Traumatic Spinal Cord Trauma – Quiz

  1. The following mechanism of injury indicate a need for spinal immobilization EXCEPT:
  2. Ground level fall
  3. Auto-pedestrian accident
  4. Motorized sports vehicle accident
  5. Fall from height >5 feet

Spinal cord injury is considered to be highest risk when there is a history of a fall greater than 1 meter or 3 feet, whenpedestrians gets hit by vehicles, sustaining injuries after sports related accidents especially those involving motorized sports vehicles, violent acts like gunshot wounds, and from motor vehicle crashes. Ground level falls are considered to be low risk and may not always necessitate a need for spinal immobilization.

  1. Which of the following are symptoms of neurogenic shock:
  2. tachycardia
  3. cool extremities
  4. hypotension despite adequate fluid resuscitation
  5. intact reflexes

Neurogenic shock is a form of distributive shock and results in hypotension and at timesbradycardia. It is attributed to the disruption of the autonomic pathways within the spinal cord. The hypotension results from the pooling of blood in the extremities because of a decrease in systemic vascular resistance from a lack of sympathetic tone. Bradycardia usually results from unopposed vagalactivity and can be exacerbated by hypoxia and endobronchial suction. Neurogenic shock can be fatal if not recognized promptly and treated.

  1. True or False: Prior to age 8 years, children require a recession of the head (or an elevation of the body relative to the head) for adequate spinal alignment during spinal immobilization

Neutral positioning in children has to allow for the relatively large head size and can be difficult to achieve. To allow for neutral positioning of the spine,some pediatric boards have depressed areas for the occiput. Another approach can be to place padding under the back from the base of the shoulders to the lumbar spine. The mean back elevation to provide neutral position is 2.5 cm.

  1. Which type of erection is most likely to occur in a male with SCI
  2. reflexogenic
  3. psychogenic

Reflexogenic erections are mediated by a reflex arc exclusively in the sacral spinal cord. Up to 98% of men with incomplete upper level injuries and 93% or complete upper level injuries have reflexogenic erections.

  1. During spinal shock the bladder is ______. How is the bladder managed for a patient in acute spinal shock?
  2. Flaccid, Valsalva or Crede maneuver
  3. Flaccid, urinary catheterization
  4. Spastic, Valsalva or Crede maneuver
  5. Spastic, urinary catheterization

The immediate and early effects of SCI on bladder function are quite different from those that follow recovery from an initial injury. Spinal shock usually makes the bladder “atonic” or “flaccid” as all reflexes are depressed. The bladder cannot contract and empty. For this reason, the best way to manage the bladder at this stage is the use of a urinary catheter.