ATLS Module 7 - Spine & Spinal Cord
Trauma Questions with Answers 100%
what do you have to consider in up to 10% of pts with a cervical spine fx? ANSWER --
a second, noncontiguous vertebral column fx
*therefore radiographic screening of entire spine is warranted in pts with c spine fx
*red text*
when can you safely defer evaluation of spinal injury? ANSWER -- if pts spine is
protected, evaluation of spine and exclusion of spinal injury can be safely deferred...
esp in presence of systemic instability such as hypotension and respiratory inadequacy
*red text*
how can you exclude spinal injury in patients without neurological deficit, pain or
tenderness along the spine, evidence of intoxication, or additional painful injuries?
ANSWER -- absence of pain or tenderness along spine virtually excludes presence of
significant spinal injury
why should long backboards be only used during pt transportation, and every effort
should be made to remove pt from spine boards ASAP? ANSWER -- prolonged
positioning on a hard backboard with hard cervical collar can also be hazardous.... via
discomfort in conscious pts, serious decubitus ulcers, respiratory compromise
Red text
what does the spinal column consist of? ANSWER -- 7 cervical, 12 thoracic, 5 lumbar
vertebrae + sacrum and coccyx
why do ~1/3 of pts with upper cervical injuries (above C3) die? ANSWER -- from apnea
caused by loss of central innervation of phrenic nerves
how is a child's cervical spine markedly different from that of an adults until ~8-12 years
old? ANSWER -- more flexible joint capsules & interspinous ligaments, flat facet joints,
and vertebral bodies are wedged anteriorly and tend to slide forward with flexion
most thoracic spine fxs are wedge compression fxs, not associated with spinal cord
injury... however, what happens when a fracture dislocation does occur? ANSWER --
almost always results in complete spinal cord injury bc of the relatively narrow thoracic
canal
spinal cord originates at the caudal end of medulla oblongata at foramen magnum...
where does it usually end? ANSWER -- near L1 bony level... aka conus medullaris...
below this is the cauda equina
, what is a complete spinal injury? ANSWER -- pt has no sensory or motor fx below a
certain level
what is an incomplete spinal injury? ANSWER -- some degree of motor or sensory fx
remains
where is the corticospinal tract located and what is the function?
how do you test it? ANSWER -- anterior and lateral segment of cord
*controls motor power on same side of body
*test = voluntary muscle contraction or involuntary response to painful stimuli
where is the spinothalamic tract located and what is the function?
how do you test it? ANSWER -- anterolateral aspect of cord
*transmits pain and temperature sensation from opposite side of body
*test = pinprick
where is the dorsal columns located and what is the function?
how do you test it? ANSWER -- posteromedial aspect of cord
*carries position sense (proprioception), vibration sense, and some light tough
sensation from same side of body
*position sense in toes and fingers or vibration senses using tuning fork
where is C5 dermatome? ANSWER -- area over deltoid
where is T4 dermatome? ANSWER -- nipple
Where is the T10 dermatome located? ANSWER -- umbilicus
Where is the T12 dermatome located? ANSWER -- symphysis pubis
where is the L4 dermatome located? ANSWER -- medial calf
Where is the L5 dermatome? ANSWER -- web space between 1st and 2nd toes
where is S1 dermatome? ANSWER -- lateral border of foot
where is S3 dermatome? ANSWER -- ischial tuberosity
where is S4 and S5 dermatome? ANSWER -- perianal region
how do you test C5 myotome? ANSWER -- biceps... elbow flexors
how do you test C6 myotome? ANSWER -- wrist extension
how do you test C7 myotome? ANSWER -- triceps... elbow extension
Trauma Questions with Answers 100%
what do you have to consider in up to 10% of pts with a cervical spine fx? ANSWER --
a second, noncontiguous vertebral column fx
*therefore radiographic screening of entire spine is warranted in pts with c spine fx
*red text*
when can you safely defer evaluation of spinal injury? ANSWER -- if pts spine is
protected, evaluation of spine and exclusion of spinal injury can be safely deferred...
esp in presence of systemic instability such as hypotension and respiratory inadequacy
*red text*
how can you exclude spinal injury in patients without neurological deficit, pain or
tenderness along the spine, evidence of intoxication, or additional painful injuries?
ANSWER -- absence of pain or tenderness along spine virtually excludes presence of
significant spinal injury
why should long backboards be only used during pt transportation, and every effort
should be made to remove pt from spine boards ASAP? ANSWER -- prolonged
positioning on a hard backboard with hard cervical collar can also be hazardous.... via
discomfort in conscious pts, serious decubitus ulcers, respiratory compromise
Red text
what does the spinal column consist of? ANSWER -- 7 cervical, 12 thoracic, 5 lumbar
vertebrae + sacrum and coccyx
why do ~1/3 of pts with upper cervical injuries (above C3) die? ANSWER -- from apnea
caused by loss of central innervation of phrenic nerves
how is a child's cervical spine markedly different from that of an adults until ~8-12 years
old? ANSWER -- more flexible joint capsules & interspinous ligaments, flat facet joints,
and vertebral bodies are wedged anteriorly and tend to slide forward with flexion
most thoracic spine fxs are wedge compression fxs, not associated with spinal cord
injury... however, what happens when a fracture dislocation does occur? ANSWER --
almost always results in complete spinal cord injury bc of the relatively narrow thoracic
canal
spinal cord originates at the caudal end of medulla oblongata at foramen magnum...
where does it usually end? ANSWER -- near L1 bony level... aka conus medullaris...
below this is the cauda equina
, what is a complete spinal injury? ANSWER -- pt has no sensory or motor fx below a
certain level
what is an incomplete spinal injury? ANSWER -- some degree of motor or sensory fx
remains
where is the corticospinal tract located and what is the function?
how do you test it? ANSWER -- anterior and lateral segment of cord
*controls motor power on same side of body
*test = voluntary muscle contraction or involuntary response to painful stimuli
where is the spinothalamic tract located and what is the function?
how do you test it? ANSWER -- anterolateral aspect of cord
*transmits pain and temperature sensation from opposite side of body
*test = pinprick
where is the dorsal columns located and what is the function?
how do you test it? ANSWER -- posteromedial aspect of cord
*carries position sense (proprioception), vibration sense, and some light tough
sensation from same side of body
*position sense in toes and fingers or vibration senses using tuning fork
where is C5 dermatome? ANSWER -- area over deltoid
where is T4 dermatome? ANSWER -- nipple
Where is the T10 dermatome located? ANSWER -- umbilicus
Where is the T12 dermatome located? ANSWER -- symphysis pubis
where is the L4 dermatome located? ANSWER -- medial calf
Where is the L5 dermatome? ANSWER -- web space between 1st and 2nd toes
where is S1 dermatome? ANSWER -- lateral border of foot
where is S3 dermatome? ANSWER -- ischial tuberosity
where is S4 and S5 dermatome? ANSWER -- perianal region
how do you test C5 myotome? ANSWER -- biceps... elbow flexors
how do you test C6 myotome? ANSWER -- wrist extension
how do you test C7 myotome? ANSWER -- triceps... elbow extension
