Trauma Care and Cervical Spine Protection

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Questions and Answers

What is the most common mechanism of injury (MOI) leading to spinal cord injuries?

Sports injuries

Falls

Violence

Motor vehicle collisions (correct)

Which vertebrae are the most frequently injured?

Cervical vertebrae (correct)

Sacral vertebrae

Lumbar vertebrae

Thoracic vertebrae

What can localized edema cause?

Airway obstruction (correct)

Deep venous thrombosis

Pulmonary emboli

Decubitus ulcers

What is the function of the anterior (ventral) horn in the spinal cord?

Motor Signup and view all the answers

What is a common complication of spinal cord injuries due to decreased mobility?

Deep venous thrombosis Signup and view all the answers

How many pairs of spinal nerves are there?

31 pairs Signup and view all the answers

What is the goal of administering Methylprednisolone (MP) within 8 hours of injury?

To prevent cellular death and decrease edema to the spinal cord Signup and view all the answers

What is the purpose of applying cervical tongs or halo devices in unstable cervical fractures?

To provide traction and minimize cord compression Signup and view all the answers

What is the purpose of spinal protection in patient assessment?

To immobilize the spine Signup and view all the answers

What occurs in complete spinal cord transections?

Loss of all motor and sensory function below the level of injury Signup and view all the answers

What is the recommended method of immobilizing the spine?

Using a backboard with straps across the chest, abdomen, and knees Signup and view all the answers

What is the definition of spinal shock?

Loss of reflexes and motor and sensory function below the level of the injury Signup and view all the answers

What is a common mechanism of injury (MOI) associated with cervical spine injuries?

Falling from a height greater than or equal to 3 feet Signup and view all the answers

Why is early endotracheal intubation considered in patients with injuries at the C5 level or above?

To prevent airway obstruction Signup and view all the answers

When should spinal injuries be suspected?

In patients with multisystem injuries or significant MOI Signup and view all the answers

What is a risk factor for pulmonary emboli in spinal cord injury patients?

Decreased mobility Signup and view all the answers

What is a sign of a potential spinal cord injury?

Neck pain or altered sensation in the upper extremities Signup and view all the answers

What is a visible sign of spinal injury during inspection?

Deformity of the vertebral column Signup and view all the answers

What is the effect of injuries to the cord between C3 and C5?

Progressive respiratory insufficiency Signup and view all the answers

What is an indication of a cervical spine injury?

Priapism Signup and view all the answers

What is a characteristic of a patient with a spinal cord injury?

They are poikilothermic Signup and view all the answers

What is a characteristic of neurogenic shock?

Slow and strong pulse Signup and view all the answers

What is the purpose of radiographic evaluation in patients with spinal trauma?

To assess the extent of spinal trauma Signup and view all the answers

What is a risk for patients with cervical spine trauma during airway management?

Hypoxia Signup and view all the answers

What is a characteristic of spinal and neurogenic shock?

Hypotension and bradycardia Signup and view all the answers

What is a symptom of an incomplete spinal cord injury?

Flaccid paralysis and some preserved sensations below the level of injury Signup and view all the answers

What is central cord syndrome caused by?

Hyperextension Signup and view all the answers

In anterior cord syndrome, which sensations are preserved?

Vibratory sense, touch, pressure, and proprioception Signup and view all the answers

What is a characteristic of posterior cord syndrome?

Impaired light touch and proprioception Signup and view all the answers

In Brown-Séquard syndrome, which sensations are affected contralaterally?

Pain and temperature sensations Signup and view all the answers

What is a type of nerve root injury?

Conus medullaris syndrome Signup and view all the answers

What is a common cause of nerve root injuries?

Nerve root compression (vertebral fractures or disk herniation) Signup and view all the answers

Study Notes

Cervical Spine Injuries

Localized edema can cause airway obstruction, and endotracheal intubation should be considered early in patients with injuries at the C5 level or above.
Cervical spine protection equipment includes a rigid cervical collar, lateral head immobilizer, and full backboard with straps.

Circulation Management

Patients may experience hypotension due to neurogenic or hypovolemic shock.
Injuries at T6 or above can cause loss of sympathetic tone, leading to hypotension and bradycardia.

Pharmacologic Management

Methylprednisolone (MP) may be administered within 8 hours of injury to reduce edema, ischemia, and prevent cellular death.

Cervical Tongs and Skeletal Fixation

Unstable cervical fractures may be stabilized in the ED with application of cervical tongs or halo devices to provide consistent traction and minimize cord compression.

Spinal Cord Injuries

Injuries of the vertebral column may occur with or without associated spinal cord injury.
Spinal cord transections may be complete or incomplete, with complete transections leading to loss of all motor and sensory function below the level of the injury.
Incomplete spinal cord transections result in partial preservation of some motor and/or sensory tracts.
Patients with spinal cord injuries are at risk for deep venous thrombosis, decubitus ulcers, and pulmonary emboli.

Spinal and Neurogenic Shock

Spinal shock is the loss of reflexes and motor and sensory function below the level of the injury.
Neurogenic shock is characterized by hypotension and bradycardia, usually seen with injuries above the T6 level.

Anatomy and Physiology

The vertebral column consists of 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 sacral vertebrae, and 1 coccygeal vertebrae.
The cervical vertebrae are the most frequently injured due to their high mobility and delicate structure.
The spinal cord consists of the posterior (dorsal) horn for sensory function, lateral horn for autonomic function, and anterior (ventral) horn for motor function.
There are 31 pairs of spinal nerves, including 8 cervical nerves, 12 thoracic nerves, 5 lumbar nerves, 5 sacral nerves, and 1 coccygeal nerve.

Patient Assessment

All patients with multisystem injuries or significant mechanisms of injury should be suspected of having a spinal injury and should be completely immobilized.
Spinal protection involves manual immobilization with hands, cervical collar, lateral head support, and backboard with straps.
The entire spine should be immobilized using a backboard with straps across the chest, abdomen, and knees.

Mechanism of Injury

Common mechanisms of injury associated with cervical spine injuries include falls from a height greater than or equal to 3 feet or five stairs, axial loading, motor vehicle collisions at a high rate of speed with rollover or ejection, and bicycle collisions.
Suspicion of spinal injury should be raised if the patient has a fall resulting in fractures of the heels or an unrestrained patient presents with facial injuries.

History and Inspection

Pieces of history that may indicate a potential spinal cord injury include significant trauma, altered mental status, seizure activity, complaint of neck pain or altered sensation, neck tenderness, loss of consciousness, and incontinence.
Obvious signs of spinal injury include deformity of the vertebral column, cervical edema, ballistic wounds, and abrasions or contusions at the level of the lap or shoulder belt.

Reflex Testing

Biceps reflex tests C5-C6, and anal wink reflex tests S2-S4.

Radiographic Evaluation

Cervical spine and all seven cervical vertebrae, including the C7-T1 junction, should be evaluated.
Patients with a history of a fall or significant chest and abdominal trauma should have thoracic and lumbosacral spine films.
Patients with an altered mental status require complete spinal radiographic evaluation.

Airway Management

Patients with cervical spine trauma are at risk for hypoxia, respiratory arrest, and aspiration.

Incomplete Spinal Cord Injuries

Types of incomplete spinal cord injuries include central cord syndrome, anterior cord syndrome, posterior cord syndrome, Brown-Séquard syndrome, and nerve root injuries.
Characteristics include asymmetric reflexes, flaccid paralysis, and some preserved sensations below the level of the injury.
Central cord syndrome causes greater loss of function in the upper extremities than in the lower extremities, and bowel and bladder function are typically maintained.
Anterior cord syndrome results in loss of motor function and pain and temperature sensations below the level of the injury.
Posterior cord syndrome is rare and results in impaired light touch and proprioception.
Brown-Séquard syndrome results in ipsilateral paresis or hemiplegia and loss of motor function, touch, pressure, vibratory sense, and proprioception, and contralateral loss or decreased sensation of pain and temperature.
Nerve root injuries include conus medullaris and cauda equina syndromes, resulting from nerve root compression.

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Description

This quiz covers the importance of early endotracheal intubation, cervical spine protection, and circulation management in trauma patients with spinal injuries. Topics include equipment usage, shock management, and sympathetic tone.