![]() ![]() To add the entire transcript to the document, select Add all to document. To add a specific transcript section, hover over the section and select the Add section to document icon. Instead, from the Transcribe pane, you can add the entire transcript, or specific sections of it, to the document. ![]() Unlike Dictate, Transcribe doesn't automatically add the audio to the document. To save your changes, select the Confirm icon. To change all instances of a label, select Change all Speaker. In the Transcribe pane, hover over a section you want to edit.Įdit the content or change the label. You can also edit the content of a section to correct any issues in transcription. You can edit the speaker label and change all occurrences of it to something else. The transcription service identifies and separates different speakers and labels them "Speaker 1," "Speaker 2," etc. Select the timestamp of any transcript section to play that portion of audio. The relevant transcript section highlights as it plays. Use the controls at the top of the Transcribe pane to play back your audio. The audio file, whether recorded or uploaded, is saved to the Transcribed Files folder in OneDrive. You can interact with the transcript in a few different ways. If you close and reopen the pane or close and reopen the document, the transcript remains saved with the document. Your transcript is associated with the document it’s attached to until you remove it. Feel free to do other work or switch browser tabs or applications and come back later. Keep the Transcribe pane open while the transcription is being made. Transcription may take a while depending on your internet speed. When finished, select Save and transcribe now to save your recording to OneDrive and start the transcription process. Resume recording by selecting the microphone icon. Pause recording by selecting the pause icon. Leave the Transcribe pane open while recording. Start talking or begin a conversation with another person. Wait for the pause icon to be outlined in blue and the timestamp to start incrementing to let you know that recording has begun. That way, the recording can pick up the sound coming out of your device. If you want to record and transcribe a virtual call, don't use your headset. For example, if your computer's microphone input is set to your headset mic based on the last time you used it, it won't work well for picking up an in-person meeting. Be careful to set the correct microphone input on your device, otherwise results may be disappointing. ![]()
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![]() For those that haven’t played the Nintendo game, this is a cozy and laidback pack that provides a homier Minecraft experience to play with. Many of the textures and details will be appreciated for those that have experienced the Animal Crossing universe. In the end, this texture pack is designed for fans of Animal Crossing. ![]() Apart from the unique designs and blocks, the developers used some new shader tools to add more detail to the water and add extra shadows to add to the beautiful environmental feeling. However, it is still easy to distinguish each block in its familiar Minecraft appearance, so you won’t be confused when you place a block or item down. You will see very familiar textures to the original Nintendo game due to the creator’s detailed designs of each unique block. Nothing like some tasty fish to keep you energized in Survival. ![]() This developer has ensured to make the fishing rod a key item in your inventory during your playthrough. Of course, one of the most popular quests in Animal Crossing is collecting all of the fish after hours and hours of fishing in-game. The designer has created custom mob skins that make everything from cows to creepers appear like our favorite Animal Crossing characters. The grass is designed to appear just like Animal Crossing, the inventory HUD is remade to look just like the Animal Crossing in-game inventory, and even the painting textures use screenshots from the beloved Nintendo game. Some of the most beautiful details are found in some of the smallest places. The developer of this pack took many of the fan-favorite display and textures from Animal Crossing and ported them to Minecraft. This means that this is a suitable texture pack for only the latest versions of Minecraft. There are also textures for some of the most recent Minecraft items, such as the new campfires. This texture pack does use some familiar shaders and high quality renders for each block. This Animal Crossing resource pack provides you endless hours of exploration and crafting fun. Originally known as ‘Animal Crafting’ this texture pack was built for years from the ground up in order to provide a comfortable and familiar Animal Crossing vibe to Minecraft. The recent popularity of Animal Crossing ‘New Horizons’ on the Nintendo Switch has made this texture pack downloaded more than ever by Minecraft players. ![]() Download Here:īlueNerd Craft 1.14 + (More Updates Soon)ĭon’t Like The Glass Textures? Download the clear glass texture pack and place it above this texture pack in the resource pack list.Ĭlear Glass 1.Since the early days of Minecraft, crossovers between Nintendo’s animal crossing and our beloved Mojang game have be extremely popular, because of this, we see the glorious Animal Crossing Resource Pack. If you are a Minecraft fan you may like my Minecraft Youtube channel, I post Minecraft House Tutorials, Redstone Tutorials and even Let’s Play videos where I take on huge projects. ![]() Some of these textures originally came from the following texture packs: I have also changed all the mobs, villagers and animals in the pack so they blend with the texture pack very well. I wanted to keep the textures looking vanilla style so the blocks could be recognized but with a cleaner, smoother texture. Many of the textures within this pack was have been used from a combination of other packs, some of which I have made small changes too, some of which I kept in original state and some I have completely designed myself. I’v been putting this texture pack together for some time now, to create a nice fantasy/medieval style texture pack with a clean look and feel. Welcome to the BlueNerd Craft 1.13 Texture Pack. ![]() ![]() ![]() Avoid anything with less than 4GB of Ram. Won’t be particularly fast, but fine for very light note taking and browsing the internet. Less than £200 – Intel Celeron or Atom processors, 4GB of Ram and 32GB of storage.How much should I spend on a Windows laptop? Now compare all tested models with our independently lab tested laptop reviews. You'll see a few top picks from various price brackets, and if you want to see the rest and use more specific filters, head to our Windows laptop reviews. Best Windows 11 laptopsīelow you'll find the best Windows laptops at a variety of prices, from £1,500 down to under £400. If you’re not yet a member, you can get instant access by joining Which?. Only logged-in Which? members can view our recommendations in the table below. Not necessarily wedded to a Windows laptop? See our pick of the best laptops. On this page we've only featured the best Windows laptops that either run Windows 11 from new or are likely to be able to upgrade to Windows 11. To know for sure, use our Windows 11 requirements checker tool to find out whether your computer will be compatible. But if you're buying used or refurbished, it could be that your device won't work with Windows 11. If you're buying a new Windows 10 laptop from a major retailer, it's likely your computer will work with Windows 11 and will be eligible for a free upgrade. While it's still possible to find some Windows 10 laptops available, the vast majority will now be on Windows 11. Windows 11 is the very latest version of Microsoft's familiar operating system. This means there’s a huge variety of devices to choose from, ranging from budget netbooks to high-end multimedia laptops. ![]() Microsoft’s Windows operating system is the most widely used computer software on the planet. ![]() ![]() Turn off all mobile devices, phones, etc.Ĭlear your desk of all external materials - books, papers, other computers, or devices. Test Taking Tipsįinally, when taking an online exam, follow these guidelines:Įnsure you're in a location where you won't be interrupted. NOTE: You cannot use Respondus Monitor on a tablet or smartphone. In some cases, your instructor may use Respondus Lockdown Browser with a live proctoring scenario. The Webcam Check will confirm that your webcam and microphone are working properly. You will first need to review and agree to the Terms of Use. If an exam requires LockDown Browser and a webcam, follow steps 1-5 in the previous “Taking A Test” section. At this point, the Startup Sequence for the webcam begins. Mac users must have Adobe Flash Player installed to Safari, even if a different browser is normally used. Your computer must have a functioning webcam and microphone. (The webcam feature is sometimes referred to as “Respondus Monitor.”) You may be required to use LockDown Browser with a webcam, which will record you during an online, non-proctored exam. Err on the side of caution and take your test on a desktop or laptop, preferably with a wired connection. There is a mobile app, but your instructor must configure the test to allow its use. I really hope this situation does not happen during the actual test and ruin my chances of passing.REMEMBER: Once a test has been started with Respondus LockDown Browser, you cannot exit until the Submit button is clicked. I partially blame this on college board as well since I get kicked off of practice test all the time. ![]() I had to ultimately email my teacher so I don’t get points take away for not completing this assignment. While I was able to access my other applications now, it still didn’t allow me to finish my practice exam. ![]() I had to fully shut down the IPad to exit out of the frozen screen. I spent 20 minutes stressing out because I had other assignments I had to work on. I also couldn’t use the home button or the power button either, so I was stuck on the sign in screen. ![]() It at first didn’t bother me since I usually get kicked out of practice test on the college board site, however, because I had the LockDown browser open, I was not able to login again. While I was taking a practice exam(I was on question 43 out of 60), I was randomly kicked out of it and brought back to the sign in screen. Screw this app and its Neanderthal developers.īecause of distance learning, college Board requires AP students to download this app for the exams. The quiz was an easy 10 questions long and would have taken me no more than 10 minutes to complete. And here I am, a straight A student getting the first B in my college career all because of an embarrassing excuse of a mobile test proctoring application. The former would even be preferred at this point. I might as well have just gone to a public bathroom and flipped through pages of an STD textbook for 2 hours instead of going through the immeasurable suffering that was trying to make this app work. Considering most professors in this online day and age don’t trust students when test taking at home, they didn’t buy that this garbage app was the culprit and not my iPad or WiFi which has never had any problems to date. ![]() I started logging into canvas to take a 30 minute quiz just so the app would freeze and crash over a dozen times, effectively taking more time than the quiz allowed for, granting me a 0 on it. This is the first app review I’ve ever made and I’ll just start off by saying that using lockdown browser was the absolute worst test taking experience I have ever had. ![]() ![]() ![]() But please read the safety instructions on page 2, then have a look through some of the features and details in this manual first. It cannot be ruled out that your data collected by Facebook will also be transmitted to the USA. to try out your new Onyx Blackbird 16x16 FireWire Recording Interface. Running the v1.7 driver (downloaded from mackie) and it has been rock solid on x399 platform with the SYBA SY-PEX30016. We ourselves are not in a position to identify you personally via the meta pixel, as apart from your browser ID no other data is stored with us via the pixel.įor more information about the Meta Pixel, the details of data processing via this service and Meta's privacy policy, please visit Meta Privacy Policy - How Meta collects and uses user data for Facebook and Meta Privacy Policy - How Meta collects and uses user data for Instagram. Just adding another note that the 1640i (003 serial in this case) is working perfectly under windows 10 v2004. Meta then delivers individualised ads from us on Facebook or on Instagram that are tailored to your needs. We would like to use it for a recording, but I can't find the drivers to install on our mac (Os Sierra). Need to get something working on your computer How about a firmware update Good chance you ll find it here. Meta is able to identify you by your browser ID, as this is linked to other data about you stored by Meta on your Facebook or Instagram user account. 1 upperlip Registered User Joined: May 2007 Posts: 16 15 years Mackie Onyx 1640 drivers At school, we have a long time not used Mackie Onyx 1640 with firewire card. When you visit our websites, the pixel establishes a direct connection to Meta's servers. I got my mackie new in 2012 but these things are cheap to buy used these days. I did post a question in a thread about Linux benefits in audio, but realized it might be better to make my own. For whatever reason, my computer recognizes the setup.exe as a text file and I can't figure out any way to get it installed. I'm actually not a reaper user (yet), but I'm currently trying to resurrect my former analog workflow with my darling Mackie Onyx 1640i. The meta pixel are code snippets which are able to identify your browser type via the browser ID - the individual fingerprint of your browser - and to recognise that you have visited our websites and what exactly you have looked at on our websites. The site explains that the driver works for both Windows and Mac but the download only includes windows instructions. The Meta Pixel is a remarketing pixel implemented on our websites that allows us to target you directly via the Meta Network by serving ads to visitors of our websites when they visit the social networks Facebook and Instagram. Old hardware working in Window 10 without new drivers Just wanted to let y'all know that I just did an in-place upgrade from Windows 7 (64-bit) to Windows 10 (64-bit), expecting that my old Mackie ONYX 1200F Firewire interface and my M-Audio FastTrack Pro would be non-functional since there are not going to be any new drivers published for either. ![]() ![]() Race against other players or challenge yourself with a punishing obstacle race against the clock. Whatever results you're aiming for, don't settle for second place. The objective of the game might be to cross the finish first, or just to get to the end of the road safely and with your vehicle in one piece. Test your talent and your willpower as you weave your racing car past the traffic and get ahead of your opponents. Whether you love a cartoony car rally with wacky weapons, or brutal vehicle chases in which you have to mow down hordes of zombies as you barrel down ruined roads, Bgames has everything you need! Racing toward the finish line, without downloads In some games you'll really be able to floor the gas pedal as you soar down a wide expanse of motorway in bright and dry weather conditions, while in others you'll really have to pull out all the stops to survive dangerous illegal drag races in dark and rainy urban settings. We've got some amazing car stunt games with 3D graphics and untimed play, as well as tough 3D off-road championships on difficult terrain. Have a look around for the modes of transport and the sports you love and find your newest favorites! Free car racing games of all stripesĮvery guy will have their own preferences for the type of car racing games they like best, and that's why we've put together a very varied collection. And our best drag racing games also have their very own subsection at Bgames. Jump into your car and get ready to embrace the thrill of racing under the stars. Aside from our thrilling car racing games and grand prix championship rallies, we also have amazing games featuring all kinds of other vehicles, including speed boats and jet skis in our collection of boat games, as well as lots of motorcycle, BMX, quad, and dirt bike games. Drag Race 3D will take you through multiple challenging races against the best drivers in the city. We actually don't need to buy a new one if we can just clean and repair the old one.Experience the excitement of reckless motor racing and drag races without the expensive wreckage and real-world insurance worries in our free online racing games! Car racing games are extremely popular among boys, so we make sure to regularly update and expand this section with awesome new games. You also get to choose among these well-designed and colorful tires that will surely make your car look cooler and edgier than ever! As you can see, it is actually possible to turn a muddy and worn-out car into a colorful and useful one. You can pick any color and designs for every part of the car to make it look brand new and unique. Decorating the car is such a fun part because you can apply that inner artistic side of you. Lastly, we can now proceed with decorating the car. We must repair its wires and replace the old gauges in order for them to work well. Many of our racing games put you in the driver's seat, so you. Navigate racetracks in our collection with ease Peel out from the start, skid around turns, and speed through straightaways. Play these online Racing Games for free in your browser. The speedometer is also an important part to repair because it determines the speed of the car and the engine's status. Put the pedal to the metalwithout blowing out your enginein this drag racing arcade game. Our Racing Games consist out of Car Games, Motorbike Games, Bike Games, Multiplayer Games and more. Modify your car with countless options, race in tournaments, and much more. After fixing the machine parts, you can now proceed with the broken radio. Nitto 1320 Legends is a free live online drag racing game featuring the hottest cars. You will also need to add the missing parts so that the car will work fine. ![]() Then, you have to repair the parts now and replace the battery that is not working anymore. The game called Drag Racer v3 is also connected with the following keywords: Drag Racer V3, Free Online Driving Game, Free Racing Game. After cleaning, we need to patch the tires and inflate those flat tires. Make sure to clean those edges to make sure that both the outer and inner parts of the car are squicky clean. First, we need to take out those muds and wash it away. Even if the car is already worn-out, full of mud, and has lots of disgusting cockroaches, when you repair it, it will become an ideal car for you and can still be as useful as it used to be. This car repair game teaches the kids on how to value things that are abandoned already. ![]() ![]() ![]() ![]() Thoughts, ideas, workarounds…? Although I think I’ve tried them all and I'm afraid there isn't an easy solution as it probably comes down to PlayStation's horrible parental controls.How-to Guides How to Get Zadie (& All Additional Styles) How to Get Caper and Alias (& Additional Gear) How to Get the Transformers Pack How to Get the Infinite Drift Pack How To Get Eminem Skin How to Get Lewis Hamilton Skins How to Get Invincible Skins (Omni-Man, Invincible, Atom Eve) How To Get Stranger Things Skins (Eleven, Hopper, & Demogorgon) How to Get WWE Skins How to Get Jujutsu Kaisen Skins How To Get Terminator Skin (Arnold Schwarzenegger) How To Get Ciri And Yennefer Skins (The Witcher) How To Get Optimus Primal Skin How to Get the Miles Morales and Spider-Man 2099 Skins How to Get Son Gohan and Piccolo Skins How To Get Skull Trooper’s Back Bling How to Get Black Adam Skin How to Get Starfire Skin How to Get Destiny 2 Skins How to Get Patrick Mahomes Skin How to Get Dragon Ball Skins How to Get John Cena Skin How to Get Obi-Wan Skin How to Get Chica Skin How To Get The Weekend Skin How To Get John Wick Skin How To Get John Wick Skin How To Get Teenage Mutant Ninja Turtles Skins How To Get Teenage Mutant Ninja Turtles Skins How to Get the Chilling Mystery Pack How to Get the Chilling Mystery Pack How To Get Frieza & Cell Skins How To Get Frieza & Cell Skins Long story short, I’ve talked to PlayStation support who referred me to Epic Games support who, after quite a few email exchanges (in each telling me not to worry and that they will solve this for me), in the end they referred me back to PlayStation support! Don’t think this will be going anywhere with either of them.įunnily enough, it seems that I can purchase something from my Fortnite account and send it as a gift to my son (yeah I know, go figure)! □□♂️ But again, I repeat that Fortnite is one of the games in his allowed list and the error message I'm getting above is most definitely not pointing in that direction. I have tried redeeming the same code on my own PSN account and it's allowing me to go through (although I never complete the procedure so as to maintain the validity of the code) so this tells me that the code is definitely valid and my feeling is that the whole thing has to do with PSN's parental controls. ![]() So I recently purchased a redeemable code (for a Fortnite add-on) intending to redeem it on my son's account but when I login to his PSN account and attempt to redeem the code I get the below error message (notice how there’s no specific mention of why the code cannot be redeemed and that I should "try again later"). I have also upgraded the ghost account Fortnite has created for him to a normal Epic Games account. ![]() I have set up a child account on my PS5 for my son and have allowed him to play Fortnite on it. Just wondering if anyone else has faced this before and if they have managed to solve it somehow. Legacy Platforms: PS4 - PS3 - PS2 - PS1 - PSP Spoiler GuideĪlternatively, use the redesign spoiler tag found in the toolbar. Monthly Games and associated DLC that require base game.No, you keep some things and get the rest back when you renew. Note: PS3 and Vita monthly games were discontinued from March 2019. Member exclusive discounts, themes and avatars Online multiplayer access (free-to-play games do not require this)ġ00GB Automatic cloud storage for game saves *regions with no streaming services will have Deluxe tier instead of Premium at a reduced cost.įull details can be found on official blog post with a summary on this thread.Īvoid asking for deals - check this link instead.Īt least one PS5 and two PS4 games monthly Legacy PS+ benefits: See Essential Tier section belowĬloud streaming for PS1, PS2, PSP & PS4 games Game Catalog & Classics Release: 15th AugustĮssential Games Announcement: 30th AugustĪll-new PlayStation Plus at a glance: Key Benefits Game Catalog & Classics Announcement (Extra/Premium/Deluxe): 9th August ![]() ![]() ![]() As someone who can't code I've been having fun looking at the code and trying to see how things work and I think I've slowly started to learn some things. MonMae isn't perfect, still has a way to go, and is missing a few things I would personally like, but Yana is working hard on it as a solo dev and every update improves things, fixes bugs, or lays the foundation for new features in the future. I thought this was perfect and my best shot at making my dream a reality, so I backed the Kickstarter the day I learned of it. Yana aims to create an engine that non or less skilled coders can use to create monster taming games. One problem I don't know how to code, so I figured this all would just be a dream to think about to kill time. To push monster tamer games to their limit and beyond! Please build responsibly ♡Įver since sword and shield released I always wanted to create my own monster taming game with all the features I personally wanted in a game. This engine was made with the intention to inspire people's creativity and bring healthy competition into the monster taming world. making games with copyrighted artwork, or art or other assets you otherwise do not have direct permission to use from the copyright holders. Please do not use this engine to make illegal products, i.e. ![]() itch.io does not offer refunds, and you can not return a product after a purchase, so please take careful consideration before placing a purchase.Ģ. MonMae is coded in GML and requires GameMaker (free download) to use, you can see the initial setup process from the YouTube Tutorial Series.ġ. Dokimon - Starters Set 2 by YanaĪt current, MonMae is built-on and depends on GameMaker, for things like asset handling, world building, exporting your game. You may be interested in checking out GM's system requirements and exporting licenses before making your final decision. Dokimon - Starters Set 1 by Yana • Made using MonMae © Yanako RPGs LLC 2022īefore you buy, also unlock all assets released in the future by purchasing the bundle below MonMae + Dokimon Bundle Pass by Yana*If you wish to use this art in other engines, please look at our asset packs instead. These rules apply regardless of intent or derivation. Do not create NFT projects or games with copyrighted assets, or e xport any assets found within MonMae to use with other engines. Share or sell this engine, nor assets within it.Edit and use this engine, as well as assets within it to create commercial or non-commercials games.All assets available individually, and options to also get all future assets from our new bundle pass.We are constantly adding new art and features Countless pre-curated scripts, totaling thousands of lines of code in total.100+ Editable Moves, example interiors and exteriors, example NPC's.All the UI you'll ever need, including multiple versions of some menus.Giant, Multi Biome Tileset (Includes MegaCity Tiles, and interiors).8 Playable Characters each with Battle Sprites and Animations. ![]() 20+ Unique Battle Animations (countless with palette swaps).40+ Song OST instantly available upon purchase.60+ NPC's with 56x56 Battle Sprites, and 4 facing directions (100+ Total).100+ Monsters, with both 56x56 Battle Sprite and also 16x16 versions.MonMae currently includes the following assets and features: So I bought MonMae, what comes in the Box? With this, intuitive Visual Editors, responsive support, and a dedicated YouTube Tutorial Series, making montamer games is easier than ever! MonMae contains all of the art, animations, and code you would ever need for making the game of your dreams, with the ability to export to Nintendo Switch, Xbox, PS4, and of course PC, Web, iOS, Android, and Ubuntu. Indulge in the power of an engine that exports to all major consoles, yet requires no coding experience to start!Īll the hard work has been done for you. With a massive library of ever expanding, beautiful artwork at your fingertips, and a 40+ OST, making the next best selling Monster Taming game has never been easier! If there's any doubt, we even have a YouTube Tutorial Series to guide you through the process.Why pick MonMae over other Engines? MonMae (MonTamer Maker) is your one stop shop for monster tamer games! MonMae strives to offer intuitive building mechanics that rival RPGMaker, without all of the suffocating limitations. ![]() ![]() Hearts uses a normal 52 card deck (minus Jokers). Hearts is a versatile game - it can be played by 3-7 players, though 4 is the standard number. In that case, that player must win 0 tricks by themselves, and the tricks they win do not contribute to the other player’s tricks won (though they still count as bags).Grab a standard deck, a few friends, and some scratch paper. The only exception is if either of the players bid nil. The team’s bid is equal to the sum of bids of each of the players, and the team’s tricks won is also equal to the sum of the tricks won by each of the players. When playing in teams of two, the first and third players are teamed up versus the second and fourth players. However, if you win any tricks, you will receive a 100 point penalty. If you bid 0 (or nil), you gain an 100 point bonus if you successfully win zero tricks. When you reach 10 bags, you lose 100 points, and your bags counter resets. At that time, the player with the most points wins.īags accumulate over the course of rounds. The game ends when one or more players pass 500 points. You also get a bag for each trick you win over your bid. If you won as many or more tricks as what you bid, you get (10 x the number of tricks you bid) + (1 point for each trick you won past your bid). Otherwise, the highest card of the suit of the first card played wins the trick.Īt the end of a round, the scoring is calculated as follows: if you did not get at least the number of tricks that you bid, you will lose 10 * the number of tricks that you bid. On a given turn, the player who won the trick is determined as follows: the highest spade wins the trick. tricks won (see 'Scoring'), and the dealer will rotate to the next player. Players will keep taking turns until everyone runs out of cards dealt for the round, and then round restarts.Īt the end of each round, scoring will be tallied based on tricks bid vs. The player who won the trick then starts the next turn. Once each player has played a card, the player who won the trick can be determined (see 'Winning a trick'). The dealer cannot start with a spade until either another player has played a spade, or they have only spades in their hand. If the player does not have that suit, then the player is free to play any card. Players must follow the suit of the first card played. Play a card by dragging it to the table, or by double-clicking on it, if you're not on a phone. Next, starting to the left of the dealer, players will complete a turn by placing one card on the table. To make a bid, click on the number corresponding to what you'd like to bid Each round, 13 cards are dealt to each player.Īt the beginning of the round, starting to the left of the dealer (□), each player will make a bid on the number of 'tricks' will be won by that player in the round. You may optionally choose to play in teams of 2. They will not be able to join after you start the game. Be sure all other players have joined before you start the game. Once you select Play Spades, you'll see the other players who have joined the room and an option to Start Game. ![]() To get started, enter a name for yourself (ex: "player-1") and a room name. Spades is multiplayer! You can play with a total of 2-4 players. To win, players try to score the most points. Spades is a trick-taking card game using a standard 52 card deck. ![]() ![]() This is manifested by paralysis, hypotonia, and areflexia below the level of injury and is felt to be due to transient dysfunction of the spinal cord following injury rather than physical derangements of the spinal cord. Post-injury patients will often exhibit spinal shock soon after their injury. Spinal cord injuries may be complete (with no motor or sensory function below the level of injury) or incomplete (with at least some motor and/or sensory function remaining). In a survey of 165 trauma centers, the incidence among trauma patients of cervical spine injury was 4.3 % and cervical spinal cord injury was 1.3 %. In the case of penetrating trauma without neurologic deficit, clinically significant spinal injury is rare, and providers must weigh the risk of concurrent blunt trauma and occult spine injury with the impediments of strictly maintained spinal immobilization. Immobilization does pose risks of airway obstruction and obscuring other injuries. Placing these patients on a standard backboard will lead to an abnormal lordotic force about the spine, and the rigidity of their spines will potentially transmit this force to any site of injury. These patients have a rigid stooped forward posture and will require elevation of their head with blankets or pillows to maintain their natural “neutral” position. This is often seen in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis. The second is patients with rigid, kyphotic spines. For this reason, children need a blanket or other support beneath their chest to prevent being forced into kyphosis. The first is pediatric patients the relative growth of the skull precedes the growth of the chest (leading to a large head-to-body ratio). This has important implications for positioning for airway management.Īlthough most patients are served well with a standard collar and backboard for spine immobilization, two categories of patients require special consideration. Most cervical spine injuries lead to kyphosis, and many are relatively unstable in flexion (which imparts a further kyphosing movement to the spine). The cervical spine normally maintains a lordotic alignment which helps to position the head in space with respect to the body and also helps to absorb and dissipate any energy from impacts. The remaining flexion, extension, rotation, and lateral bending occur through the subaxial spine (C3–T1). 1a, b, respectively.Īpproximately 50 % of cervical flexion/extension occurs through the atlanto-occipital joint similarly, ~50 % of rotation occurs through the atlanto-axial joint. The normal anatomic alignment of the cervical spine and typical lines that are used to assess alignment and injury are demonstrated in Fig. ![]() The spinal cord lies within the vertebral canal and the cervical nerve roots exit in the foramina between each vertebra. Intervertebral disks reside between adjacent vertebral bodies and are composed of an external annulus fibrosus surrounded by an internal nucleus pulposus. The ligamentum flavum connects the adjacent lamina posteriorly, and the spinous processes are connected by the interspinal and supraspinal ligaments. Running superiorly and inferiorly on the anterior and posterior surfaces of the vertebral bodies are the anterior and posterior longitudinal ligaments. Similar to C1 and C2, they have bilateral transverse foramina through which the vertebral arteries ascend. The remaining five cervical vertebrae (C3-C7) are anatomically similar and gradually increase in size. The anterior articular surface of the dens articulates with the posterior surface of the anterior arch of C1 its position is maintained by a complex set of ligaments including the apical, alantodental, and alar ligaments. The second vertebral body (C2, also known as the axis) is characterized by an anterior process (odontoid or dens) that protrudes upwards from its vertebral body into the ring of C1. The atlas has no vertebral body and no spinous process, but does have lateral transverse processes with transverse foramina through which the vertebral arteries pass. ![]() The first cervical vertebrae (C1) is also referred to as the atlas and has two lateral masses with smooth superior surfaces that articulate with the occipital condyles at the base of the skull at the level of the foramen magnum. The cervical spine is composed of seven cervical vertebrae (C1-7). ![]() |
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