What percentage of pt with spinal injury have at least a mild brain injury
at least 25%
what percentage of injuries occur in each part of the
... [Show More] spine
cervical 55%, thoracic 15%, thoracolumbar junction 15%, lumbosacral 15%
what do approx 10% of pt with c spine fracture have
second non contiguous vertebral column fracture
why do at least 5% of pts experience onset of neuro sx after reaching ED
ishcaemia, or progression of spinal for oedema, or failure to adequately immobilise.
how to exclude spinal injury if pt awake and alert
neurologically intact, no pain or tenderness along spine
risk of prolonged immobilisation
pressure sores (decubitus ulcers) - so come off the spinal board and log roll every two hours
components of spinal stability
facet joints, interspinous ligaments, paraspinal muscles
why do some c spine injury pts die at the scene
apnea from loss of phrenic nerve
what type are most thoracic fractures
wedge compression - not associated with spinal cord injury usually, but fracture dislocation has high chance of complete spinal cord injury
three spinal cord tracts that can be clinically assessed
corticospinal (posterolateral) - ipsilateral motor power, spinothalamic (anterolateral) - contralateral pain and temperature, posterior columns - proprioception, vibration
how to demonstrate sacral sparing
sensory perception in perianal area, or voluntary contraction of anal sphincter
Key sensory points - C5, C6, C7
C5- area over deltoid. C6 Thumb. C7 Middle finger
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Key sensory points C8 T4 T8 T10
C8 little finger. T4 Nipple. T8 xiphisterum. T10 umbilicus
Key sensory points T12 L4 L5
T12 symphysis pubis. L4 medial aspect of calf. L5 1st-2nd toe webspace
Key sensory points S1, S3, S4/5
S1 Lateral border of foot, S3 ischial tuberosity, S4/5 Perianal
Key muscles C5 C6 C7
C5 deltoid. C6 Wrist extensors. C7 Elbow extensors
Key muscles C8 T1 L2
C8 middle finger flexor, T1 small finger abductors, L2 hip flexors
Key muscles L3/4, L4/5/S1, L5, S1
L3/4 - knee extensors. L4/5/S1 - knee flexors. L5 ankle and big toe dorsiflexors. S1 ankle plantar flexors
how is muscle strength graded
0 total paralysis. 1 palpable contraction. 2 full ROM but not against gravity. 3 full ROM against gravity. 4 weaker than normal. 5 normal.
how to identify neurogenic shock
loss of sympathetic pathways - vasomotor done drops, vasodilation, bradycardia. consider vasopressors and atropine once certain
what is spinal shock
flaccidity and loss of reflexes, seen after spinal cord injury - makes spinal injuries seem worse than they reallya re
pitfall of cervical and thoracic spinal injuries
may hypoventilate. may not percieve pain from an acute abdomen
four characteristics to classify spinal injury
level, severity, spinal cord syndrome, morphology
further classification of level
sensory level (lowest level with normal function) motor level (al least 3/5) - there may be a zone of partial preservation. Bony level and neurologic level also.
which injuries result in quadriplegia or paraplegia
above T1 - quad. below T1 - para
what is central cord syndrome
arms weaker than legs with varying sensory loss. often after hyperextension with preexisting cervival canal stenosis.
mechanism for central cord syndrome
thought to be due to vascular compromise - anterior spinal artery
what is anterior cord syndrome
paraplegia and dissociated sensory loss with a loss of pain and temperature. posterior column (position and vibration) is preserved
what is Brown-Sequard syndrome
hemisection of the spinal cord - often after penetrating trauma. ipsilateral motor and porterior column losses, contralateral pain and temperature
most common C1 fracture
burst fracture (jefferson) - best seen on peg view
how many C1 fractures have associated C2 fracture
40%
types of C2 fracture
60% involve the peg, Hangman's fracture involves pars interarticularis - 20%
most common level of cervical spinal injury in adults
C5 fractures, and C5 on C6 subluxation
what feature makes neurological injury more likely
facet dislocation - unilateral 80% will have neuro injury
types of thoracic fracture
anterior wedge compression, burst injuries, chance fractures, fracture-dislocation
what is a chance fracture
transverse fractures through the vertebral body, caused by flexion about an axis anterior to the vertebral column
define thoracolumbar junction. who sustains fractures at this level
T11-L1. fall from height, restrained drivers with severe flexion energy transfer
steps in xray evaluation of c spine
lateral AP and peg view. examine films. if normal, remove collar. then obtain flexion and extension views
ABCDE of c spine
adequacy, alignment, bones, cartilace, dens, extraaxial soft tissues
assessment of atlanto occipital joint
power's ration >1 - (distance from basion to posterior arch C1)/ (distance from anterior arch of C1 to opisthion)
wackenheims line - alignment of posterior clivus to posterior tip of dens
things to feel for when palpating spine
deformity and/or swelling, grating crepitus, increased pain with palpation, contusion and lacerations and penetrating wounds [Show Less]