Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury...
-
Upload
elijah-hancock -
Category
Documents
-
view
217 -
download
0
Transcript of Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury...
![Page 1: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/1.jpg)
Spine and Spinal Cord Trauma
![Page 2: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/2.jpg)
Objectives
• Anatomy/physiology
• Evaluate a patient with spinal injury
• Identify common spinal injuries and Xray features
• Appropriately manage the spinal-injured patient
• Determine appropriate disposition
![Page 3: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/3.jpg)
Suspected Spinal Injury
• High speed crash
• Unconscious
• Multiple injuries
• Neurologic deficit
• Spinal pain/tenderness
![Page 4: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/4.jpg)
Spinal injury
• 5% worsen neurologically at hospital
• Protection is a priority
• Detection is a secondary priority
• Spinal evaluation complicated by TBI
• Remove spine boards ASAP
![Page 5: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/5.jpg)
Cord Injury Severity
• Complete = no motor function or sensory function below the injury level
• Incomplete = any preservation of function– Sacral sparing may be the only preservation of
function
![Page 6: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/6.jpg)
Sensory Examination
• Levels vs sensation
![Page 7: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/7.jpg)
Motor Examination
• Table outlining levels
![Page 8: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/8.jpg)
Neurogenic Shock
• Hypotension associated with cervical/high thoracic spine injury
• Bradycardia
• Tx: fluid, atropine, pressors
![Page 9: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/9.jpg)
Spinal Shock
• Neurologic, not hemodynamic phenomenon
• Occurs shortly after cord injury
• Flaccidity
• Loss of reflexes
![Page 10: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/10.jpg)
Effects on other organ systems
• Inadequate ventilation
• Compromised abdominal evaluation
• Occult compartment syndrome
![Page 11: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/11.jpg)
Classification of Injuries: Levels of injury
Clinical exam
Most caudal
Normal bilaterally
Motor/sensory function
Bony = site of vertebral damage
![Page 12: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/12.jpg)
Classification
• Incomplete– Any sensation
– Position sense
– Voluntary movement in lower extremity
– Sacral sparing
• Complete– No motor/sensory
function
– No sacral sparing
– May have reflexes
![Page 13: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/13.jpg)
Spinal Cord Syndromes
• Central• Anterior• Brown-sequard
• Anatomy diagram
![Page 14: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/14.jpg)
Classifications: morphology
• Fracture or fracture dislocation
• SCIWORA
• Penetrating
![Page 15: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/15.jpg)
Classification: morphology
• Unstable if:– Xray evidence of injury– Neurologic injury– Severe pain on spine movement or palpation
![Page 16: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/16.jpg)
Xray Guidelines
• A• A• B• B• C• C• D• S
• Normal C spine Xray
![Page 17: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/17.jpg)
C spine Xrays
• Cross table lateral detects 85%
• Additional 2 views excludes most fractures
• May also require:– Swimmer’s– CT– Flex/ex– MRI
![Page 18: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/18.jpg)
Cspine Xrays
• 10% have a second fracture
• Look for second fracture!
• One fracture mandates full spine films
![Page 19: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/19.jpg)
Xray Guidelines
• Adequacy• Alignment• Bones• Cartilage• Contours• Disc space• Soft tissue
• Thoracolumbar spine Xray
![Page 20: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/20.jpg)
Screening for Spinal Injury
• Algorithim – Paraplegia/quadraplegia– Presumed spinal instability– Identify bony fracture-subluxation– Consult neurosurgery or orthopedics
![Page 21: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/21.jpg)
Screening for Spinal Injury
• Alert, sober neurologically normal patient:– No neck pain or tenderness– No distracting injury– No pain with voluntary movement
• No further Xrays required
![Page 22: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/22.jpg)
Screening for spinal injury
• Alert, sober, neurologically normal patient– Neck or spin pain or tenderness to palpation or
voluntary movement– After removal of c-collar?– If yes to any question
• Protect cspine
• Obtain necessary Xray exams
![Page 23: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/23.jpg)
Screening for spinal injury
• Altered LOC– Complete spine films– Plain films– CT prn
![Page 24: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/24.jpg)
Screening for Spinal Injury
• Radiographic– Normal Xray
• Clinical– Normal neurologic exam and– Absence of spinal pain/tenderness
• Caution!– Drugs, alcohol, distracting injuries
![Page 25: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/25.jpg)
Management
• Immobilization– Entire patient
– Propper padding
– Maintain until cleared
– Avoid prolonged use of backboard
• Decubitus ulcer
![Page 26: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/26.jpg)
Medical Management
• Ensure A/B
• Maintain BP
• Atropine prn
• Methylprednisolone
![Page 27: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/27.jpg)
Medical Management
• Intravenous fluids– Treat hypovolemia first– Consider neurogenic shock– Insert foley
![Page 28: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/28.jpg)
Medical Management
• Steroids– Methylpred doses
![Page 29: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/29.jpg)
Medical Management
• Transfer– Unstable fractures– Neurologic deficit– Avoid delay– Proper immobilization– Respiratory support as needed
![Page 30: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/30.jpg)
Questions
![Page 31: Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e0e5503460f94af850f/html5/thumbnails/31.jpg)
Summary
• Treat life-threatening injuries first (ABCD)
• Immobilization
• Appropriate Xrays
• Document examination
• Consultation
• Transfer