Chapter 32 (spinal trauma)

Most authorities agree that the moderndash-day EMS system evolved after the release of what​ document? A.The White Paper​ "Accidental Death and​ Disability: The Neglected Disease of Modern​ Society" B.The Emergency Medical Services Act of 1973 C.The Emergency Medical​ Services: Agenda for the Future D.The American Heart Association Guidelines for Cardiac Resuscitation

A)

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

A)

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.the scene is not safe. B.you have other patients to care for at the scene. C.the​ patient's condition is​ stable, with no signs of neurologic deficit. D.you have enough help to do so.

A)

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

A) cervical spine.

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

A) A.securing the​ patient's torso to the board before securing the head.

When treating a patient with suspected head or spine​ injury, manual stabilization of the head and neck can be​ released: A.after the cervical collar is applied. B.only after the​ C-spine has been cleared by an​ X-ray. C.after the patient is secured to a backboard. D.when you find a good​ pulse, motor​ function, and sensation in the distal extremities.

After the patient is secured to a backboard. Maintain manual stabilization even after the collar is in place until the patient is secured to a​ backboard, because no collar completely restricts motion.

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

B)

What will be the effect of the Institute of​ Medicine's report, The Future of EMS​ Care: EMS at the Crossroads on EMS in the next​ decade? A.All training programs will need to be accredited by their respective state. B.States should adopt a common scope of practice for prehospital personnel. C.State certification will be a prerequisite for national credentials. D.Interstate reciprocity will come to an end.

B)

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

B)

You are dispatched for a fall at the local mall. When you arrive you are led by security to a location on the sidewalk where a​ 43-year-old male patient is lying on his back. He is alert and oriented and tells you that he was running to cross in front of a car when he tripped on the​ curb, striking his head on the sidewalk. He then rolled onto his back and can NO longer move his​ hands, legs, or​ trunk, although he can still move his arms. At what spinal level has his injury likely​ occurred? A.Midthoracic B.Low cervical or high thoracic C.Midcervical D.High thoracic

B) His spinal injury is likely low cervical or high thoracic. Specifically at C8 to T1 the legs and trunk are​ paralyzed, eyelids​ droop, there is a loss of sweating to the forehead​ (Horner syndrome), and the arms are relatively normal but hands are paralyzed.

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

B) B. Motor impulses from the brain only travel down the spinal cord.

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

B) Immobilization

After sustaining a fall from a​ roof, your patient presents with an inability to move their​ arms, but they can still move their legs just fine. What type partial cord injury is​ this? A.Anterior cord syndrome B.Central cord syndrome C.Lateral cord syndrome D.Posterior cord syndrome

B) Central cord syndrome 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. 887

You respond to the scene of an explosion to treat a victim with a penetrating injury to the occipital area from shrapnel. Which of the following additional injuries should you have a high level of suspicion​ for? A.Transection of the trachea B.Hyperflexion of the cervical spine C.Carotid artery involvement D. Hyperextension of the cervical spine

B) The force required to penetrate the occipital area of the skull can easily propel the head forward while the balance of the body maintains the same position. This movement would result in hyperflexion of the cervical​ spine, which can result in injuries such as anterior wedge vertebral fractures.

LOSS OF FUNCTION TO ONE SIDE OF THE BODY (HEMIPLEGIA) IS MORE TYPICAL OF THIS TYPE OF INJURY

BRAIN INJURY OR STROKES ARE MORE TYPICALLY GOING TO CAUSE HEMIPLEGIA.

A 40dash-yeardash-old man has been seriously injured in a car crash. He is unresponsive and has what you believe to be a collapsed lung.​ Additionally, his left leg is severely deformed and his vital signs are unstable. A passenger in the car informs you that the patient is a diabetic and has heart problems. Given this​ information, which one of the following is the best destination for this​ patient? A.Spine injury center B.Cardiac center C.Trauma center D.Stroke center

C)

An involuntary erection of the​ penis, caused by a spinal cord​ injury, is called A. neurologism. B. spinal shock. C. priapism. D. neurologic hypotension.

C)

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.The patient should be able to feel you touching each finger. C.Have the patient grip your hands simultaneously. D. Have the patient grip your​ hands, one at a time.

C)

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

C)

Once a scene is free of safety hazards to those operating around the​ scene, the EMT should focus on the needs of​ the: A.utility workers. B.police department. C.patient. D.fire department.

C)

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

C)

The vertebrae are divided into five areas. From top to​ bottom, these areas​ are: 3—​lumbar, 1—​cervical, 4—​sacral, 2—thoracic. A.​1, 4,​ 2, 3 B.​4, 2,​ 1, 3 C.1, 2,​ 3, 4 D.​2, 1,​ 3, 4

C)

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

C) 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)

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.After extremely low speed collisions C.When the mechanism of injury is not indicative of spinal compromise D.Never

D.Never

Common mechanisms of injury for the spine​ include: A.​extension, when there is severe forward movement of the head. B.​flexion, when there is severe backward 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.

D.compression, when the weight of the body is driven against the head ​flexion, when there is severe forward movement of the head.

Which of the following injuries would you be likely to encounter while treating the driver of a motor vehicle which has been struck from​ behind, and may result in a cord​ injury? A.Rotational subluxation B.Fracture of the posterior vertebral elements C.Lateral compression fracture of a vertebra D.Hyperflexion of the cervical vertebrae

Fracture of the posterior vertebral elements Hyper-extension injuries may cause disc​ disruption, compression of the interspinous​ ligaments, and fracture of the posterior vertebral elements. An example of a hyper-extension injury mechanism is a​ rear-impact auto collision.

HEMIPLEGIA VS PARAPLEGIA

HEMIPLEGIA: PARALYSIS TO EITHER THE LEFT OR RIGHT SIDE OF THE BODY PARAPLEGIA: PARALYSIS TO THE LOWER HALF OF THE BODY.

During the immobilization of a spinal trauma​ patient, what is the LAST part of the body to be​ immobilized? A.Extremities B.Chest C.Neck D.Head

Head The immobilization of a patient to a long backboard ends with the head being secured with a CID very last. Following​ this, the PMS findings should be​ reassessed, and only then can the person at the head let go of manual stabilization.

loss of sweating to the forehead​

Horner syndrome

Difference in skin presentation between hypovolemic shock and Spinal Shock

Hypovolemic shock: pale, moist skin. SPINAL SHOCK: warm, dry, and pink or red. This is due to sympathetic nerve impulses to the adrenal glands being lost, which prevents the release of epinephrine and norepinephrine. This cause vessel dilation and a lack of sweat .

The difference between pain and tenderness?

Pain is what the patient complains of. Tenderness is pain elicited on palpation.

The bradycardia and hypotension that accompanies spinal shock is due to the inability of what nervous system from innervating certain​ organs? A.Parasympathetic B.Sympathetic C.Voluntary D.Cholinergic

Sympathetic The loss of sympathetic tone in high cord injuries results in the inability of the heart to increase its rate and the blood vessels dilate. This results in a drop in blood pressure and a slowing of the heart rate.

While you are assessing the sensory function of a patient with a suspected spinal​ injury, what BEST describes what you should instruct your patient to do before you perform the​ test? A.Clear your mind. B.Squeeze your fingers together. C.Close your eyes. D.Hold your breath.

Close your eyes. During your assessment of the sensory component of the​ PMS, have the patient close their eyes so as to not confuse the ability to feel where you are touching them with being able to see where you are touching them.

Which of the following is a TRUE statement regarding the relationship between a spinal cord injury and a spinal column​ injury? A.You can only have a cord injury if there is a concurrent column injury. B.If there is a cord​ injury, the patient will complain of some type of pain to the vertebral column. C.You can have a cord injury without a column injury. D.The presence of pain along the vertebral column indicates the presence of a cord injury.

C) You can have a cord injury without a column injury. It is possible for a patient to suffer either an incomplete or complete cord transection without sustaining any type of spinal column injury. 886

While palpating the posterior vertebrae of a patient who wrecked his​ motorcycle, you find tenderness and instability around the fourth and fifth thoracic vertebrae. If this is resulted to a complete cord​ injury, the patient may have NO sensory finding beneath what level. A.Umbilicus B.Shoulders C.Mid nipple line D.Knees

C.Mid nipple line An injury to the cord at that level can cause the cessation of sensory stimuli from the mid nipple line down.

The three most common types of incomplete spinal cord injuries

CENTRAL CORD SYNDROME ANTERIOR CORD SYNDROME BROWN-SEQUARD SYNDROME. 887

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

D)

You are called to the scene of an automobile accident in which the driver was wearing his shoulder belt improperly and struck his face on the steering wheel. As you approach the​ vehicle, you see the door has been opened and the driver is​ unconscious, with his head still against the wheel and blood flowing freely from his nose and mouth. His respirations are 18 and shallow and his pulse is 102 radially. Which of the following initial treatment plans is MOST​ appropriate? A.Apply high flow oxygen without restricting the flow of​ blood, place a cervical collar and then perform a rapid​ extrication, clear the​ airway, and complete the primary assessment.​ Finally, expedite transport to the ED. B.Apply high flow oxygen without restricting the flow of​ blood, complete primary​ assessment, perform a rapid​ extrication, clear the​ airway, suction as​ required, intubate the victim while maintaining alignment. C.Place a cervical​ collar, apply high flow​ oxygen, complete primary​ assessment, perform a rapid​ extrication, clear the​ airway, suction as​ required, expedite transport to the ED. D.Manually obtain cervical immobilization and clear the airway prior to applying high flow oxygen. Perform a rapid​ extrication, while maintaining​ alignment, and reassess the airway and consider the need insert a mechanical airway.

D) After initially controlling the cervical spine​ manually, your next priority for a victim with a pulse is to clear and secure the airway with manual techniques and suctioning as necessary. After​ extrication, consider the need to place a mechanical airway if manual techniques fail. There will most certainly be additional treatment​ required, but you must complete your primary assessment in order to treat the victim optimally.

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.Rotation C.Flexion D. Compression

D) Compression

How is the​ patient's torso immobilized during the rapid extrication​ process? A.A short​ vest-type immobilization device is applied. B.The thorax is wrapped with an ace bandage. C.A short backboard is applied. D.There is no torso immobilization​ performed, it is supported during the extrication.

D) During a rapid extrication​ procedure, a cervical collar is applied and the patient is rolled out of the car and onto a backboard. This is done while supporting the thorax as much as possible.

Which of the following tools is NOT recommended for removing the face mask from a football​ helmet? A.PVC pipe cutter B.FM extractor C.Pruning shears D.Screwdriver

D) 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. 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.

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.The spinal column is made up of 42 irregularly shaped bones called vertebrae. C.A solid pad of cartilage called a disc separates each vertebra. D.Ribs originate from the spinal​ column, and the ribs are directly or indirectly attached to it.

D) .Ribs originate from the spinal​ column, and the ribs are directly or indirectly attached to it. The spinal column is made of 33 vertebrae. injury to the cervical vertebrae is more common.

Which choice best describes what the underlying pathophysiology is in a patient with spinal​ shock? A.Paralysis to only one side of the body that does not resolve B.Inadequate circulation indicated by a rapid pulse and​ cool, clammy skin C.Paralysis of the respiratory​ muscles, occurring with injury to the thoracic spine D.Dilation of the blood vessels resulting in reduction of perfusion to tissues

D) Dilation of the blood vessels resulting in reduction of perfusion to tissues With a spinal cord injury there can be a severing of the sympathetic nerve tracts which will result in vasodilation and an inability to increase the heart rate. This can result in hypotension from vasodilation and a drop in cardiac​ output, leading to poor peripheral perfusion.

Which of the following accurately reflects the pathophysiology of​ Brown-Séquard syndrome? A.A​ flexion-extension injury which results in damage to the vertebral​ artery; the cord is damaged by vascular disruption and subsequent ischemia and infarction B.Results from hyperextension of the cervical spine resulting in motor weakness of the upper extremities 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.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

D)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 AN INJURY TO ONE SIDE OF THE BODY DISRUPTS THE SPINAL TRACTS ON ONLY THAT SIDE OF THE CORD. !!!! THE PATIENT LOSES MOTOR FUNCTION AND LIGHT TOUCH SENSATION ON ONE SIDE BUT ALSO LOSES PAIN SENSATION ON THE OPPOSITE SIDE!!!!!

Shock, or​ hypoperfusion, caused by a spinal cord injury is classified​ as:

Neurogenic.