ATLS Module 7 - Spine & Spinal Cord
Trauma
35 yo guy ejected for MVC. Vitals are BP 80/40, HR 11, RR 24, GCS 15. Airway and
respiration are intact. He complains of severe lower back ache, has no sensation underneath
umbilicus, decrease thoracic tenderness, not able to transport decrease extremities. Chest
and pelvic x-rays are regular. In conjunction with management of IV fluids, which of following
is maximum suitable tx for pt's hypotension?
A. Vasopressor
b. Ct scan
c. Follow pelvic binder
d. Perform FAST or DPL - ANS-d
although pt probably has spinal twine harm, tachycardia & hypotension must lead you to
hemorrhage as etiology of hemodynamic abnormality
40 yo in MVC is evaluated in rural clinic w/o surgical capability. Pt has clear cervical spine fx
at C4 with incapability to transport any extremities and sensation is confined to
supraclavicular area. He's having difficulty respiratory w RR of 30. BP is 80/40 and HR 50.
What ought to be performed previous to transfer? - ANS-crystalloid bolus, provoke pressors,
intubate, after which transfer pt once hemodynamically stable
are C1 jefferson fractures usually related to spinal twine damage? - ANS-no... However
they're volatile and to begin with tx'd with rigid cervical collar
are penetrating spinal injuries solid? - ANS-normally solid until missile destroys a large
portion of vertebra
blunt trauma to neck can bring about carotid and vertebral artery accidents... What are spinal
warning signs to screen for this? - ANS--C1-C3 fx
-c backbone fx with subluxation
-fx involving foramen transversarium
cervical spine accidents constitute more than 1/2 of all spinal column accidents. What
additional accidents are generally a/w cervical fractures? - ANS-brain harm and additional
spinal fractures
*25% of all spine accidents have at the least mild shape of mind harm & 10% of patients with
a cervical fx could have any other noncontiguous backbone fx
for the duration of the preliminary treatment, what do you keep in mind in all pts with
radiographic evidence of damage and with neurological deficits? - ANS-unstable spinal harm
elderly lady falls & sustains hyperextension harm to neck. Examination demonstrates
reduced power in top extremities as compared with lower extremities. What is the cause of
uncommon neuro findings? - ANS-central wire syndrome
side joints of thoracic and lumbar vicinity make fx dislocations enormously uncommon...
Except excessive flexion or sever blunt trauma happens... But, once they occur, what's
commonplace? - ANS-fracture subluxations in thoracic spine generally result in complete
neurological deficits bc the spinal canal is slender when it comes to spinal wire (purple
textual content)
, how can spine accidents effect the potential to understand ache? - ANS-incapacity to
perceive ache can mask a potentially critical damage elsewhere within the frame, inclusive
of the standard signs of acute abdominal or pelvic pain a/w pelvic fx
how can you exclude spinal harm in sufferers with out neurological deficit, pain or
tenderness alongside the backbone, evidence of intoxication, or additional painful injuries? -
ANS-absence of pain or tenderness alongside backbone genuinely excludes presence of
vast spinal damage
how do you test C5 myotome? - ANS-biceps... Elbow flexors
how do you take a look at C6 myotome? - ANS-wrist extension
how do you check C7 myotome? - ANS-triceps... Elbow extension
how do you take a look at C8 myotome? - ANS-finger flexors
how do you take a look at L2 myotome? - ANS-hip flexion
how do you check L3 myotome? - ANS-knee extension
how do you test L4 myotome? - ANS-ankle dorsiflexion
how do you take a look at L5 myotome? - ANS-long toe extensors
how do you check S1 myotome? - ANS-ankle plantar flexors
how do you take a look at T1 myotome? - ANS-finger abduction
how does a pt with C1 rotary subluxation present? - ANS-persistent rotation of head
(torticollis)
*the odontoid is no equidistant from the two lateral hundreds of C1
*restriction motion with head in turned around function and refer for similarly specialized tx
how is a toddler's cervical backbone markedly one-of-a-kind from that of an adults till ~8-12
years antique? - ANS-more bendy joint capsules & interspinous ligaments, flat side joints,
and vertebral our bodies are wedged anteriorly and tend to slide ahead with flexion
how is the C1 jefferson fracture excellent seen on imaging? - ANS-open mouth view of
C1-C2 location and axial CT scans
if pt has neck ache and ordinary radiograph, whats subsequent? - ANS-MRI... It's miles
feasible for pt to have isolated ligamentous spine damage that consequences in instability
w/o fx/subluxation
most thoracic spine fxs are wedge compression fxs, no longer associated with spinal twine
damage... But, what happens while a fracture dislocation does arise? - ANS-nearly usually
outcomes in complete spinal wire injury bc of the notably narrow thoracic canal
neurogenic shock is associated with what stage of spinal twine damage and reasons
systemic hypotension through what mechanism? - ANS-T6 and higher
*thru distributive shock from lack of vasomotor response
*due do injury to descending sympathetic fibers from top thoracic spinal wire that assist
preserve tone of vasculature and coronary heart fee
*pt may have relative bradycardia a/w distributive surprise from dilation of peripheral
vasculature
physiologic results of neurogenic shock are not reversed with fluid resuscitation alone... And
massive resuscitation can bring about fluid overload and/or pulmonary edema... What can
be required after slight quantity substitute? - ANS-vasopressors
*atropine may be used to counteract hemodynamically big bradycardia
pt can't circulate legs
can pass fingers & wrists bilaterally
weak tricep extension on left
can not circulate elbow on right
can experience digits on both palms
Trauma
35 yo guy ejected for MVC. Vitals are BP 80/40, HR 11, RR 24, GCS 15. Airway and
respiration are intact. He complains of severe lower back ache, has no sensation underneath
umbilicus, decrease thoracic tenderness, not able to transport decrease extremities. Chest
and pelvic x-rays are regular. In conjunction with management of IV fluids, which of following
is maximum suitable tx for pt's hypotension?
A. Vasopressor
b. Ct scan
c. Follow pelvic binder
d. Perform FAST or DPL - ANS-d
although pt probably has spinal twine harm, tachycardia & hypotension must lead you to
hemorrhage as etiology of hemodynamic abnormality
40 yo in MVC is evaluated in rural clinic w/o surgical capability. Pt has clear cervical spine fx
at C4 with incapability to transport any extremities and sensation is confined to
supraclavicular area. He's having difficulty respiratory w RR of 30. BP is 80/40 and HR 50.
What ought to be performed previous to transfer? - ANS-crystalloid bolus, provoke pressors,
intubate, after which transfer pt once hemodynamically stable
are C1 jefferson fractures usually related to spinal twine damage? - ANS-no... However
they're volatile and to begin with tx'd with rigid cervical collar
are penetrating spinal injuries solid? - ANS-normally solid until missile destroys a large
portion of vertebra
blunt trauma to neck can bring about carotid and vertebral artery accidents... What are spinal
warning signs to screen for this? - ANS--C1-C3 fx
-c backbone fx with subluxation
-fx involving foramen transversarium
cervical spine accidents constitute more than 1/2 of all spinal column accidents. What
additional accidents are generally a/w cervical fractures? - ANS-brain harm and additional
spinal fractures
*25% of all spine accidents have at the least mild shape of mind harm & 10% of patients with
a cervical fx could have any other noncontiguous backbone fx
for the duration of the preliminary treatment, what do you keep in mind in all pts with
radiographic evidence of damage and with neurological deficits? - ANS-unstable spinal harm
elderly lady falls & sustains hyperextension harm to neck. Examination demonstrates
reduced power in top extremities as compared with lower extremities. What is the cause of
uncommon neuro findings? - ANS-central wire syndrome
side joints of thoracic and lumbar vicinity make fx dislocations enormously uncommon...
Except excessive flexion or sever blunt trauma happens... But, once they occur, what's
commonplace? - ANS-fracture subluxations in thoracic spine generally result in complete
neurological deficits bc the spinal canal is slender when it comes to spinal wire (purple
textual content)
, how can spine accidents effect the potential to understand ache? - ANS-incapacity to
perceive ache can mask a potentially critical damage elsewhere within the frame, inclusive
of the standard signs of acute abdominal or pelvic pain a/w pelvic fx
how can you exclude spinal harm in sufferers with out neurological deficit, pain or
tenderness alongside the backbone, evidence of intoxication, or additional painful injuries? -
ANS-absence of pain or tenderness alongside backbone genuinely excludes presence of
vast spinal damage
how do you test C5 myotome? - ANS-biceps... Elbow flexors
how do you take a look at C6 myotome? - ANS-wrist extension
how do you check C7 myotome? - ANS-triceps... Elbow extension
how do you take a look at C8 myotome? - ANS-finger flexors
how do you take a look at L2 myotome? - ANS-hip flexion
how do you check L3 myotome? - ANS-knee extension
how do you test L4 myotome? - ANS-ankle dorsiflexion
how do you take a look at L5 myotome? - ANS-long toe extensors
how do you check S1 myotome? - ANS-ankle plantar flexors
how do you take a look at T1 myotome? - ANS-finger abduction
how does a pt with C1 rotary subluxation present? - ANS-persistent rotation of head
(torticollis)
*the odontoid is no equidistant from the two lateral hundreds of C1
*restriction motion with head in turned around function and refer for similarly specialized tx
how is a toddler's cervical backbone markedly one-of-a-kind from that of an adults till ~8-12
years antique? - ANS-more bendy joint capsules & interspinous ligaments, flat side joints,
and vertebral our bodies are wedged anteriorly and tend to slide ahead with flexion
how is the C1 jefferson fracture excellent seen on imaging? - ANS-open mouth view of
C1-C2 location and axial CT scans
if pt has neck ache and ordinary radiograph, whats subsequent? - ANS-MRI... It's miles
feasible for pt to have isolated ligamentous spine damage that consequences in instability
w/o fx/subluxation
most thoracic spine fxs are wedge compression fxs, no longer associated with spinal twine
damage... But, what happens while a fracture dislocation does arise? - ANS-nearly usually
outcomes in complete spinal wire injury bc of the notably narrow thoracic canal
neurogenic shock is associated with what stage of spinal twine damage and reasons
systemic hypotension through what mechanism? - ANS-T6 and higher
*thru distributive shock from lack of vasomotor response
*due do injury to descending sympathetic fibers from top thoracic spinal wire that assist
preserve tone of vasculature and coronary heart fee
*pt may have relative bradycardia a/w distributive surprise from dilation of peripheral
vasculature
physiologic results of neurogenic shock are not reversed with fluid resuscitation alone... And
massive resuscitation can bring about fluid overload and/or pulmonary edema... What can
be required after slight quantity substitute? - ANS-vasopressors
*atropine may be used to counteract hemodynamically big bradycardia
pt can't circulate legs
can pass fingers & wrists bilaterally
weak tricep extension on left
can not circulate elbow on right
can experience digits on both palms
