Spinal Injury Assessment Quiz

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Questions and Answers

Which of the following presents a dangerous mechanism of injury that should prompt suspicion of spinal injury?

A fall from a height of less than 3 feet

A motor vehicle accident with the patient being ejected from the vehicle (correct)

A sports injury involving a twisting motion

A minor collision with a stationary object

What is the primary reason for ensuring airway patency in a patient with suspected spinal injury?

To prevent aspiration of foreign objects

To allow for easy access to the airway for intubation

To facilitate communication with the patient

To maintain adequate oxygenation and prevent hypoxia (correct)

What is the most common site of cord injury?

Thoracic spine

Cervical spine (correct)

Sacral spine

Lumbar spine

Which of the following pre-existing conditions increases the risk of spinal injury?

Osteoporosis (A) Signup and view all the answers

What is the purpose of using sandbags or blocks placed on either side of the head during spinal immobilization?

To immobilize the patient’s head and neck and prevent rotation (E) Signup and view all the answers

Which of the following is a sign of a potential spinal injury?

All of the above (D) Signup and view all the answers

What is the preferred method for immobilizing the cervical spine?

Both B and C (D) Signup and view all the answers

Which of the following is NOT a sign of flaccid areflexia?

Response to painful stimulus below the clavicle (D) Signup and view all the answers

What is the muscle supplied by the C6 spinal cord segment?

Wrist extensors (extensor carpi radialis) (B) Signup and view all the answers

Which type of spinal cord injury results in a loss of vibration and proprioception sensation?

Posterior Cord Syndrome (A) Signup and view all the answers

In a complete spinal cord injury, what is absent?

All of the above (D) Signup and view all the answers

What is the neurological level of injury defined as?

The lowest cord segment for which the key muscle has a strength grade of 3. (D) Signup and view all the answers

Which type of spinal cord injury is most commonly associated with hyperextension injuries?

Central Cord Syndrome (B) Signup and view all the answers

What is the primary physiological cause of neurogenic shock following a spinal cord injury above T6?

Interruption of the sympathetic system, leading to vasodilation and venous pooling. (B) Signup and view all the answers

What is the characteristic presentation of Brown-Sequard Syndrome?

Ipsilateral loss of motor and vibration sensation, contralateral loss of pain and temperature sensation (C) Signup and view all the answers

What muscle does the L5 spinal cord segment supply?

Big toe extensor (extensor hallucis longus) (C) Signup and view all the answers

Which of the following is NOT a typical feature of neurogenic shock?

Rapid, bounding pulse. (C) Signup and view all the answers

What is the primary objective when managing abdominal distension in a patient with a suspected spinal cord injury?

Reducing the risk of aspiration by preventing gastric distension. (A) Signup and view all the answers

Which of the following is a characteristic of a Motor Incomplete spinal cord injury?

Muscle strength in most muscles below the injury level are strong enough to lift against gravity. (B) Signup and view all the answers

What is the significance of monitoring urinary output (UOP) in a patient with a suspected spinal cord injury?

To prevent bladder distension and related complications. (D) Signup and view all the answers

Which of the following is the MOST important consideration when performing endotracheal intubation (ETT) in a patient with a suspected spinal cord injury?

Limiting cervical spine movement during the procedure. (B) Signup and view all the answers

What is the primary purpose of the pinprick test when assessing sensory level in a spinal cord injury?

To determine the presence of pain sensation. (A) Signup and view all the answers

What is the primary purpose of using a nasogastric (NG) tube in a patient with a suspected spinal cord injury?

To prevent gastric distension and aspiration. (C) Signup and view all the answers

What is the most likely reason for a patient with a spinal cord injury above T6 to develop bradycardia?

Loss of sympathetic innervation to the heart. (C) Signup and view all the answers

Study Notes

Spinal Trauma - Suspicion and Management

Early Suspicion: Spinal injury should be suspected early for immediate immobilization and airway management. Neck injuries are the most common. Failure to immobilize unstable injuries can cause further cord or nerve root damage.
When to Suspect:
- Major trauma
- Minor trauma with spinal pain or neurological symptoms
- Altered consciousness after injury (flaccid areflexia, decreased anal tone, diaphragmatic breathing issues, limited movement in C5, C7, and below clavicle)
- Hypotension with bradycardia or priapism.
Dangerous Mechanisms of Injury:
- Motor Vehicle Accidents (MVAs) with patient ejection or rollover
- Pedestrian accidents or bicycling accidents without a helmet
- Falls from heights (> 3 feet for children, >5 feet for adults)
- Head struck by high-impact objects
Pre-existing Spinal Disease: Suspect a spinal injury when a patient has rheumatoid arthritis, ankylosing spondylitis, severe osteoarthritis, osteoporosis, or is on steroid therapy. These conditions can make injuries worse.

Spinal Trauma - ABCDE Approach

Airway Management and Immobilization (A):
- Perform rapid manual immobilization without traction
- Keep the head and neck in a neutral position by using both hands around the neck and interlocking the movement to avoid any movement.
- Use sandbags or blocks placed on the sides of the head and tape/ straps to prevent rotation.
- Use a cervical collar (Stifneck or Miami J collar—better than a hard collar) to avoid overtightening
- Make sure the airway is clear to avoid hypoxia that compromise the damaged cord
- If the patient is unconscious, perform jaw thrust and clear the airway with suction if needed. Adjuncts like OPA or NPA might be useful.
- If endotracheal intubation (ETT) is needed, it must be performed by an expert in advanced anesthetic techniques (usually rapid sequence intubation (RSI)) with assistance to control the head and neck to limit cervical spine movement
Breathing and Ventilation (B):
- Regularly assess breathing and diaphragmatic breathing (using accessory muscles if needed)
- Continuously monitor oxygenation (pulse oximetry) and ventilation (ABG analysis), to avoid deterioration due to cord oedema/ ischaemia.
- Tracheal intubation and controlled ventilation might become necessary if needed.
Circulation (C):
- Monitor ECG (electrocardiogram), blood pressure (BP), and heart rate (HR).
- Insert a urinary catheter to monitor urine output (UOP) and prevent bladder distension.
- Insert a nasogastric (NG) tube to prevent gastric distension (common after cord injury) and reduce risk of aspiration if there is no craniofacial injury.
- May need to assess for neurogenic shock (pathophysiology: loss of vasomotor tone, decreased blood pressure; presentation: flaccidity and areflexia, warm VD, bradycardia, hypotension, and hypothermia)
- Exclude and treat other causes of hypotension like blood loss or tension pneumothorax. If blood loss is suspected an IV fluid is usually sufficient to correct hypovolaemia
- Consider inotropes for hypotension if volume replacement is not successful and correct bradycardia using atropine if needed
Disability (D):
- Level of Injury: The point where the spinal cord is injured. This determines the effected body part or areas that are affected and unaffected.
- Sensory Level: The most caudal segment of the spinal cord with intact sensation on both sides of the body.
- Assess sensation using light touch and pinprick tests to determine sensory level.
- Types of Spinal Cord Injury: (Complete, Sensory Incomplete, Motor Incomplete, Motor Incomplete, Normal)
- Complete: No motor or sensory function below level of injury, no muscle movement, light touch, pin prick or pressure feelings.
- Sensory Incomplete: Feeling present but limited movement below the level of injury
- Motor Incomplete: Some muscles can move below neurological level but cannot support gravity
- Motor Incomplete: Many muscles can move below neurological level but can support gravity
- Motor Level: The lowest cord segment where a muscle has a strength grade of 3 (muscle strength 0-5, 0 being paralysis, 5 being normal).
Exposure (E): Log roll the patient using adequate methods. Consider using a 6+ lift and slide maneuver
Cervical Spine Imaging: Imaging is needed in cases of suspected injury but must be avoided if no risks are present such as symptoms of neuro deficit, spinal tenderness, altered mental states and intoxication or distracting injuries.

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Description

Test your knowledge on spinal injuries and their management with this quiz. Questions cover mechanisms of injury, spinal cord anatomy, and critical signs. Perfect for medical students and professionals encountering trauma cases.