TCRN Spinal Cord and Vertebral Trauma Flashcards

A patient arrives following a diving accident with suspected cervical spine injury. What is the FIRST priority for the trauma nurse?

Answer: Maintain cervical spine immobilization while managing the airway

Airway management with simultaneous cervical spine stabilization is the first priority in any suspected spinal cord injury, following the primary survey framework.

Using the ASIA Impairment Scale, a patient with incomplete SCI whose key muscles below the injury level have a motor grade less than 3 in the majority is classified as:

Answer: ASIA C — motor incomplete, most muscles grade < 3

ASIA C denotes incomplete injury with preserved motor function below the level but with most key muscles graded below 3 (antigravity strength).

Which clinical finding best distinguishes neurogenic shock from hemorrhagic shock in a trauma patient with spinal cord injury?

Answer: Hypotension with bradycardia and warm vasodilated skin

Neurogenic shock results from loss of sympathetic tone, producing hypotension paired with paradoxical bradycardia and peripheral vasodilation, contrasting with the tachycardia of hemorrhagic shock.

Current evidence-based guidelines regarding high-dose methylprednisolone for acute spinal cord injury state that it:

Answer: Is no longer recommended as standard care due to complications outweighing benefit

High-dose methylprednisolone has been removed from standard SCI protocols because risks — including infection, GI bleeding, and pulmonary complications — outweigh the marginal neurological benefit shown in older trials.

A patient sustains a complete C5 spinal cord injury. Which functional finding would the nurse expect on assessment?

Answer: Intact elbow flexion but inability to extend the wrist

C5 preserves elbow flexion (biceps, C5-C6) but a complete C5 injury eliminates C6-innervated wrist extension, creating this characteristic pattern.

Which spinal cord syndrome is characterized by disproportionately greater motor weakness in the upper extremities than the lower extremities following a hyperextension mechanism?

Answer: Central cord syndrome

Central cord syndrome, most common in older patients with cervical spondylosis after hyperextension, injures the central gray matter and medial corticospinal fibers serving the arms more than the legs.

Current guidelines recommend maintaining a mean arterial pressure (MAP) of at least _____ for the first 7 days after acute spinal cord injury to optimize cord perfusion:

Answer: 85 mmHg

Guidelines recommend MAP ≥ 85 mmHg for 7 days post-acute SCI to support spinal cord perfusion pressure and limit secondary injury, a higher target than general ICU goals.