EMST / ATLS Ch 7 Spine and Spinal cord
What percentage of pt with spinal injury have at least a mild brain injury - ANS at least 25%
what percentage of injuries occur in each part of the spine - ANS cervical 55%, thoracic 15%,
thoracolumbar junction 15%, lumbosacral 15%
what do approx 10% of pt with c spine fracture have - ANS second non contiguous vertebral
column fracture
Why do at least 5% of pts experience onset of neuro sx after reaching ED - ANS ischaemia, or
progression of spinal for oedema, or failure to adequately immobilise.
how to exclude spinal injury if pt awake and alert - ANS neurologically intact, no pain or
tenderness along spine
risk of prolonged immobilisation - ANS pressure sores (decubitus ulcers) - so come off the
spinal board and log roll every two hours
components of spinal stability - ANS facet joints, interspinous ligaments, paraspinal muscles
why do some c spine injury pts die at the scene - ANS apnea from loss of phrenic nerve
what type are most thoracic fractures - ANS wedge compression - not associated with spinal
cord injury usually, but fracture dislocation has high chance of complete spinal cord injury
three spinal cord tracts that can be clinically assessed - ANS corticospinal (posterolateral) -
ipsilateral motor power, spinothalamic (anterolateral) - contralateral pain and temperature,
posterior columns - proprioception, vibration
how to demonstrate sacral sparing - ANS sensory perception in perianal area, or voluntary
contraction of anal sphincter
Key sensory points - C5, C6, C7 - ANS C5- area over deltoid. C6 Thumb. C7 Middle finger
Key sensory points C8 T4 T8 T10 - ANS C8 little finger. T4 Nipple. T8 xiphisternum. T10
umbilicus
Key sensory points T12 L4 L5 - ANS T12 symphysis pubis. L4 medial aspect of calf. L5 1st-2nd
toe webspace
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