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70 Cards in this Set

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Spinal cord injury can have a profound effect on human what
Physiology, lifestyle adn finanical circumstances
At what age does most spinal cord injurys occur at
16-35 years of age
What are the most common causes of spinal cord injures
MVC
Falls
What is the age group for the 2nd and 3rd largest age group for spinal injures
2nd is 21-25years of age
3rd is 26-35 years of age
What is the age group for most trauma patients
16-20 years old
What are the 4 concepts that the EMT needs to understand when it comes to spinal injurys
1) The head is like a bowling ball at the top of the neck. It moves in diffect directiosn from the torso

2) Objects in motion stay in motion

3) Sudden or violent movment of the upper legs moves the pelivs. Which moves the lower spine. Whcih caues movments of the upper spine

4) Lack of a nero deficts does not rule otu bone or ligament injuy to the spine
What conditions should the EMT start to think spinal injury
Any blut mechanism that would produce impact on head, neck, torso or pelivs

Sudden acceleration, deceleration, lateral bending to the neck/ torso

Falls

Ejection
Shallow water diving incident
What is the spinal columm made up of
33 bones called vertebrae
What is the largest part of the vertebra called
The anterior part called the body
What is uniquie about the body
It is the weight baring part of the vertebrate
What are:
Neural arrches and the spinous process
Neural arches are the two curved spides of the vertebrae

spinous process is the posteriso part of the vertebra
What are the parts of the spine called
Cervical, Thoracis, Lumbar, Sacral and coccygeal regions
What precrent of spinal injures happend in the:
Cervical
Thoracis
Thoracolumalr
lumbosacral
Cervical-15%
thorac-15%
Thoracolumbar15%
Lumbosacral-15%
How much does the human head weight
16-22lbs
Spinal tracts are divided into what
Ascending and descending tracts
What do the ascending spinal tracts do
Carry sensory impulse from body parts through the cord up the brain
The ascending tracts can also be diviend in to what
Tracts that carry differnt sensations of pain, temp. touch, pressure and motion viberation, postion and light toubh
The tracts that carry pain and temp. do what in the body
Cross over. So left tract gets right body info.
What do descending nerve tracts do
Carry motor impulses from the brain throguh the cord down to the body. They also control all muslce movement and muscle tone
The spianl cord has______ pars of spinal nerves
31
What is the dorsal root used for and what is the ventral used for
Dorsal-sensory impulses
Ventral-motor impulses
What is a dermatome
The sensory area on the body for which a nerve root is responsible
Were is the T4 and T10 dermatome located
T4-nipple level
T10-is the umbilicus level
What happes if the phrenic nerve is cut or if the spinal cord is cut above c2
The pt will lose the ability to breath spontaneously.
The bony spine can normally withstand forces up to how many lbs/ft
1000lbs/ft
How are some of the ways that the cord can be injuied
Compression fractures that prdouce wedge compression or total flattening of the vertebra

Fractures that produce small fragments of bone that may lie in the spinal cannel near the cord

Subluxation, partial dislocation of the vetebra from its normal alignmen tin the spinal column

Overstretching or tearing of th eligaments and muslce producing instability between the verebrate
What is the chance that a pt who has had a spianl injurie will have anohter one
10% chance
Cord contusion
brusing or bleeding into the tissues of the spinal cord, Which may also resutl in tempoary loss of cord function distal to the injury
What is cord contusion usually caused by
Penentratin type of injury or movement of bony fragments
Cord compression
Pressue on the spinal cord caused by swelling, But also may be from traumatic disc rupture and bone fragments
Cord laceration
When the cord is cut
Complete cord transection
A complete break in the spinal cord
incomplete cord transection
A half break of teh spinal cord
What are the types of incomplete cord transection
Anterior cord syndrome
Central cord syndrome
Brown-Sequard syndrome
What is anteriror cord syndrome
Bony fragements or pressue on the spianl arteries
Symptoms of anteriror cord syndrome
Loss of motor function, pain, temerature and light touch sensations.

Light touch, motion position and vibration sensatiosn are spared
What nerves does anterior cord syndrome effect
Spinothalamic tract
What is central cord syndrome
usually occures with hyperextension of the cervical area
Symptoms of central cord syndrome
Weakness or paresthesia in the upper extremities but normal strengh in the lower extremities. Some bladder dysfunction
What spinal cord tracks does Central cord syndrome effect
All of them-Pyramidal tract, Posetrior columnus and spinothalamic tract
Spinothalamic tract
Pain and tempreature sensation on th eopposite side
Pyramidal tract
Motor function on the same side
Posterior columnus
Position and vibration sensation on the same side
What is brown sequal syndrome
Penetration injury and invovle hemi-transection of the cord
Symptoms of Brown sequard syndrome
complete cord damage and loss of function on the affected side.
Were should the BP be maintated at with spinal cord injures
85-90mmHg
How is field neurologic exam done
The pt is asked to move the arms, hands and legs. Any inability to do so is noted
Were should the neuro exam start on the body
Shoulders and down to the feet
What is the primary care focus of spinal trauma
Recongnize the indications for spinal immobilzation rather then attempt to clear the spine
What does an assessment of the spinal cord include
Motor and sensory functions, Presnece of pain or tenderness and patient reiability as predictors of spinal cord injury
What are the cornerstone to proper spinal care
Superior assessment with appropriate and timely treatment
What are some major causes of spinal inj. in the adult pt
MVC, shallow water incidents
motorcyle crashes
Falls, Sport injuries
What are some major causes of spianl inj. in PEDS
Falls from heights(2-3x the Pts height)
Falls from tricyle or bicyle
Being struck by Motor Vehicle
What are some situations were the provider should asume the presence of a spinal injury
Any blunt mechanism, that produced a violent impact on the head, neck, torso or pelvis

Sudden accelerations, decelerations, or lateral bending on the neck or torso

All falls.

Ejection

Victim of a shallow water incident
What are some situations that may not be as clear but may warrent spinal damage
Head Injs. with ALOC
Helmet Damage
Blunt inj to torso
Impacted or other deceleration fx of the legs and hips

Significat localized injuires to the area of the spinal column
What is the general rule when it deals covers assessment and spinal inj.
If the Pt didn't sustain any neuo damage, nothing has happend
What is the rule of spinal injs when it comes to penetrating Trauma
if the object didn't damage the cord, the pt probablly will not have any neuo damage
What is the golden rule when it comes to Spinal immobilization
When it doubt-immobilize
What are some clear indicatiosn for teh need for spinal imobilization
ALOC,
Spinal pain or tenderness
Neuo defict or complaint
Anatomic deformity of the spine

Intoxication, Distracting painfull injuires, Communicatiosn barriers
What is the managemnt in the US for spinal inj.
Immoblize the pt to a supine position on a backbord in a neutral inline position
Spinal immobilization follows what common princile
Fx managment-immobilizing the joint above and the joine below an inj.
What are the four general postures that an Pt will present in
Sitting, semi-prone, supine or standing
When must in line position be stoped
Resistance is noted
Neck muslce spasm
increased pain
Start or increase of Nero Defict such as numbness, tingling or loss of motor ability
Compromise of teh airway or ventilation
When should in-line movement not be attempted
pts injuries are so sever that the head presents with such misalignment that it no longer appears to extent from the midline of the shoulders
What are some common mistakens when backboarding
Inadequate immobliation
Immoblization w. head hyperextended

Immobilizing teh head before the torso or eadjusting the torso straps after teh head has been seured

Inadequate padding
What is the goal with spinal injuires when it comes to trasnport
Move patients at little as possible. Movie pt after being secured to the backbord
What are the steps in immobization
Torso, head, legs, arms
What are some drugs and dosages that may be used with spinal injres
Steroids-methylpredniscolne,
30mg/kg follwed by 5.4mg/kg/hr for up to 48hrs
What is a hallmark sign of high cervical spine inj.
Bradycardia
Hypotension, with Tachycardia may leand to what
Presence of hypovoemic