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17 Cards in this Set
- Front
- Back
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Where do a good percentage of spinal injuries occur?
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-during field stabilization, transit to the hospital, or early in the course of therapy
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What is the clinical evaluation for spinal cord injuries?
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-assess ABC's!!! airway, breathing, and circulation
-mobilize neck from the accident scene until the spine is cleared for fracture (soft collars are not adequate! best isa rigid collar with sandbags on both sides of the head) |
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When is a cervical fracture assumed in trauma patients?
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-If patient is alert, and there is ANY pain or tenderness in the neck it likely indicates a cervical fracture
-in depressed consciousness you must ALWAYS ASSUME cervical fracture |
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What are the 3 views of standard radiologic evaluation? How many cervical vertebrae must be visualized?
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-cross table lateral, open mouth, apnterior-posterior
-ALL 7 |
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What is better to ID injuries at C1 and C2?
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-CT is better than x rays
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What are thetypes of surgical intervention that may be necessary for SC injuries?
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-decompression laminectomy (to remove tissue or blood), stabilization of spine using hardware, spinal traction (for realignment)
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Explain brown sequard syndrome? Is it a complete or incomplete lesion? What are the ipsilateral vs. contralateral findings?
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-incomplete
-hemisection of spinal cord -ipsilateral: see loss of proprioception (posterior column disruption) and motor paralysis (corticospinal tract disruption) -contralateral: loss of pain and temp at 2 levels below lesion, light touch is preserved! (due to anterior spinothalamic tracts) |
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How would a pt. present with central cord syndrome? Incomplete or complete?
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-Incomplete
-due to hyperextension of nect, weakness is greater in upper extreities as opposed to lower, varying degress of sensory loss, sphinctor dysfunction! (can initiate stream of urine) |
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How would a pt. present with anterior cord syndrome? incomeplete or complete?
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-incomplete
-caused by compression of the anterior spialartery. See bilateral paralysis (below the level of the lesion), posterior column funciton is preserved (proproiception intact), but you have loss of pain and temp |
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How would a pt. present with posterior cord syndrome? incomplete or complete?
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-incomplete
-burning paresthesias (tingling, pricking sensation) involving neck, arms and torso, may see mild weakness in upper extremities, more sensory problems! |
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Describe complete SC injuries?
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-immediately after injury, hemorrhages occur in the central grey matter of SC
-a zone of hemorrhage, edema and necrosis spreads and ma ultimately involve the entire diameter of the cord within 6 to 24 hours.so gets worse! |
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Explain the damage to the grey matter?
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-damage to grey matter usually onlyinvolves two or three segments at the level of injury, which isolates the body region below the level of injury
-progressive loss of function occurs over the first 24 hours |
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Describe acute phase complete SC trauma symptoms?
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-massive autonomic instability (aka sympathetic stimlation with reflexive parasympathetic activity)
-spinal shock (flaccid paralysis, areflexia, hypotension, bradycardia, urinary retention and bowel hypoactivity |
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What should one give right away if it is a compete SC trauma?
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-corticosteroids (methyprednisolone)! to reduce edema
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Describe chronic phase complete SC trauma symptoms?
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-sympathetic tone will begin to return in 4-7 days, reflex activity begins to return after about 4 weeks (see spastic motor reflex, hyperactive tendon relfexes, persistent autonomic hyperreflia, return of involuntary bladder funciton etc.
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What is the prognosis for complete SC injuries?
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-higher up on the SC causes more disability
-the quicker the recovery begins the better the prognosis (max recovery occurs within 6 mos.) |
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What is the long term care for pts with complete SC injuries?
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-devices to aid in mobility, be aware of probs assoc with immobility (skin breakdown, infeciton, contractures) , catherterization/bowel program, may require ventilation, support, home modification
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