BLA Spinal cord injuries, pathophysiology, and SOPs
injuries to ligaments, tendends, or muscles
- Anterior longitudinal ligament-this ligament runs along the anterior portion of the body and is a major source of stability and protects against hyperextension - Posterior longitudinal ligament-this ligament runs along the posterior body within the vertebral canal and prevents hyperflexion. It can be a major source of injury - Cruciform ligament and the accessory atlantoaxial ligament-these ligaments add to the strength, stability, and articulation of the spinal column
Important stats about SCI
- about 363,000 people have suffered from an SCI - 2.4% of blunt force trauma patients experience some degree of musculoskeletal injury to the spine - 43% of severe cervical spine injuries in children younger than 8 may be due to (Spinal cord injury without radiological abnormality) - alcohol plays 25% in SCI's - about 18% results in quadriplegia - mortality rates for patients with SCI are most high, only one year following
Autonomic Dysreflexia Syndrome
- aka autonomic hyperreflexia syndrome - is a late complication of a spinal cord injury, but can happen acutely - it can be a life threatening emergency and happens above T4 - T6 85% of patients with SCI above T6 will develop AHS
Anterior cord syndrome
- caused by flexion injuries - occurs when 2/3 of the anterior cord is lost - *motor function, pain, and temperature sensation
the spinal cord helps to
- control movement - interpret sensory information - change control of movement
Demographics of SCI's
- males at a 78% risk - 16-30 year olds 50%-70% risk
Health conditions present and elevated risk of
- tumors in the spinal region--increase risk of fracture and pressure on spinal tissue. - degenerative bone disease which is called osteoporosis - down syndrome
Cauda Equina Syndrome
-Injury at the L1 level and below resulting in a LMN lesion -Flaccid paralysis w/no spinal reflex activity
Other races and ethnicities have what % risk to SCI's 1% 1.5% 1.7% 1.9%
1.9%
African Americans have what % risk to SCI's 20.2% 22.7% 24.3% 25.1%
22.7%
how many pairs of nerves originate from the spinal cord? 21 27 30 31
31
whites have what % risk to SCI's 54.3% 66.21% 67.2% 71.9%
67.2%
Hispanics have what % risk to SCI's 4.7% 5.9% 8.2% 8.4%
8.2%
blood-brain barrier/ Blood-spinal-cord barrier
A ______ comprised primarily of endothelial cells lining the blood vessels, prevents immune cells and substances in circulation (as well as some medications) from penetrating the brain and spinal cord.
osteroporosis
A condition in which the body's bones become weak and break easily.
A B C D E's are
Airway breathing circulation disability exposure
After firmly securing the chest and pelvis straps of a vest-type immobilization device, what step would follow immediately? a) Secure the patients wrists with a tie b) Secure the straps for the bow ridge and chin c) Add padding to provide support behind the neck of the patient d) Carefully and smoothly remove the patient, placing him/her in a supine position on the backboard
C
neurogenic shock
Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord injuries. all velles below the injury site will dilate relative bradycardia will occur
Brown-Sequard Syndrome
Damage to all spinal tracts on the involved side Damage to half of spinal cord Loss of pain and temperature sensation on contralateral side of body Loss of proprioception and discriminatory touch on ipsilateral side of body.
fractures
Fractures can occur anywhere along the spine. Five to ten percent of spinal fractures occur in the cervical spine. Most, in fact 64%, of spinal fractures occur in the lumbar spine. The most common type of spinal fracture is a vertebral body compression fracture. Spinal fractures can pinch, compress and even tear the spinal cord. Also, loose bone fragments can cause secondary injuries to the cord (for example, transection or compression) and to the surrounding tissues. The possibility of a bone fracture is indicated by the MOI involved and the signs and symptoms presented by the patient.
extension or hyperextension
Hyperextension of the head and neck can produce fractures and ligament injuries with variable stability. Hyperextension injuries can be caused by situations such as a rear end motor vehicle crash, where the body is suddenly pushed out from under the stationary head. This sudden backwards movement of the head can create avulsion fractures of the anterior arch of C1, a vertical fracture through the posterior arch of C1, or fractures of C2.
where does the spinal cord end
L1 and L2 in the Lumbar Division
Posterior Cord Syndrome
Loss of dorsal columns bilaterally, bilateral loss of proprioception, vibration, pressure, stereognosis, 2 point discrimination; preservation of motor function, pain and light touch; very rare!
Nerve root C8 and T1 motor and sensory controls
Motor: Finger abduction/ and adduction Sensory: Little finger
Nerve root C4 motor and sensory controls
Motor: Trapezius (shoulder shrug) Sensory: top of the shoulder
Nerve root T10 motor and sensory controls
Motor: Umbillicus
Nerve root S2, 3, and 4 motor and sensory controls
Motor: anal sphincter tone Sensory: perianal
Nerve root C5 and 6 motor and sensory controls
Motor: biceps (elbow flexion) Sensory: thumbs
Nerve root S1 and 2 motor and sensory controls
Motor: foot plantar flexion Sensory: none
Nerve root L5 motor and sensory controls
Motor: great toe/ foot dorsiflexion Sensory: lateral calf
Nerve root L1 and 2 motor and sensory controls
Motor: hip flexion Sensory: inguinal crease
Nerve root S1 motor and sensory controls
Motor: knee flexion Sensory: lateral foot
Nerve root T4 motor and sensory controls
Motor: nipple
Nerve root L3 and 4 motor and sensory controls
Motor: quadriceps Sensory: medial thigh/calf
Nerve root C3, 4, and 5 motor and sensory controls
Motor: the Diaphragm Sensory: top of shoulders
Nerve root C7 motor and sensory controls
Motor: triceps (elbow extension) and wrist/finger extension Sensory: Middle finger
intervertebral foramen
Opening formed by the inferior and superior notches on the pedicles of adjacent vertebrae. Allows passage of spinal nerves and vessels. it is a notch in the bone.
disc herniation
Rupture of the soft tissue that separates two vertebral bones into the spinal canal, some may cause no symptoms but others may have symptoms of numbness
____________is a temporary condition that may follow spinal cord injury. It eventually resolves (from 24 to 72 hours later). It can vary in presentation depending on the amount of time that has lapsed since the injury was sustained.
Spinal Shock
distraction injury
The spine is excessively pulled, tearing the spinal cord
dorsal root ganglion cells
also known as the spinal ganglion or the posterior root ganglion, are located just outside the spinal cord, and transmit ascending impulses.
spinal interneurons
are located inside the spinal cord. They help coordinate control of muscles by relaying signals between sensory neurons and motor neurons.
Axons
are long nerve fibers that carry signals (ascending to the brain and descending from the brain)
microglial cells
are small glial cells. Their function is to respond to injury and remove waste. There are nine distinct subtypes and each has a different function. They constantly scavenge the central nervous system for plaques, damaged or unnecessary neurons, and synapses.
dermatome
are the particular area of the body that spinal nerves sense or control
Dermatomes
are the particular area of the body that the spinal nerves sense or control.
causes of SCI's
blunt or penetrating trauma, extreme or non-anatomical ranges of motion, insupportable stress loading on spinal structure, pathologies such as osteoporosis, rheumatoid arthritis, spinal tumor, or a blood clot.
Transection injury
can result in spinal shock, can be complete or incomplete. loss of motor function depending on site of injury
vertebral foramen
canal through which spinal cord passes - it begins at the first cervical vertebra (C1) and continues to lumbar vertebra #5 or (L5) other wise known as the Spinal canal
vertebrates five devisions
cervical vertebrae, thoracic vertebrae, lumbar vertebrae, sacral vertebrae, and the coccyx
vertical compression injury
commonly result from trauma to the head, causing spinal compression. These injuries typically result from a direct blow to the crown of the skull, commonly affecting the cervical spine, or from a rapid deceleration from a fall transmitting impact through the feet, legs, and pelvis commonly affecting T12 to L2. - can also cause damage is the patient falls head first
Meninges
consist of three membranes that line the skull and vertebral canal. They also enclose the brain and spinal cord. The three membranes are: pia mater (the innermost), arachnoid mater (the middle), and dura mater (the outermost).
perform full spinal cord imobilization
for all MOI supporting a spinal injury
White matter
gets its name from the insulating sheath of whitish material (or myelin) covering axons on the outer part of the spinal cord.
penetration injury
injury results from penetrating trauma to the spine. It is most commonly associated with injuries such as gunshots, impalements, or lacerations. The severity of the injury to the spine depends on the extent to which the bullet or other penetrating object has impacted spinal tissues or other vessels (such as arteries) that supply blood to the tissues.
Ependymocytes
line the ventricles of the brain and play an important role in the production and regulation of cerebral-spinal fluid.
Central Cord Syndrome
loss of function in upper extremities caused by injury to the middle portion of the spinal cord, 70% of all incomplete injuries.
peripheral nervous system
nerves that lie outside of the brain and spinal cord
finger abduction/adduction C8/T1 dermatome functioning
patient spreads all 10 fingers. then the EMS provider squeezes the 2nd and 4th fingers. Funtions are considered normal if resistance is "spring like"
leading causes of death from people with SCI's
pneumonia, pulmonary embolism, and septicemia
The ____________prevents hyperflexion and can be a major source of injury.
posterior lingitudinal ligament
transverse process
projects laterally and posteriorly, it is between the pedicles and laminae in most vertebrae. is it the site of attachment for muscles and ligaments as well as the point of articulation for the ribs.
spinous process
protrudes where the laminae of the vertebral arch join and provides the point of attachment for muscles and ligaments of the spine.
Oligodendrocytes
provide support and insulation to the axons with myelin to improve impulse conduction. They also inhibit axon regeneration.
Gray matter
refers to nerve cells and dendrite branches. It can be found on the inner part of the spinal cord.
Dislocation/Subluxation
separation of two bones at a joint, loss of mobility and stability to spinal column
Vertebrae
the 33 individual bones that interlock with each other to form the spinal column.
Thoracic Division includes
the chest region, which contains the chest, and abdominal muscles, Vertebrae numbers are T1-T12
vasoconstriction
the constriction of blood vessels, which increases blood pressure.
autonomic nervous system
the control of bodily functions not consciously directed (under involuntary control) such as breathing, heartbeat, and digestive process
rotational injury
the head or spine hyperextends in a lateral direction. This most often occurs as a result of forces of acceleration. The resultant injury can cause: - flexion-rotation dislocation - rupture of supporting ligaments - fracture or dislocation of vertebrae A common injury site for rotation injuries is the cervical region, but such injuries could potentially occur in the lumbar region, as well.
Lumbar Division includes
the middle back region, which contains the leg muscles, Vertebrae numbers are L1-L5*
Astrocytes
the most common glial cells. They function to regulate chemicals surrounding cells, support the BB/BSC barriers, stimulate nerve cells, and respond to injuries by forming scar tissue.
flexion or hyperflexion
the neck or torso hyperextends in a forward direction and is typically the result of a sudden and rapid deceleration. At the level of C1 to C2, these forces can produce an unstable dislocation with or without an associated fracture. A dislocation can be complete or partial and is called a subluxation.
Cervical division include
the neck region, which contains the head, diaphragm, arms, shoulders, wrists, and hands. Vertebrae numbers are C1-C7
Finger/hand extension tests C7 dermatome functioning
the patient holds the wrist and fingers extended in a straight line. The EMS provider provides support under the wrist. Then the EMS provider pushes down on the patients fingers. when moderate pressure is applied, normal resistance should be felt on both the right and left sides.
Sacral Division includes
the posterior pelvis region, which contains the bowel, bladder, and sexual functions, Vertebrae numbers are S1-S5
voluntary nervous system
the somatic nervous system, part of the peripheral nervous system, associated with the voluntary control of muscles resulting in movements of the body
Coccyx Division includes
the tailbone, which contains protection, and structural support, 4 vertebrae
Nerve Roots
these are found at each segment of the spinal cord. A set of anterior motor and dorsal for sensory
glial cells
these cells are more numerous than nerve cells and are key to various functions (for example, blood-brain and blood spinal cord barriers, myelin insulation, and exchange metabolites with neurons). these types of cells include microglia, astrocytes, oligodendrocytes, and ependymocytes.
motor neurons
these control skeletal muscles.
manual stabilization
using your hands to physically hold the body part and keep it from moving
the spinal column contains
vertebrae, intervertebral discs, spinous process, ligaments, the spinal head, the base of the spine
A patient involved in a diving accident would most likely sustain a(n) _________________injury.
verticle compression
Positive MOI
when a full spinal immobilization is required
Negative MOI
when a spinal immobilization is not necessary
uncertain MOI
when a spinal immobilization may or may not be required
Pain tracts
which are dual-side ascending tracts that transmit pain stimuli to the brain (Note that the signals are carried on the opposite side of the stimuli, in other words contralateral to it.)
Light touch tracts
which are dual-side ascending tracts that transmit touch stimuli to the brain (Note that signals are carried on the same side as the stimuli, in other words, ipsilateral to it.)
motor tracts
which are right-side descending tracts that transmit movement stimuli from the brain to the muscles
