Bb Spinal Cord Injury

Front 1

Where does the radicularis magna typically arise?

Back 1

T9-T12 in 85% of patients, T5 in 15% of patients

Front 2

Where do the radicular branches arise?

Back 2

total of 4-10 branches from the vertebral, cervical, intercostal, and lumbar arteries

Front 3

What forms the anterior spinal artery?

Back 3

union of two vertebrals with contribution from radicular arteries(minimal in thoracic region)

Front 4

What part of the spinal cord is supplied by the anterior spinal artery?

Back 4

anterior 2/3s of the spinal cord(mainly motor function)

Front 5

What forms the posterior spinal artery?

Back 5

vertebrals or from the posterior inferior cerebellar arteries

Front 6

What can occur immediately after injury to the cervical spine and lasts for hours to about a month, and is due to loss of descending impulses from higher centers, especially the corticospinal tract, and is characterized by alveolar hypoventilation, hypoxemia, and decreased ability to protect the airway?

Back 6

spinal shock

Front 7

What are manifestations of cervical spine injuries?

Back 7

flaccid paralysis, loss of reflexes(DTR's and vasopressor), bradycardia, hypotension, EKG changed

Front 8

In a patient with a cervical spine injury how should you manage induction?

Back 8

awake intubation is probably the safest (can also try RSI), try to avoid block of the recurrent laryngeal nerve due to patient's likely full stomach

Front 9

Above what spinal level do patients typically not survive spinal cord injury?

Back 9

above C2

Front 10

What are the stages to paralysis in T-spine injuries?

Back 10

flaccid: lasts 1-4 weeks, is manifested by absence of neurologic function below the lesion, including motor, sensory, reflexes, and autonomic, characterized by spinal shock; spastic paralysis: 4 weeks after injury is manifested by motor and autonomic hyperreflexia

Front 11

What are common problems experienced by paraplegics?

Back 11

respiratory infection and dysfunction, anemia, dehydration, electrolyte imbalances, bowel, bladder, and respiratory dysfunction

Front 12

When is SCh contraindicated following spinal cord injury?

Back 12

after 1 day to 1year

Front 13

What is the treatment of Vfib following SCh administration?

Back 13

ABCs, DC shock, and treatment of hyperkalemia

Front 14

Why is spinal anesthesia a good option in paraplegics?

Back 14

blocks afferent impulses, want level high enough so that stimulation will not cause autonomic hyperrelexia

Front 15

How can you evaluate the level of spinal anesthesia in a paraplegic patient?

Back 15

test for the sympathogalvanic response, if block is high enough there is no change in skin resistance to sympathetic stimulation, if block is absent there is an increase in skin resistance with sympathetic stimulation

Front 16

When does autonomic hyperreflexia most commonlly occur?

Back 16

6month to 2 years following injury

Front 17

Above what level must a spinal cord injury occur for a patient to get autonomic hyperreflexia?

Back 17

T7

Front 18

What stimuli can cause autonomic hyperreflexia?

Back 18

any endogenous stimulus below the level of the lesion, distention of rectum or bladder is the most common cause, the magnitude of the response is proportional to the magnitude of the stimulus and generally greater as the distance increases between the level of the cord lesion and the level of entry of the stimulus

Front 19

What are signs of autonomic hyperreflexia?

Back 19

htn, bradycardia, ventricular arrhythmias, and profuse sweating and flushing(vasodilation above the lesion) and blanching and vasoconstriction below the lesion, severe headache, difficulty breathing, nausea, shivering, blurred vision

Front 20

What is the cause of the htn and bradycardia with autonomic hyperreflexia?

Back 20

htn: centrally mediated increased sympathetic stimulation, bradycardia secondary to htn acting upon the carotid sinus

Front 21

What is the most effective prevention of autonomic hyperreflexia?

Back 21

spinal or general anesthesia(epidural, topical, or bilateral paravertebral sympathetic blockade is less reliable)

Front 22

What is the best treatment of autonomic hyperreflexia?

Back 22

remove the offending stimulus, SNP for hypotension

Front 23

Why are patients with spinal cord injury prone to respiratory insufficiency after extubation?

Back 23

cord edema or hematoma at the operative site

Front 24

Patients with what level of spinal cord injury are prone to vasomotor instability?

Back 24

cervical

Front 25

Why are spinal cord injury patients prone to hypothermia?

Back 25

no temperature regulation below the level of the lesion

Front 26

Why are patients with spinal cord injuries prone to hyperkalemia?

Back 26

muscle membrane becomes chemically active as well as electrically active following injury from 1day to 1yr

Front 27

How is respiration affected spinal cord injury?

Back 27

normally the diaphragm:intercostal muscle contribution to ventilation is 70/30% respectively, if intercostal muscles are lost vital capacity is decreased 40% with the diaphragm making up the difference