Chief Complaint: 19-year-old man with broken back. History: Allen Dexter, a 19-y

Question

Chief Complaint: 19-year-old man with broken back.

History: Allen Dexter, a 19-year-old college student, was rock climbing when he fell 30 feet to the ground. Paramedics arriving at the scene found him lying in the supine position, unable to move any extremities and complaining of neck pain. He was alert and oriented to his current location and the details of his fall. He complained that he could not feel his arms and legs. His pupils were equal and reactive to light. His vital signs revealed a blood pressure of 110 / 72 and a heart rate of 82 beats per minute. Breathing was steady but shallow. The paramedics immobilized his neck and transported him to the trauma center.Upon examination Allen had some sensation in his arms, but could not localize touch or describe texture. He was able to raise his shoulders and tighten his biceps brachii slightly in each arm, but could not raise either arm against gravity. His lower extremities were flaccid, despite attempts to move them. Vital signs were taken again at the hospital and were as follows: blood pressure = 94 / 55; heart rate = 64. X-rays taken upon arrival revealed a fractured vertebra at a particular location. Allen was transferred to intensive care and his condition was stabilized.

Guiding Questions

Answer the questions below and submit as a Microsoft Word document or PDF. DUE Friday by 11:59 pm.

1. Allen's heart rate and blood pressure were abnormally low, but we would reasonably expect the opposite in times of high stress. Which division of the autonomic nervous system do Allen’s symptoms suggest is most active in this case? What is the cause of this phenomenon?

2. Which vertebral bone do you think was fractured? Give specific reasons for your answer and be sure to relate this both to the skeletal muscles which are affected and the changes in general sensation that are noted.

3. What is the primary muscle of respiration under normal circumstances? What nerve innervates this muscle? What are the accessory muscles of respiration? Does innervation of those muscles arise in the same or a different level of the spinal cord?

4. Which spinal nerves contribute nerve fibers to the nerve you named in question #3? What is a benefit of redundancy in nerve input to named nerves?

Explanation / Answer

1) generally in stress,sympathetic division comes into play due to which blood pressure and heart rate increases,but due to this increased heart rate and blood pressure sensed by baroreceptors,parasympathetic division comes into play and it has inhibitory effect on blood pressure and heart rate,that is reduces heart rate and blood pressure.

2) Fracture may be in thoracolumbar spine.

3) primary muscle of respiration is- diaphragm

Accesory muscle- external intercostals,internal intercostals,pectoralis major,pectoralis minor, sternocleidomastoid,serratus anterior, etc.

They receive different innervation.

4) diaphragm is innervated by phrenic nerve arising from cervival plexus and brachial plexus.

External intercostal is innervated by nerves arising from thoracic spinal nerve.

Inernal intercostals is innervated by intercostal nerves.

Other muscles are innervated by nerves arising from brachial plexus.

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