Questions and Answers
What was the mortality rate for patients with this condition during WWI?
What is the first action in managing an unconscious patient involved in an accident?
Which factor is a common cause of spinal injuries in South Africa?
What is an important consideration when transporting a patient with suspected spinal cord injury?
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What does the ideal management of a spinal injury demand?
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According to UK statistics, what is the incidence of this condition per million population?
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What should be considered when managing a patient in spinal shock?
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Which condition indicates a higher spinal cord lesion during assessment?
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What is the primary benefit of a log-roll maneuver during secondary survey?
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Which of the following is a classic presentation of anterior cord syndrome?
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What is the critical initial imaging for a cervical spine injury?
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Which classification system for spinal injuries was revised in 2013?
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What indicates that a spinal injury may be unstable?
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Which reflex is monitored to determine the end of spinal shock?
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Study Notes
Historical Context
- Recognized as a mortal condition since ancient times.
- First described in the Edwin Smith papyrus around 2500 BC.
- Labeled as “an ailment not to be treated”; historical mortality rate of 90% for affected patients during WWI within one year.
Incidence of Spinal Cord Injury
- UK statistics report an incidence of 10-15 per million population.
- South Africa statistics show a higher incidence of 35-40 per million.
- In first world countries, major causes include motor vehicle accidents (MVAs).
- In South Africa, cases are primarily due to interpersonal violence combined with MVAs.
Management at the Scene
- Assume spinal cord injury (SCI) in unconscious patients until proven otherwise.
- Adhere to basic ABC (Airway, Breathing, Circulation) principles in resuscitation.
- Airway management is crucial; must be secured first.
- Indications for tracheal intubation are similar across trauma cases.
- After securing the airway, establish intravenous access.
Evacuation and Transfer Protocols
- Employ short and long splints to minimize spinal column movement.
- Use rigid neck collars in conjunction with splints.
- Maintain neutral neck position; adjust for age differences.
- For transportation, keep patients supine if conscious; intubate if unconscious.
- Remove hard objects from pockets to prevent pressure sores.
- Patients often become poikilothermic (unable to regulate body temperature).
Initial Management at the Hospital
- Follow Advanced Trauma Life Support (ATLS) principles: A-airway, B-breathing, C-circulation.
- Conduct secondary survey after life-threatening issues are addressed.
Secondary Survey
- If no urgent injuries exist, palpate the spine while patient is supine.
- Comprehensive examination should occur during log-roll procedure; look for bruising or deformity.
- Priapism and diaphragmatic breathing often indicate higher spinal lesions.
- Limit time on spinal board to a maximum of 30 minutes.
Neurological Assessment
- Use the ASIA (American Spinal Injury Association) scale for grading.
- Consider various muscle and reflex functions, including those not listed in standard assessments.
Spinal Shock
- Defined as areflexia in the initial injury phase; all reflexes rarely absent.
- Consensus indicates spinal shock ends with return of bulbocavernosus reflex in supra-sacral lesions.
- Diagnosis includes hypotension and bradycardia in patients.
Partial Spinal Cord Injury Syndromes
- Anterior cord syndrome: loss of motor function and reduced pain/temperature sensation below injury.
- Central cord syndrome: disproportionately affects upper limbs compared to lower limbs.
- Posterior cord syndrome: primarily loss of proprioception.
- Brown-Sequard syndrome: unilateral loss of power and proprioception on the injured side with contralateral sensory terms intact.
Radiological Investigations
- Initial cervical spine imaging should include a lateral X-ray demonstrating the C7/T1 junction; AP and open-mouth views also required.
- ABC rules (Alignment, Bones, Cartilage, Soft tissues) are critical for interpretation.
C-Spine Investigations
- Helical CT scanning is preferred for sensitivity, specificity, and efficiency over traditional radiographs.
- Superior visualization of occipito-cervical and cervico-thoracic junctions.
- CT is also effective in assessing abdominal and chest injuries.
Thoracic and Lumbar Spine Considerations
- Double-level injuries occur in 10-20% of cases; evaluation of stability is essential.
- Multiple classification systems exist, with AO spine injury classification updated in 2013.
- TLICS (Thoracolumbar Injury Classification and Severity Scale) is widely utilized and published in November 2013.
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Description
Explore the historical recognition of mortal conditions, tracing back to the Edwin Smith papyrus from 2500 BC. This quiz delves into the incidence of these conditions through statistics from the UK, South Africa, and first-world countries, highlighting the impact of motor vehicle accidents and interpersonal violence. Test your knowledge on patient management and treatment evolution.
