32: EMT: Spinal Column and Spinal Cord Trauma Study HW Study Plan Guide

A cord transection at what level can cause the patient to quit​ breathing? A. C3 B. T1 C. T5 D. S3

C3 A cord transection at the third cervical vertebrae is high enough to cause injury to the phrenic nerve which innervates the diaphragm and is also well above the nerve fibers for the intercostal muscles. This results in the inability to breathe whatsoever.

A 22 year old female dove into the shallow end of the pool and injured her neck. Which of the following spinal injuries is most​ likely? A. Hyperextension B. Compression C. Rotation D. Flexion

Compression 884 Compression injuries occur when the weight of the body is driven against the head.

This form of spinal injury is most common in hangings. A. Compression B. Rotation C. Distraction D. Lateral bending

Distraction 885-886 Distraction injuries occur when the vertebrae and spinal cord are stretched and pulled apart. This is common in hangings.

The number one​ engine-related concern when extricating a victim from a vehicle that has been involved in a frontal collision​ is: A. battery acid. B. fire. C. electrical short. D. fuel leaks.

Fire The most common concern to the extrication team is fire. Attention to disconnection of the battery and control of any fuel leak should be part of the extrication​ team's standard operating procedure.

Where should the pulse be evaluated​ at, during the PMS assessment of a patient who fell from the bed of a​ pickup? A. Carotid and wrist B. Brachial and popliteal C. Wrist and ankle D. Carotid and ankle

Wrist and ankle The assessment of pulses should be done at the wrist and the ankle when determining the quality of peripheral perfusion during the PMS assessment.

Which of the following injuries has a high probability for associative spinal​ injury? A. A gunshot wound to the pelvis B. Knife wounds to the proximal extremities C. A twisting fracture of the tibia D. A​ full-thickness burn to the chest

A gunshot wound to the pelvis The entrance of a bullet into the abdominal cavity could cause the bullet to fragment or change directions and wind up hitting the vertebrae with enough force to cause a spinal cord injury.

Which of the following patients would you NOT suspect as having sustained a spinal​ injury? A. A​ 19-year-old male with two gunshot wounds to the abdomen B. A woman who tripped and fell on a carpeted surface and has wrist pain C. A belted passenger in a​ low-speed MVC, complaining of neck pain and no LOC D. Driver of an MVC with air bag​ deployment, who has no complaint of injury

A woman who tripped and fell on a carpeted surface and has wrist pain Of the four patients and potential injuries the fall onto a carpeted surface broken by an outstretched wrist has the least amount of energy applied to the spine.

When is it appropriate to use a cervical spine collar as the only immobilization device for a known spinal injury​ patient? A. When the patient complains of only mild​ "soreness" or​ "stiffness" in the neck B. When the mechanism of injury is not indicative of spinal compromise C. Never D. After extremely low speed collisions

C. Never It is never standard practice to immobilize a patient using only a cervical​ collar, especially when it is strongly suspected or known that the patient has a cord injury.

Which intervention should the EMT perform first during the primary survey of a patient with a suspected spinal cord​ injury? A. Assess for a radial and carotid pulse. B. Establish​ in-line spinal stabilization. C. Apply oxygen if the pulse ox reading is less than<94%%. D. Determine whether the patient is breathing.

Establish​ in-line spinal stabilization. After taking proper Standard​ Precautions, the EMT should establish manual​ in-line stabilization of the cervical spine. While doing​ so, the EMT can employ a​ jaw-thrust maneuver and assess the​ airway, managing it as needed. Breathing is supported after the airway is clear​ (to include using​ oxygen), and circulation is assessed after the airway and breathing components.

All known spinal cord injuries should receive which of the​ interventions? A. Pulse oximetry monitoring B. BGL assessment C. Immobilization D. Waveform capnography

Immobilization Although the spinal cord injury patient would not be harmed by ongoing pulse oximetry or​ assessment, they must be fully immobilized to help prevent additional damage to the cord or column during transport.

Your patient displays the inability to move their arms following a diving accident into shallow​ water, but they can still move their legs just fine. What kind of injury may they​ have? A. Incomplete spinal cord transection B. Fracture of the atlas and axis C. Bilateral shoulder injuries with nerve damage D. Complete spinal cord transection

Incomplete spinal cord transection The description of the neurological findings is consistent with an incomplete spinal cord injury known at a central cord syndrome.

Which presentation would MOST likely be consistent with a patient possibly having a spinal​ injury? A. Male patient found in a tripod position in his​ garage, complaining of dyspnea B. Male patient found lying unresponsive under a tree C. Elderly female patient found lying in bed wearing pajamas D. Conscious female patient with a history of dropping a bowling ball on her foot

Male patient found lying unresponsive under a tree Even though there may be no overt signs of trauma to the​ patient, a spine injury may exist. Upon​ arrival, scan the scene closely for evidence of a mechanism of injury that could cause damage to the vertebrae or spinal cord. Look​ up, down, and around the patient for signs that an injury has occurred. If an unresponsive patient is lying on the ground near a​ tree, assume that the patient fell out of the tree until proven otherwise. The other patient presentations would be more consistent with medical problems than with traumatic injuries. pg 888

Choosing to apply full spinal immobilization on a patient with a significant MOI but no sign of spinal column injury will not protect the patient​ from: A. the formation of scar tissue. B. a herniated disk. C. SCIWORA D. arthritis.

SCIWORA SCIWORA​ (spinal cord injury without radiological​ abnormality) is a condition in which the spinal cord has become injured without any notable loss of integrity in the vertebral column.

If your trauma patient is unable to spread her fingers open upon your​ request, a possible spinal injury may have occurred at what level of the spinal​ cord? A. T10 B. T4 C. T8 D. T1

T1 The EMT should assess for the following motor findings during a routine PMS​ assessment, which represent motor functions at various levels of the spinal​ cord: "Flex your arms across your​ chest" (tests motor function at​ C6). "Extend your arms​ (straighten the arms to the side of the​ body)" (tests motor function at​ C7). "Spread your fingers out on both hands and​ don't let me squeeze them​ together" (tests motor function at​ T1) "Hold out both arms and​ don't let me push your hand​ down" (done while you support the hand under the​ wrist) (tests motor function at​ C7). pg 890

Which patient should be rapidly extricated from a car after an​ MVC? A. The patient who is unresponsive B. The patient who is tachycardic and complaining of neck pain C. The patient who is sitting closest to a door if there are multiple patients in the car D. The pediatric patient who found properly restrained in an infant seat in the vehicle

THe Patient who is unresponsive There are times when you will have to move a patient with a suspected spine injury before immobilizing him to a long backboard or even to a short spinal device. The three situations in which such movement is permissible are as​ follows: The scene is not safe​ (because of the threat of fire or​ explosion, chemical​ spills, or​ gunfire, for​ example); the​ patient's condition is so unstable that you need to move and transport him​ immediately, such as an unresponsive​ patient; or the patient blocks your access to a​ second, more seriously injured patient. It is not necessary to do rapid extrication for stable patients or multiple patients in the car if they are also stable.

There are some situations in which you may move the patient with a suspected spine injury before immobilizing him to a long or short spinal device. These situations include​ when: A. you have enough help to do so. B. the​ patient's condition is​ stable, with no signs of neurologic deficit. C. you have other patients to care for at the scene. D. the scene is not safe.

The scene is not safe If there is a threat to your safety or that of the crew at an​ MVC, it is permissible to perform a rapid extrication technique to get the patient and your crew away from the automobiles. Following​ this, then the patient can be immobilized.

The twelve vertebrae that comprise the upper back are​ the: A. lumbar spine. B. coccyx. C. thoracic spine. D. sacral spine.

Thoracic spine 883 The thoracic spine is the region of vertebrae named as such due to the attachment of the ribcage that provides the external borders of the thoracic cavity.

What may be the circulatory findings in a patient with a spinal cord injury at the level of C6 or​ C7? A. ​Cool, moist, pale skin with tachycardia B. A lowered blood pressure with a thready and rapid peripheral pulse C. ​Warm, dry skin with poor tissue perfusion D. Hypertension and bradycardia

Warm, dry skin with poor tissue perfusion As a result of spinal​ shock, blood pressure and perfusion may be poor in the patient with spine injury. If the spinal cord nerve fibers traveling from the medulla in the brain to the blood vessels are​ damaged, the blood pressure control center​ (vasomotor center) can no longer maintain the muscle tone in the blood vessels. Below the point of spinal cord​ injury, the blood vessels dilate​ (increase in​ size) and lower their resistance.​ Subsequently, blood begins to pool in the dilated​ vessels, the blood pressure​ drops, and the perfusion of other tissues of the body is reduced. Because of the blood vessel​ dilation, the skin is usually warm and​ dry, even though the tissue perfusion is poor. The heart rate typically remains normal or decreases slightly. Cool moist skin with tachycardia is an indicator of other types of shock as is a lowered blood pressure with a rapid thready pulse.

The EMT is assessing the back of a patient with a suspected spinal injury. All of the following may be detected upon visual​ inspection, EXCEPT: A. deformity or evidence of trauma. B. swelling around the spinal column. C. blunt or penetrating trauma. D. muscle spasms or tenderness.

muscle spasms or tenderness. When assessing the back of a patient with a suspected spinal​ injury, it is not possible to assess muscle spasms to tenderness on a visual inspection.

​Shock, or​ hypoperfusion, caused by a spinal cord injury is classified​ as: A. spinal cord injuries do not cause shock. B. neurogenic. C. cardiogenic. D. hypovolemia.

neurogenic Spinal cord injury can result in uncontrolled dilation of the blood​ vessels, creating more room in the container than the existing blood supply can fill.

The steps in immobilizing a supine patient to a long backboard​ include: A. removing the cervical collar once the patient is immobilized on the board. B. using the​ logroll, a move ideally performed by at least two​ rescuers; one at the​ head, the other at the hips. C. securing the​ patient's torso to the board before securing the head. D. not placing padding on the​ board, as it might move the spine out of alignment.

securing the​ patient's torso to the board before securing the head. Standard immobilization of a patient to a backboard has the torso secured before the​ patient's head.

When immobilizing a seated​ patient, do NOT forget​ that: A. you must apply manual cervical traction before applying a cervical collar. B. you must secure the​ patient's head to the device after securing the torso and the legs. C. you should assess distal​ pulses, motor​ function, and sensation before and after applying the short spinal immobilization device. D. you should place the chin strap or chin cup directly on the​ patient's chin.

you must secure the​ patient's head to the device after securing the torso and the legs. Similar to immobilizing a patient to the​ backboard, immobilizing a patient to a short spine board has the head being the last part of the body secured.

The EMS crew has decided that an unresponsive patient who was involved in an MVC needs to be rapidly extricated. What should the EMS providers do​ first? A. Provide manual​ in-line stabilization of the head. B. Place the patient on a backboard. C. Apply a properly sized cervical collar. D. Roll the patient out of the open door laterally onto a backboard.

Provide Manual in-line stabilization of the head In rapid​ extrication, the patient is first brought into alignment with manual​ in-line spinal​ stabilization, and then a cervical spine immobilization collar is applied. A long backboard is then positioned next to him. The patient is quickly transferred to the long backboard while manual​ in-line spinal stabilization is maintained.

What is the MOST common cause of spinal​ injury? A. Falls B. Sports C. Gunshot wounds D. Automobile accidents

Automobile Accidents The most common cause of spinal injuries is automobile crashes. These make up 48 percent of all spinal injuries. The next most common cause is falls​ (21 percent). Gunshot wounds and recreational​ activities, such as diving and​ football, are the next most frequent causes of spinal injuries.

You are dispatched to the scene of a​ shallow-water diving accident. While en​ route, which of the following would you consider to be the MOST likely result of this method of​ injury? A. Axial loading of the cervical spine B. Hyperextension of the cervical spine C. Hyperflexion of the cervical spine D. Excessive rotation of the cervical spine

Axial loading of the cervical spine A frequent mechanism of axial loading injury is the​ shallow-water dive. In this​ case, the diver impacts the​ pool, lake, or river bottom with the head while the weight of the lower body drives the thorax into the​ head, crushing the cervical spine.

Which of the following accurately reflects the pathophysiology of​ Brown-Séquard syndrome? A. Results from hyperextension of the cervical spine resulting in motor weakness of the upper extremities B. Caused by a penetrating injury that damages only one half of the​ cord; damage to one side results in sensory and motor loss to the ipsilateral side of the body C. Occurs when nerve roots at the lower end of the spinal cord are​ compressed, interrupting sensation and motor​ control; nerve roots that control bladder and bowel function are especially vulnerable to injury D. A​ flexion-extension injury which results in damage to the vertebral​ artery; the cord is damaged by vascular disruption and subsequent ischemia and infarction

Caused by a penetrating injury that damages only one half of the​ cord; damage to one side results in sensory and motor loss to the ipsilateral side of the body pg 888 With​ Brown-Séquard syndrome, damage to one side results in sensory and motor loss to the ipsilateral side of the body. Pain and temperature perception are lost on the contralateral side of the body because of the crossing over of certain nerve fibers​ (spinothalamic) as they enter the spinal cord.

The first seven vertebrae are referred to as the A. lumbar spine. B. sacral spine. C. thoracic spine. D. cervical spine.

Cervical Spine 883 The cervical spine is the first seven vertebrae that form the neck. Most Mobile, Delicate. Injury to the cervical spine is most common.

The rapid trauma assessment of a patient with suspected spine injury​ includes: A. carefully unbuttoning or unzipping clothing to expose the patient. B. following the assessment of the head and​ neck, applying a cervical​ collar, and releasing manual stabilization. C. checking the​ patient's grip strength in each hand separately. D. checking sensation in each hand and each​ foot, and touching one finger or toe at a time.

Checking sensation in each hand and each foot, and touching one finger or toe at a time ssessing the PMS on patients with a known or suspected spinal injury would include assessing sensation in each extremity.

You are dispatched to the scene of an assault with police on the scene. You arrive to find a​ 28-year-old female victim who received a blow to the back of the head with a club and was robbed. The patient is sitting on the​ curb, conscious and well​ oriented, but is sobbing inconsolably. A bystander is holding a jacket on the​ patient's open wound but is NOT in control of the bleeding. The patient has a respiratory rate of 16 and a radial pulse of 92. Your partner takes manual control of the​ C-spine. Which of the following initial treatment plans would be MOST​ appropriate? A. Have the bystander increase pressure on the​ jacket, apply pulse ox and administer supplemental oxygen​ accordingly, perform a rapid trauma​ assessment, and apply a cervical collar B. Give the bystander a sterile dressing and ask him to use firm​ pressure, apply pulse ox and administer oxygen​ accordingly, perform a rapid trauma​ assessment, and apply a cervical collar C. Control bleeding with a loosely bandaged absorbent​ dressing, administer high flow oxygen via a nonrebreather​ mask, perform a rapid trauma​ assessment, apply a cervical​ collar, a pulse​ ox, and titrate oxygen D. Control bleeding with an absorbent dressing​ tightly-wrapped, administer high flow oxygen via a nonrebreather​ mask, perform a rapid trauma​ assessment, begin clearance of the​ spine, and immobilize accordingly

Control bleeding with a loosely bandaged absorbent​ dressing, administer high flow oxygen via a nonrebreather​ mask, perform a rapid trauma​ assessment, apply a cervical​ collar, a pulse​ ox, and titrate oxygen Determination of the best available course of action can be made as early as the first step in the treatment plan. The patient should immediately receive manual stabilization of the cervical spine with application of soft dressings to control the bleed. The patient is also apparently too upset to clear the​ spine, so you should proceed with immobilization based on the MOI. Application of the pulse ox before or after the oxygen is needed to help titrate the appropriate amount of oxygen the patient should receive.

For which of the following reasons does spinal cord injury result in a hypotensive patient that is warm to the​ touch? A. Due to disruption of the sympathetic nervous system at the injury site causing loss of vasomotor tone and vascular dilation B. Due to disruption of the​ brainstem's autonomic control of respiration and heart rate resulting in tachycardia with increased peripheral perfusion C. Due to the resultant uncontrolled hormone releases from the adrenal medulla increasing metabolic activity D. Due to disruption of the parasympathetic nervous system at the injury site causing vasoconstriction

Due to disruption of the sympathetic nervous system at the injury site causing loss of vasomotor tone and vascular dilation A spinal​ injury, either temporary or​ permanent, disrupts nervous​ (generally sympathetic​ nervous) system control over vasculature distal to the injury. Arterioles​ dilate, the vascular container​ expands, and fluid is driven into the interstitial space.

Which finding at a​ two-car MVC would be MOST consistent with the patient likely having damage to her head and​ neck? A. Frontal impact with evidence of front and side airbag deployment B. Frontal impact with a starburst mark on the​ driver's side windshield C. Lateral impact with the patient suffering a concurrent humerus and forearm fracture D. Rear impact with minimal damage to either car

Frontal impact with a starburst mark on the​ driver's side windshield With a frontal​ impact, the patient can travel forward if not restrained properly and may strike her head against the​ windshield, causing a starburst pattern. This typically results in hyperextension of the​ neck, which can damage the vertebrae and spinal cord. Airbag deployment has been shown to reduce the incidence and severity of injury to the patient. A lateral impact is less likely to cause spinal trauma than a frontal impact. A​ low-speed impact that minimally damages the vehicle would also be less likely than a frontal impact with a starburst pattern to cause spinal injury.

What tool is recommended for removing the plastic clips of a football helmet so that the face mask can be​ removed? A. Seatbelt cutter B. Gardening pruning tool C. Screwdriver D. EMT shears

Gardening pruning tool Several different types of​ tools, such as the FM​ extractor, Trainer's​ Angel, knives, pruning​ shears, and PVC pipe​ cutters, can be used to remove the face mask of a football helmet. Even though the plastic clips holding the face mask are typically screwed in​ place, a screwdriver is not recommended to take off the face mask. Unscrewing the clips causes excessive movement of the​ head, especially if the screws have been in place for some time and are rusted.​ DuraShears, EMT​ shears, and a seatbelt cutter are also not recommended because these tools take too much time to cut the plastic clips. A simple pruning tool used for gardening often is the best device to use.

How should the EMT properly assess muscle strength in the upper​ extremities? A. The patient should be able to flex and extend all fingers. B. Have the patient grip your hands simultaneously. C. The patient should be able to feel you touching each finger. D. Have the patient grip your​ hands, one at a time.

Have the patient grip your hands simultaneously. When assessing​ strength, the EMT should instruct the patient to squeeze both of your hands simultaneously to allow you to gauge the quality of the strength and the symmetry of the strength. pg 890

You are assessing a patient who will need a cervical collar because of his possible neck injury. Of the following steps which should be done​ FIRST? A. Apply the collar around the neck. B. Reassess​ pulses, motor​ function, and sensation. C. Manually stabilize the spine. D. Measure the collar size.

Manually stabilize the spine The steps for applying a cervical collar​ include: 1) manually stabilize the​ spine, 2) measure the collar​ size, 3) apply the collar around the​ neck, 4) apply the​ Velcro®, 5) reassess​ pulses, motor​ function, and​ sensation, 6) maintain manual stabilization till the patient is immobilized on a KED or long backboard. pg893

One of the MOST important factors in assessing a patient with a potential spinal injury​ is: A. sensation. B. motor function. C. mental status. D. muscular rigidity.

Mental status An important factor to consider in the patient with a possible spine injury is the mental status. If the mental status is​ altered, it may be an indication of a head​ injury, alcohol​ intoxication, drug​ influence, shock,​ hypoxia, or other causes. An altered mental status does not allow the patient to respond adequately to questions or physical assessment or to provide complaints of​ pain, numbness,​ tingling, weakness,​ paralysis, or other signs of neurological dysfunction. pg 889

Which of the following is TRUE regarding the​ body's nervous​ system? A. The voluntary nerves influence the activity of the​ body's glands. B. The autonomic nervous system is independent from the rest of the nervous system. C. Motor impulses from the brain only travel down the spinal cord. D. The​ brain, spinal​ cord, and voluntary nerves make up the central nervous system.

Motor impulses from the brain only travel down the spinal cord. 882 The brain can only send out motor impulses to the body which travel down the spinal​ cord, and can also only receive sensory information from the body that would travel up the spinal cord to the brain. The autonomic nervous system​ (sympathetic and​ parasympathetic) is integrated into all the​ body's processes and nervous system so it is not independent of anything. The central nervous system is comprised of only the brain and spinal cord whereas the peripheral nervous system includes the crainial nerves and all the spinal nerves traveling out to the body. And​ finally, it is the autonomic nervous​ system, not voluntary nervous​ system, that provides innervation to the​ body's glands.

Why is it critical that the decision to apply spinal immobilization be based on MOI rather than clinical​ presentation? A. Fine neurological deficits are often not tested for or are overlooked in the field. B. It takes up to 3 hours for neurological deficits to become apparent. C. Only 15%% of patients with fractured or dislocated spinal columns show neurological deficits. D. Reliable neurological testing cannot be conducted on intoxicated patients.

Only 15%% of patients with fractured or dislocated spinal columns show neurological deficits. Only 14 to 15 percent of patients who have spinal column fractures or dislocations will have a spinal cord injury that results in neurological deficits​ (motor or sensory​ dysfunction). This means that 85 to 86 percent of the patients who have a spinal fracture or dislocation will not present with a neurological deficit. The other choices represent various potential reasons the correct answer may be true

You have a patient with a spinal cord​ injury, as evidenced by paralysis of the legs. The patient has become​ unresponsive, and you note sonorous airway sounds. What should you​ do? A. Open the airway with a​ jaw-thrust maneuver. B. Provide full immobilization on a backboard before managing the patient any further. C. Insert an OPA airway if there is no gag reflex. D. Initiate PPV with oxygen at a rate of 10 to 12 per minute.

Open the airway with a​ jaw-thrust maneuver. If the patient has become​ unresponsive, the EMT should repeat the primary survey and start by opening and maintaining the airway with the​ jaw-thrust maneuver​ (this technique will cause the least manipulation to the damaged area of the spinal​ cord). Then, in the absence of a gag​ reflex, insert an oropharyngeal airway​ (or a nasopharyngeal airway if the gag reflex is​ present). Provide suction as needed without turning the​ patient's head. After​ this, provide positive pressure ventilation or supplemental oxygen to maintain an SpO2 of 94 percent or more while manual​ in-line stabilization is maintained.

What is the oxygenation guideline for a patient with a suspected spinal cord​ injury? A. Provide oxygen to keep the pulse ox greater than or equals≥ 96 percent. B. Provide oxygen to keep the pulse ox greater than or equals≥ 94 percent. C. Provide oxygen to keep the pulse ox greater than or equals≥ 98 percent. D. Provide oxygen to keep the pulse ox greater than or equals≥ 92 percent.

Provide oxygen to keep the pulse ox greater than or equals≥ 94 percent. The spinal cord injured patient should be given oxygen to maintain a pulse ox reading greater than or equal to 94 percent.

The spinal column is the principal support system of the body. Which of the following is TRUE about the spinal​ column? A. The cervical vertebrae are the​ strongest; injury to the lumbar vertebrae is more common. B. A solid pad of cartilage called a disc separates each vertebra. C. The spinal column is made up of 42 irregularly shaped bones called vertebrae. D. Ribs originate from the spinal​ column, and the ribs are directly or indirectly attached to it.

Ribs originate from the spinal​ column, and the ribs are directly or indirectly attached to it. 883-884 The spinal column supports the body and provides a point of attachment for each of the 12 pairs of ribs posteriorly.

During the assessment of a patient who was injured in an industrial​ accident, the EMT notes that the patient has priapism during the assessment of the pelvis. This finding​ suggests: A. airway occlusion. B. pelvic fracture. C. spinal cord injury. D. brain injury.

Spinal Cord Injury Priapism is a persistent erection of the penis resulting from injury to the spinal nerves to the genitals. It occurs soon after injury and is a classic sign of cervical spine injury. Pelvic fractures typically result in bleeding into the pelvic​ cavity, causing​ hypoperfusion, a brain injury more likely results in​ hemiplegia, and an airway occlusion is obviously unrelated.

A temporary condition in which the patient loses the ability to move voluntary muscles and typically loses bowel and bladder control is​ called: A. spinal shock. B. priapism. C. vertebral concussion. D. neurolysis.

Spinal Shock Spinal shock is a temporary​ concussion-like insult to the spinal cord that causes effect below the level of the injury. Such an injury usually occurs high in the cervical region. Below the level of injury there is a loss of muscle tone​ (flaccid muscles), the patient is unable to feel sensations of light touch or pinch​ (anesthetic effect), and the patient is unable to move the extremities or any voluntary muscles​ (paralysis). The patient will typically lose control of the bladder and bowel.

A temporary injury to the spinal cord that may resolve over time is called A. partial spinal cord injury. B. incomplete spinal cord injury. C. spinal shock. D. complete spinal cord injury.

Spinal Shock 886-887 Spinal shock is a temporary​ concussion-like insult to the spinal cord that causes effect below the level of the injury.

What is a temporary​ concussion-like insult to the spinal cord that causes effects below the level of the​ injury? A. Neurogenic hypotension B. Cord transection C. ​Brown-Sééquard syndrome D. Spinal shock

Spinal Shock Spinal shock is a temporary​ concussion-like insult to the spinal cord that causes effects below the level of the injury. Such an injury usually occurs high in the cervical region. Below the level of​ injury, there is a loss of muscle​ tone, the patient is unable to feel sensations of light touch or​ pinch, and the patient is unable to move the extremities or any voluntary muscles. Neurogenic shock results from an injury to the spinal cord that interrupts nerve impulses to the arteries. When the arteries lose nervous impulses from the brain and spinal​ cord, they relax and dilate. This vasodilation causes a relative hypovolemia within the circulatory system. A complete spinal cord injury results when an area of the spinal cord has been completely transected​ (cut crossways) either physically or physiologically.​ Brown-Séquard syndrome results from injury to the right or left half of the cord.

Which statement regarding spinal shock is MOST​ accurate? A. Spinal shock typically results in neurogenic hypotension. B. Spinal shock is differentially diagnosed by​ x-ray. C. Spinal shock commonly results in permanent neurological deficit. D. Spinal shock is differentially diagnosed in the field by elevated blood​ pressure, normal​ pulse, and warm dry skin.

Spinal shock typically results in neurogenic hypotension. Spinal shock is a temporary​ concussion-like insult to the spinal cord that causes effects below the level of the injury. Neurogenic hypotension from spinal​ shock, also called​ spinal-vascular shock or neurogenic​ shock, results from an injury to the spinal cord that interrupts nerve impulses to the arteries. When the arteries lose nervous impulses from the brain and spinal​ cord, they relax and dilate. This vasodilation causes a relative hypovolemia within the circulatory​ system; that​ is, there is more space than there is blood to fill the arteries. Because of​ this, the patient becomes hypotensive​ (has lowered blood​ pressure). Spinal shock usually resolves within 24 hours after the incident but may last for several days. It is not differentially diagnosed by​ x-ray.

Fracture of the cervical spine at the atlas and axis is responsible for half of the fatal spine injuries.​ Why? A. Thoracic vertebrae are less mobile than cervical vertebrae. B. The atlas and axis form the transition from the spinal cord to the brainstem. C. The atlas and axis are exceptionally mobile and susceptible to fracture or dislocation. D. The atlas and axis are more easily crushed due to axial loading.

The atlas and axis form the transition from the spinal cord to the brainstem. The atlas and axis​ (C1/C2) protect the segment of the spinal​ cord, which transitions into the brainstem. Disruption of the cord at this level terminates virtually all vital communication of the brain with the body as well as potentially damaging the brainstem where autonomic functions are carried out.

When should the EMT remove the helmet of an injured​ patient? A. The patient presents with significant neck and back pain. B. The helmet is a​ sports-type helmet. C. The helmet interferes with your ability to assess the airway. D. The helmet does not have a chin strap.

The helmet interferes with your ability to assess the airway. Activities such as bicycle​ riding, motorcycle​ riding, and playing football can easily lead to accidents that can produce spine injury. People taking part in such activities often wear​ helmets, and you may arrive at an accident scene to encounter a patient still wearing a helmet. Removal of a helmet should not be an automatic step. Such removal could risk aggravating the spine injury if one exists. You should remove the helmet if your assessment reveals the​ following: The helmet interferes with your ability to assess or reassess airway and​ breathing; the helmet interferes with your ability to adequately manage the airway or​ breathing; the helmet does not fit well and allows excessive movement of the head inside the​ helmet; the helmet interferes with proper spinal​ immobilization; or the patient is in cardiac arrest.

What is the MOST accurate statement about the ability of a patient to breathe when she has suffered a spinal cord​ injury? A. The patient may be able to breathe adequately or inadequately or may not be able to breathe at all. B. The patient will have rapid and shallow​ breathing, but it will be adequate. C. The patient will be apneic if there is a spinal cord injury. D. The patient will have slow and shallow breathing that will likely be inadequate to sustain life.

The patient may be able to breathe adequately or inadequately or may not be able to breathe at all. Paralysis of the respiratory muscles may occur with injury to the cervical spine. Rapid deterioration of the​ patient's condition and death may result without quick intervention by the EMT. Depending on the level of the cord​ injury, both the diaphragm and the intercostal muscles may be paralyzed. In lower spinal​ injuries, the diaphragm may continue to function even if the chest wall muscles are paralyzed. The patient will display​ shallow, inadequate breathing with little movement of the chest or abdomen. Continuous positive pressure ventilation is necessary.

What is the hallmark indicator of central cord​ syndrome? A. Losing nervous impulses from the brain and spinal​ cord, arteries relax and dilate. B. The patient suffers weakness or paralysis and loss of pain sensation to the upper​ extremities, while the lower extremities have good function. C. The patient loses motor function and light touch sensation on one side of the body but loses pain sensation on the opposite side. D. The patient suffers loss of some function in some areas of the body.

The patient suffers weakness or paralysis and loss of pain sensation to the upper​ extremities, while the lower extremities have good function. pg 887 If the central portion of the spinal cord is injured the patient may present with weakness or paralysis and loss of pain sensation to the upper extremities while the lower extremities have good function. Central cord syndrome is more commonly seen in elderly patients. Neurogenic hypotension from spinal​ shock, also called​ spinal-vascular shock or neurogenic​ shock, results from an injury to the spinal cord that interrupts nerve impulses to the​ arteries, causing them to dilate. The loss of some function in some areas of the body is typically attributable to an incomplete spinal cord injury.

Which statement accurately reflects the effect of anterior cord​ syndrome? A. Nerve roots at the lower end of the spinal cord are​ compressed, interrupting sensation and motor​ control; nerve roots that control bladder and bowel function are especially vulnerable to this injury. B. The patient will present with loss of sensation to pain and loss of motor function below the site of cord​ injury; however, the patient will retain the ability to feel light touch. C. The patient may present with weakness or paralysis and loss of pain sensation to the upper extremities while the lower extremities have good function. D. Anterior cord syndrome is caused by a penetrating injury that damages only one half of the​ cord; damage to one side results in sensory and motor loss to the ipsilateral side of the body.

The patient will present with loss of sensation to pain and loss of motor function below the site of cord​ injury; however, the patient will retain the ability to feel light touch. pg 887 Anterior cord syndrome results from injury of the sensory and motor​ tracts, which are located in the anterior portion of the cord. The posterior portion of the​ cord, where the tracts for light touch are​ located, is not injured. The patient will present with loss of sensation to pain and loss of motor function below the site of cord​ injury; however, the patient will retain the ability to feel light touch. Damage to one side of the cord is​ Brown-Séquard syndrome the symptoms vary depending on which side of the cord is damaged. In central cord​ syndrome, the patient may present with weakness or paralysis and loss of pain sensation to the upper extremities while the lower extremities have good function.

A spinal column injury typically​ damages: A. the spinal cord. B. light touch sensation. C. ambulation. D. the vertebrae.

The vertebrae A spinal column injury​ is, by​ definition, an injury to one or more​ vertebrae, that​ is, the portion of the spine that is composed of bone. Whether it is a fracture or a​ dislocation, a spinal column injury is a bone injury. Loss of ambulation or sensation indicate damage to the spinal cord.

The mechanism of spinal injury resulting from an automobile​ accident: A. is always compression of the spinal column. B. typically leaves the patient with a discernible neurological deficit. C. is dependent on the direction of impact. D. does not affect intoxicated drivers.

is dependent on the direction of impact. The most common cause of spinal injuries is automobile crashes. These make up 48 percent of all spinal injuries. The mechanism of spinal injury​ (compression, hyperextension,​ hyperflexion, rotation,​ etc.) is largely dependent on the direction of the forces in the impact​ (front collision, rear​ collision, etc.). It is important to note that​ multiple-impact and rollover accidents may involve more than one mechanism. Neurological deficit occurs in about 15 percent of patients with spinal column injury. Intoxication increases the chance of being involved in an accident but does not protect the driver from injury.

Emergency medical care of the patient with suspected spinal injury​ includes: A. using sandbags to immobilize the​ patient's head on the long backboard. B. using manual cervical spine traction until the application of a cervical collar can be done. C. opening and maintaining the airway using the​ head-tilt, chin-lift method if the patient is responsive. D. palpating the cervical region for any deformities or tenderness.

palpating the cervical region for any deformities or tenderness. Part of the management for spinal injuries is to determine the extent of the injuries. Since vertebral injury may be better felt than​ seen, the EMT should lightly palpate the posterior vertebrae while assessing for any​ instability, malalignment, or stepping off of vertebrae.

Remember the following regarding the signs and symptoms of spinal​ injury: A. the patient may complain of pain to the legs if the thoracic spine is injured. B. check for loss of sensation above the suspected level of injury. C. paralysis of the extremities is a reliable sign of spine injury. D. have the patient move to try to elicit a pain response.

paralysis of the extremities is a reliable sign of spine injury. While a disruption of the spinal cord can cause the cessation of nerve impulses from reaching a muscle​ (causing paralysis), remember that the presence of motor function may rule out a complete cord​ transection, but not a partial cord transection.

When immobilizing infants and​ children, it is important to​ remember: A. that if an automobile collision involves a child in a car​ seat, you cannot use that car seat to stabilize the child for transport. B. to pad from the shoulders to the heels of an infant or child to maintain neutral​ in-line immobilization. C. that​ adult-sized backboards and cervical collars can be modified to use with children. D. that if you do not have a cervical collar that​ fits, use one that is slightly larger.

that if an automobile collision involves a child in a car​ seat, you cannot use that car seat to stabilize the child for transport. If you are at an automobile collision involving a child in a car​ seat, you cannot use that car seat to stabilize the child for transport. Car seats involved in crashes may have lost the integrity of the structure and may not provide protection to the child if another crash were to occur. Transfer the child to a backboard.

If your patient is wearing a​ helmet, you should leave it in place​ if: A. there are no impending airway or breathing problems. B. the helmet has been damaged. C. the helmet is too snug to remove easily. D. the helmet is loose enough to allow you to assess the​ patient's head and neck.

there are no impending airway or breathing problems. It is permissible to leave the helmet in place if there is no airway or ventilatory problems that you will need to manage.

It is more common for spine injuries to cause​ paralysis: A. on only one side​ (hemiplegia). B. to all four extremities​ (quadriplegia). C. to only the upper extremities. D. to only one leg or the other.

to all four extremities​ (quadriplegia). Compare the sensory function and strength in the upper and lower extremities. It is more common for spine injuries to cause paralysis to all four extremities​ (quadriplegia) or to the lower half of the body only​ (paraplegia). Loss of function confined to the right or left side of the body​ (hemiplegia) is more typical of a brain injury or stroke. Conflicting or partial loss of motor or sensory function may be an indication of an incomplete spinal cord injury.

During your initial​ assessment, it is important to​ remember: A. to initiate immediate manual​ in-line spinal stabilization based on patient need. B. that the​ patient's skin may be​ cool, pale, and moist below the site of spinal cord​ injury, and warm and dry above the site of injury. C. to open the airway of an unresponsive patient using the​ head-tilt, chin-lift method. D. that inadequate breathing may result from spinal cord damage from a thoracic spine injury.

to initiate immediate manual​ in-line spinal stabilization based on patient need. The EMS providers should always assess the need​ for, and immediately implement spinal precautions if the​ patient's mechanism of injury or presentation necessitates it. pg 889

Which of the following results from penetrating injury that affects one side of the​ cord? A. Central cord syndrome B. Anterior cord syndrome C. ​Brown-Sééquard syndrome D. Cauda equina syndrome

​ Brown-Sééquard syndrome pg 888 Brown-Séquard syndrome is usually caused by a penetrating injury that affects one side of the cord​ (hemitransection). This causes disruption of nerve transmissions on that side of the cord.

Common mechanisms of injury for the spine​ include: A. ​flexion, when there is severe backward movement of the head. B. ​extension, when there is severe forward movement of the head. C. ​rotation, when the vertebrae and spinal cord are stretched and pulled apart. D. ​compression, when the weight of the body is driven against the head.

​compression, when the weight of the body is driven against the head. A compression mechanism occurs when there is axial loading of weight on the vertebrae. This could happen with falling and landing on the​ feet, or falling and landing on the head.