ATLS MODULE 7 SPINE & SPINAL CORD
TRAUMA
1. where is the L4 dermatome located?
Answer: medial calf
2. Where is the L5 dermatome?
Answer: web space between 1st and 2nd toes
3. where is S1 dermatome?
Answer: lateral border of foot
4. where is S3 dermatome?
Answer: ischial tuberosity
5. where is S4 and S5 dermatome?
Answer: perianal region
6. how do you test C5 myotome?
Answer: biceps... elbow flexors
7. how do you test C6 myotome?
Answer: wrist extension
8. how do you test C7 myotome?
Answer: triceps... elbow extension
9. how do you test C8 myotome?
Answer: finger flexors
10. how do you test T1 myotome?
Answer: finger abduction
11. how do you test L2 myotome?
Answer: hip flexion
12. how do you test L3 myotome?
Answer: knee extension
13. how do you test L4 myotome?
, Answer: ankle dorsiflexion
14. how do you test L5 myotome?
Answer: long toe extensors
15. how do you test S1 myotome?
Answer: ankle plantar flexors
16. what does neurogenic shock result in?
Answer: loss of vasomotor tone and sympathetic innervation to the heart
17. physiologic effects of neurogenic shock are not reversed with fluid resus-citation
alone... and massive resuscitation can result in fluid overload and/orpulmonary
edema... what may be required after moderate volume replacement?
Answer: vasopressors
*atropine may be used to counteract hemodynamically significant bradycardia
18. what does spinal shock refer to?
Answer: flaccidity (loss of muscle tone) and loss ofreflexes that occur immediately
after spinal cord injury
19. how can spine injuries effect the ability to perceive pain?
Answer: inability to perceive pain can mask a potentially serious injury elsewhere
in the body, such as theusual signs of acute abdominal or pelvic pain a/w pelvic fx
20. what is central cord syndrome?
Answer:
-disproportionately greater loss of motorstrength in the UPPER extremities vs the
lower extremities
-varying sensory loss below level of injury
21. when do central cord syndromes occur?
Answer: after a hyperextension injury in ptwith preexisting cervical canal stenosis
(particularly elderly)
*mechanism is commonly a forward fall resulting in facial impact
22. what is anterior cord syndrome?
Answer: injury to motor and sensory pathways inanterior part of cord
*characterized by paraplegia and a bilateral loss of pain and temperature sensation
*sensation of intact dorsal column (position, vibration, deep pressure) is preserved
*MC occurs following cord ischemia & has poorest prognosis
TRAUMA
1. where is the L4 dermatome located?
Answer: medial calf
2. Where is the L5 dermatome?
Answer: web space between 1st and 2nd toes
3. where is S1 dermatome?
Answer: lateral border of foot
4. where is S3 dermatome?
Answer: ischial tuberosity
5. where is S4 and S5 dermatome?
Answer: perianal region
6. how do you test C5 myotome?
Answer: biceps... elbow flexors
7. how do you test C6 myotome?
Answer: wrist extension
8. how do you test C7 myotome?
Answer: triceps... elbow extension
9. how do you test C8 myotome?
Answer: finger flexors
10. how do you test T1 myotome?
Answer: finger abduction
11. how do you test L2 myotome?
Answer: hip flexion
12. how do you test L3 myotome?
Answer: knee extension
13. how do you test L4 myotome?
, Answer: ankle dorsiflexion
14. how do you test L5 myotome?
Answer: long toe extensors
15. how do you test S1 myotome?
Answer: ankle plantar flexors
16. what does neurogenic shock result in?
Answer: loss of vasomotor tone and sympathetic innervation to the heart
17. physiologic effects of neurogenic shock are not reversed with fluid resus-citation
alone... and massive resuscitation can result in fluid overload and/orpulmonary
edema... what may be required after moderate volume replacement?
Answer: vasopressors
*atropine may be used to counteract hemodynamically significant bradycardia
18. what does spinal shock refer to?
Answer: flaccidity (loss of muscle tone) and loss ofreflexes that occur immediately
after spinal cord injury
19. how can spine injuries effect the ability to perceive pain?
Answer: inability to perceive pain can mask a potentially serious injury elsewhere
in the body, such as theusual signs of acute abdominal or pelvic pain a/w pelvic fx
20. what is central cord syndrome?
Answer:
-disproportionately greater loss of motorstrength in the UPPER extremities vs the
lower extremities
-varying sensory loss below level of injury
21. when do central cord syndromes occur?
Answer: after a hyperextension injury in ptwith preexisting cervical canal stenosis
(particularly elderly)
*mechanism is commonly a forward fall resulting in facial impact
22. what is anterior cord syndrome?
Answer: injury to motor and sensory pathways inanterior part of cord
*characterized by paraplegia and a bilateral loss of pain and temperature sensation
*sensation of intact dorsal column (position, vibration, deep pressure) is preserved
*MC occurs following cord ischemia & has poorest prognosis
