assessing spinal injuries is to determine the mechanism of injury or the nature of the injury. |
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| Signs which may indicate SCI include: | Pain Tenderness Painful movement Deformity Cuts/ bruises (over spinal area) Paralysis Paresthesias Paresis (weakness) Shock Priapism |
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| If the mechanism of injury indicates the possibility of SCI, full spinal immobilization is required. Examples include: | High speed motor vehicle crash(es) Falls greater than three times patient's height Sports injuries Other high impact situations |
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| Negative MOI If the force or impact involved does not suggest a potential spinal injury, spinal immobilization is not required. Examples include | Dropping a rock on foot Twisted ankle while running Isolated soft tissue injury |
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| Uncertain MOI If the mechanism of injury is unclear or there is uncertainty regarding the impact or forces, clinical criteria are used as a basis of whether to employ spinal immobilization. Examples of these types of injuries include: | Person trips over garden hose, falling to the ground and hitting his head Fall from 2-4 feet Low speed motor vehicle crash (fender bender) |
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| n order for assessments of pain, tenderness, motor, and sensory function to be accurate the patient must be reliable. The patient must be | Calm Cooperative Sober Alcohol Drugs Alert and oriented |
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| An unreliable patient is defined as one who exhibits the following: | Acute stress reaction Sudden stress of any type Brain injury Any temporary change in consciousness or altered level of consciousness Uncooperative or belligerent behavior Intoxication Abnormal mental status Distracting injuries Communication probl |
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| You respond to the scene of an accident where the MOI is uncertain. You assess the patient. He is unconscious and you conclude that he is "unreliable." Is spinal immobilization required? If so, what kind? | Yes, full spinal immobilization |
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| A patient with suspected SCI is found sitting in a chair. There are no other injuries and no dangers at the scene. Which of the following immobilization options should you do for the patient? | Use of a KED to remove the patient and secure him onto a long spine board |
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| The scalp is very vascular, so injuries to the scalp may bleed more than expected. Control bleeding with direct pressure. In some cases, injuries to the brain may be caused by non-traumatic conditions: | Non-traumatic injuries to the brain may occur due to clots or hemorrhaging. Non-traumatic brain injuries can be a cause of altered mental status. Signs and symptoms parallel that of traumatic injuries with the exception of evidence of trauma and a lack |
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| Signs and Symptoms of Skull Injuries | Mechanism of trauma Contusions, lacerations, hematomas to the scalp Deformity to the skull Blood or fluid (cerebrospinal fluid) leakage from the ears or nose | Bruising (discoloration) around the eyes
Bruising (discoloration) behind the ears (mastoid process)
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| Cervical Spine Immobilization Devices Cervical spine immobilization devices should be used in any situation in which injury to the spine is suspected. Indications | Any suspected injury to the spine based on mechanism of injury, history or signs and symptoms. Appropriate for use in conjunction with short and long backboards. |
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| Which of the following provides immobilization to the pelvis and extremities? | Long backboards |
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| Helmet Removal | When assessing a patient who is wearing a helmet, examine the fit of the helmet and the patient's movement within the helmet. Also check to see if you can gain access to airway and breathing with the helmet in place. |
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| Indications for Leaving the Helmet in Place | Good fit with little or no movement of the patient's head within the helmet. No impending airway or breathing problems. Removal would cause further injury to the patient. Proper spinal immobilization could be performed with helmet in place. | No interference with the EMT's ability to assess and reassess airway and breathing.
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| Indications for Removing the Helmet | Inability to assess and/or reassess airway and breathing. Restriction of adequate management of the airway or breathing. Improperly fitted helmet allowing for excessive patient head movement within the helmet. | Proper spinal immobilization cannot be performed due to helmet.
Cardiac arrest.
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| Please select four (4) indications for removing a patient's helmet. | Proper spinal immobilization cannot be performed due to helmet. The helmet is restricting adequate management of airway and breathing. The helmet restricts the ability to assess and/or reassess airway and breathing. | The patient is in cardiac arrest.
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| Immobilizing Infants and Children Special considerations: | Pad from the shoulders to the heels of the infant or child, if necessary to maintain neutral immobilization. | Properly size the cervical immobilization device. If it doesn't fit, use a rolled towel and tape to the board and manually support the head. An immobilization device with an improper fit will do more harm than good.
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| Common causes of spinal cord injuries include: | Motor vehicle crashes Falls Penetrating injuries Sports injuries |
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| A patient with SCI has no mobility in her legs. Which region of spinal nerves would be MOST likely to cause this injury? | Lumbar and sacral nerves |
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| You and your partner are removing a patient's helmet. Your partner is stabilizing the helmet and has her hands on either side of it with her fingers on the patient's mandible to restrict movement. What would be your next step? | Place one hand on the mandible at the angle of the jaw and the other hand posteriorly at the occipital region. |
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| You should maintain a high degree of suspicion of SCI when responding to calls related to: | unconscious trauma victims. |
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| Under which of the following conditions should you remove a patient's helmet? | If there is cardiac arrest |
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| A patient with SCI appears to be suffering minor paralysis and has difficulty moving her arms. Most likely, what part of the CNS could have injury? | Spinal dorsal root nerves |
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| Dispatch reports an attempted suicide by hanging. What kind of SCI might you expect to find when you arrive? | Distraction |
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| When should you NOT remove a patient's helmet? | When the patient's airway has been controlled but the removal would cause further injury to the patient |
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| A patient with SCI appears to be suffering minor paralysis and has difficulty moving her arms. Most likely, what part of the CNS could have injury? | Intercostal nerves Spinal ventral root nerves |
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| What are the two functions of cerebrospinal fluid? | To act as a shock absorber To allow for the exchange of nutrients |
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| You should always immobilize the spine if | you suspect a head injury. |
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