EMS World

AUG 2016

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 42 of 61

42 AUGUST 2016 | EMSWORLD.com be found. A cord contusion indicates some bleeding is occurring in the spinal cord and suggests the mechanism of injury was more significant. Over time the symptoms will completely resolve as the cord heals. It is not expected that a paramedic distinguish a cord concussion and cord contusion during prehospital care. Cord compression: This occurs when either a primary or a secondary cord inju- ry decreases the spinal column's foramen, resulting in a squeezing of the spinal cord. Crushed vertebrae and intravertebral disks can lead to direct compression. An example of a secondary cord injury is compression as a result of swelling developing from soft tissue injury. Regardless of the mechanism, cord compression can lead to cord ischemia. Left untreated, ischemia can lead to necrosis and non-repairable cord damage. Complete cord transection: Any time a mechanism causes a complete cut across the spinal cord, the injury is termed a complete cord transection. A cord transection elimi- nates the body's ability to send or receive signals distal of the injury site; this is a permanent injury that is not repairable and often results in paralysis. When a transection occurs above T-1, or the first thoracic ver- tebra, the patent experiences quadriplegia, which is the paralysis of all four extremi- ties. Transections that occur below T-1 cause paraplegia. Patients with paraplegia can have full use of their upper extremities but are unable to use their lower extremities. The specific site of the transection determines the amount, if any, of movement or sensa- tion the patient might retain. Patients with paraplegia typically retain use of the muscles aiding breathing—but not always. Table 1 summarizes the expected function level fol- lowing cord transection. 6 Incomplete cord transection: Spinal cord injuries do not always result in com- plete cord lacerations. Often, only part of the spinal cord is cut or transected during a spine injury. This injury, called an incom- plete cord transection, results in some nerve bundles remaining intact while others are severed. Only part of the spinal cord is affected by an incomplete cord transec- tion, which leaves the potential for some neurological recovery following injury. The following three types of incomplete cord transection are of note for EMS providers. » Anterior cord syndrome: Transection or infarction of the anterior portion of the spinal cord causes anterior cord syndrome. Typically, anterior cord syndrome occurs when the anterior spinal artery is obstruct- ed or interrupted, resulting in anterior cord ischemia and then infarction. Below the infarction site limited paralysis develops as well as impaired pain and temperature sensation. Patients often maintain a sense of touch, vibration and proprioception, which is the ability to detect the location of body parts relative to the rest of the body. 7 » Central cord syndrome: The most com- mon cause of this presented to EMS provid- ers is traumatic injury, such as hyperexten- sion of the neck. Central cord syndrome resulting from trauma most often occurs in the cervical spine and results in destruction of the motor nerves found in cord's center. EMS1606 For More Information Circle 35 on Reader Service Card

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