Tncc 2016 : Chapter 13 Spinal Cord And Vertebral Column Trauma

Front 1

The upper motor neurons form 2 major systems :

Corticospinal Tract which is responsible for ___

Extracorticospinal Tract which is responsible for__

Back 1

fine motor skills

gross motor movement

Ch13 - pg174

Front 2

Upper motor neurons cross at the ___

Back 2

brain stem.

This is the basis for loss of movement on the contralateral side from a head injury

Ch13 - pg174

Front 3

Intercostal muscles are innervated by spinal nerves ____ through ____

Back 3

T2 through T8

Ch13 - pg174

Front 4

Sacral nerves ___ to ___ supply the perianal muscles, which control voluntary contraction of the external bladder sphincter and the external anal sphincter

Back 4

S3 to S5

Ch13 - pg174

Front 5

Cervical plexus

Back 5

formed by the first 4 cervical nerves which innervate the neck and shoulders.

The phrenic nerve arises from C3 C4 C5 which innervates the diaphragm

Ch13 - pg176

Front 6

Brachial plexus

Back 6

C5 to C8 and T1, supplies motor control and sensation to arm, wrist, hand. This includes the ulnar and radial nerves.

Ch13 - pg176

Front 7

Lumbar plexus

Back 7

L1 to L4, gives rise to the femoral nerve and innervates the anterior portion of the lower body

Ch13 - pg176

Front 8

Sacral plexus

Back 8

L5 to S4. The origin of the sciatic nerve. Which innervates the posterior portion of the lower body.

Ch13 - pg176

Front 9

Four Distinct types of forces can be applied to the vertebral column

Back 9

1. Hyperextension
2. Hyperflexion
3. Rotation
4. Axial loading

Ch13 - pg178

Front 10

The ____ vertebrae are the largest and strongest in the vertebral column

Back 10

five lumbar. L1-L5

Extreme forces are required to produce fractures of the thoracic region of the vertebral column: therefore these can frequently be accompanied by SCI

Ch13 - pg177+179

Front 11

Hyperextension of Spine

Back 11

backward thrust of head

rear end MVC resulting in whiplash

C-spine

Ch13 - pg179

Front 12

Hyperflexion

Back 12

Forward flexion of the C-spine when striking an immovable object

Subluxation, odontoid or transverse process fractures

Head on MVC striking windshield

Ch13 - pg179

Front 13

Rotational

Back 13

Combination of forward flexion with lateral displacement of C-spine.

Dislocation of the vertebral body

MVC to front or rear, causing spinning

Ch13 - pg179

Front 14

Axial Loading

Back 14

Direct force transmitted along the length of the vertebral column.

Deformity of the vertebral column.

Diver striking head on bottom of pool

T12 - L2

Ch13 - pg179

Front 15

Primary Spinal cord injury

Back 15

initial mechanical damage to the spinal cord:

laceration

Crushed disc

Ch13 - pg180

Front 16

Secondary spinal cord injury

Back 16

progressive cell damage that results from biochemical and cellular reactions due to inflammatory response, hemorrhage, hypoperfusion and hypoxemia.

Ch13 - pg 180

Front 17

Cord Concusison

Back 17

Transient dysfunction of the spinal cord lasting 24-48 hours

Ch13 - pg180

Front 18

Cord Contusion

Back 18

Bruising of the neural tissue causing edema, ischemia, and possible infarction of tissue from cord compression.

Ch13 - ppg180

Front 19

Cord Transection

Back 19

Complete disruption of the neural elements.

All cord-mediated functions below the level of the injury are permanently lost

Ch13 - pg180

Front 20

Incomplete Cord Transection

Back 20

An interruption in the vascular perfusion to the spinal cord may result in cord ischemia or necrosis. Can be permanent depending on time

Ch13 - pg180

Front 21

Neurogenic Shock :

Commonly due to injury at ___ or higher

Results in ___

Back 21

Vascular System Response

T6 (just below nipple line)

Disruption of sympathetic regulation of vagal tone leading to loss of vascular resistance and generalized vasodilation

Ch13 - pg181

Front 22

Neurogenic Shock : Symptoms

Back 22

Vascular System Respons

Categorized in Distributive Shock.

Blood volume is pooled in peripheral vasculature.

Bradycardia - Sympathetic innervation is lost. Unopposed parasympathetic vagal response.

Hypotension - blood pools in periphery

Warm skin, normal skin color

core temperature instability

Ch13 - pg181

Front 23

Neurogenic Shock : Treatment

Back 23

Vascular System Response

Dopamine Not fluid bolus

Due to loss of sympathetic response

Ch13 - pg181

Front 24

Spinal Shock : define

Back 24

Nervous System Response

when normal activity in the spinal cord at and below the level of the injury ceases because of a disruption or inhibition of impulses in the spinal cord.

Ch13 - pg181

Front 25

Spinal Shock : Signs and Symptoms

Back 25

Nervous System Response

Complete loss of reflex function below the level of the injury.

Transient flacididty

Transient hypotensive period

Bowel and bladder dysfunction

Inflammatory response may contribute to ischemia.

Ch13 - pg181

Front 26

Respiratory Arrest can occur due to injury of spinal cord at ___ to ___

Back 26

C3 to C5

Can cause loss of phrenic nerve function

Ch13 - pg182

Front 27

Hypoventilation due to loss of intercostal muscles can occur due to injury of the spinal cord at ___ to ___

Back 27

T1 to T11

Ch13 - pg182

Front 28

Hypoventilation due to loss of use of abdominal muscles can occur due to injury of the spinal cord at ___ to ____

Back 28

T7 to T12

Ch13 - pg182

Front 29

Central Cord Syndrome (incomplete spinal cord lesion)

Back 29

Loss of motor function upper extremities > lower extremities.

Often sacral sparring.

Bladder function may be affected.

Ch13 - pg182

Front 30

Anterior Cord Syndrome (incomplete spinal cord lesion)

Back 30

Loss of pain and temperature sensation, with weakness, paresthesia, and urinary retention.

Damage to Lateral spinothalamic tract(pain and temperature)

Ch13 - pg182

Front 31

Brown-Sequard Syndrome (incomplete spinal cord lesion)

Back 31

Contralateral loss of pain and temperature sensation, and ipsilateral paralysis with reduced touch sensation.

Damage to L side of spinal column.

Ch13 - pg182

Front 32

Sacral Sparing is identified by the following

Back 32

Intact perianal sensation

Voluntary anal sphincter tone

Voluntary great toe flexor function

As spinal shock resolves, sacral sparing may become evident.

Ch13 - pg183

Front 33

Complete Spinal Cord Lesion

Back 33

Lose all motor and sensory function at and below the level of the lesion

Loss of ANS function - hypotension, bradycardia, poikilothermia, voluntary bowel and bladder function

Front 34

The thoracolumbar junction T11-L1 are most often fractured as a result of ___ and ___

Back 34

hyperflexion and rotation

Ch13 - pg183

Front 35

C1 Atlas Fracture, Burst Fracture, or Jefferson Fracture:

MOI

Back 35

Axial loading forces transmitted from occiput to spine

Ch13 - pg184

Front 36

The presence of peri anal sensation and anal sphincter tone when seen in conjunction with focal deficits represents an incomplete SCI,

This is an assessment for and known as ___

Back 36

Sacral sparing

Ch13 - pg187

Front 37

# of Vertebrae

Cervical

Thoracic

Lumbar

Sacral

Back 37

7 Cervical (vick)

12 Thoracic (Cunningham)

5 Lumbar (McNabb)

5 Sacral (Mcnabb - Redskins)

Ch13 - pg176