Spinal Trauma

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					Spinal Trauma
Anatomy and Physiology
   Vertebral Column
   Spinal Cord
Skeletal Injuries
   Compression fractures of vertebra
   Fractures that produce small fragments of
   Subluxation: partial dislocation of a vertebra
    from its normal place in spinal column
   Overstretching or tearing of ligaments and
Injuries to the Spine
   Varied mechanisms of injury (flexion,
    extension, rotation, distraction, compression,
    lateral flexion, combination of forces)
   Mostly blunt, some penetrating
   Spinal cord injury obviously feared,
    particularly for cervical spine
   Range from unstable injuries to stable
Common causes of spinal cord injury
   Motor vehicle accidents.
   Acts of violence.
   Falls.
   Sports and recreation injuries.
   Diseases.
Indications for Spinal Immobilization
   Altered Level of Consciousness
       Traumatic Brain Injuries (TBI)
       Altered Mental Status other than TBI
       Acute Stress Reaction
   Spinal Pain or Tenderness
   Neurologic Deficit or Complaint
   Anatomic Deformity of the Spine
    Signs and Symptoms
    The signs and symptoms of a spinal cord injury depend
     on two factors:
    1.   The location of the injury.
    2.   The severity of the injury.
    Spinal cord injuries are classified as partial or
     complete, depending on how much of the cord width is
    1.   A partial spinal cord injury, which may also be called an
         incomplete injury, the spinal cord is able to convey some
         messages to or from the brain.
    2.   A complete injury is defined by complete loss of motor
         function and sensation below the area of injury.
Signs and Symptoms
   Paralysis of extremities        Priapism
    (The most reliable sign in      Posturing
    conscious patient)              Loss of bowel or bladder
   Pain with/without                control
    movement                        Nerve impairment to the
   Tenderness anywhere              extremities
    along the spine                 Severe spinal shock
   Impaired breathing              Soft tissue injury
   Deformity                        associated with trauma
Diagnostic Procedures
   X-rays.
   Computerized tomography (CT) scan: is
    beginning to become the study of choice in
    many trauma centers and emergency
   Magnetic resonance imaging (MRI).
Emergency Care Steps
   Manual stabilization for head and neck
   Assess A, B & C
   Assess head & Neck and apply rigid cervical collar
   Assess sensory & motor function in all extremities
   Apply appropriate spinal immobilization device
   Administer Oxygen via NRM if patient has paralysis
    or weakness.
   Reassess motor and sensory in all extremities
Steroid Protocol for Spinal Cord Injury
   Solumedrol 30 mg/kg bolus followed by
    infusion 5.4 mg/kg/hr for next 23 – 48 hours
   Controversy exists

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