CHAPTER 32
Which one of the following statements about removing a helmet in the prehospital setting is true?
"It is acceptable to leave the helmet on a patient if the patient has no airway or breathing problems."
Which one of the following instructions from one EMT to another shows the correct application of a cervical spine immobilization collar?
"Keep his head in neutral position while I apply the cervical spine immobilization collar."
The vertebrae are divided into five areas. From top to bottom, these areas are: 3long dash—lumbar, 1long dash—cervical, 4long dash—sacral, 2long dash—thoracic.
1, 2, 3, 4
Approximately what percentage of patients who suffer a MOI sufficient to fracture or dislocate the vertebral column will have a neurological deficit?
15%
For which of the following patients involved in a motor vehicle collision is the use of a vestminus−type short immobilization device indicated?
33minus−yearminus−old female in the backseat who states that her neck hurts and she has a headache
Which of the following accurately reflects the pathophysiology of Brown-Séquard syndrome?
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
What area of the spinal cord is most commonly injured?
Cervical spine
While performing the primary assessment on a patient with an isolated spinal cord injury, you note that he is in severe respiratory distress and struggling to breathe. Where should you suspect the spinal cord injury has occurred?
Cervical spine
The EMT is caring for a patient who has a problem with the autonomic component of his nervous system. Which sign or symptom would most likely be caused by this condition?
Elevated heart rate
Which finding at a two-car MVC would be MOST consistent with the patient likely having damage to her head and neck?
Frontal impact with a starburst mark on the driver's side windshield
Why is it critical that the decision to apply spinal immobilization be based on MOI rather than clinical presentation?
Only 15%% of patients with fractured or dislocated spinal columns show neurological deficits.
When treating a patient with suspected head or spine injury, manual stabilization of the head and neck can be released:
after the patient is secured to a backboard
Assessment of the cervical spine of a patient, complaining of lower back pain after falling down five stairs, reveals no displacement, tenderness, or instability. Accordingly, the EMT should:
apply a properly sized cervical collar.
The first seven vertebrae are referred to as the
cervical spine.
A patient is being extricated from a car using a vestminus−type short immobilization device. After the patient has been extricated, the EMT should:
immobilize the patient with the vestminus−type short immobilization device to a long backboard.
The mechanism of spinal injury resulting from an automobile accident:
is dependent on the direction of impact.
It is more common for spine injuries to cause paralysis:
to all four extremities (quadriplegia).
During your initial assessment, it is important to remember:
to initiate immediate manual in-line spinal stabilization based on patient need.
In order from top to bottom, how many vertebrae are in each section of the spinal column?
7, 12, 5, 5, 4
Based on the structure of the nervous system, which of the following is true?
A deep laceration to the arm can sever peripheral nerves.
Which of the following injuries has a high probability for associative spinal injury?
A gunshot wound to the pelvis
What is the MOST common cause of spinal injury?
Automobile accidents
Which injury is possible based on the anatomy of the spine?
Disk injury between thoracic vertebrae 11 and 12
For which of the following reasons does spinal cord injury result in a hypotensive patient that is warm to the touch?
Due to disruption of the sympathetic nervous system at the injury site causing loss of vasomotor tone and vascular dilation
Which intervention should the EMT perform first during the primary survey of a patient with a suspected spinal cord injury?
Establish in-line spinal stabilization.
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?
T1
You arrive on the scene of a motor vehicle collision. Walking toward you is the unrestrained driver of the vehicle that sustained moderate frontminus−end damage. The patient complains of some back pain, but is walking around after the crash and does not appear to be suffering from any neurological deficits. What is your initial action in caring for this patient?
Take manual inminus−line spinal stabilization.
A patient injured in a motor vehicle collision is suffering from the separation of the rib and its associated spinal vertebrae. Based on the anatomy of the spine, where has this injury occurred?
Thoracic spine
When applying a cervical spine immobilization collar (CSIC) to a young boy who fell out of a tree, the EMT realizes the collar benefits the patient by:
decreasing downward compression on the cervical spine.
The number one engine-related concern when extricating a victim from a vehicle that has been involved in a frontal collision is:
fire.
While transporting a 38minus−yearminus−old female who fell from a secondminus−story window, you note that she is becoming confused and her pulse rate is increasing. Additionally, her blood pressure has dropped and her skin is now cool and clammy. Based on these assessment findings you would recognize:
hypovolemic shock.
Conflicting or confusing signs of spinal cord injury are typically the result of:
incomplete cord injury.
One of the MOST important factors in assessing a patient with a potential spinal injury is:
mental status.
Remember the following regarding the signs and symptoms of spinal injury
paralysis of the extremities is a reliable sign of spine injury.
An involuntary erection of the penis, caused by a spinal cord injury, is called
priapism.
The steps in immobilizing a supine patient to a long backboard include:
securing the patient's torso to the board before securing the head.
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:
the scene is not safe.
What instruction would you provide to your team immediately after securing a patient with head, neck, and back pain to the long backboard?
"Check for pedal pulses before we move him to the stretcher."
A patient is lying under a tree after being involved in a motor vehicle collision. She states that immediately after the crash, she felt okay, but now her legs are numb and tingling. She also has lower back discomfort. What question is it most important for the EMT to ask first?
"How did you get out of the car?"
Which one of the following shows that the EMT is correctly assessing motor function in the arms of a patient with potential spine injuries?
"I need you to flex both arms across your chest."
What desired minimal pulse oximeter reading does the EMT want to maintain in a patient with a spinal cord injury?
94% or more
A young intoxicated male patient cannot move his left arm and leg after diving into the shallow end of a pool and hitting the bottom head first. The EMT would recognize which of the following mechanisms as most likely responsible for this injury?
Compression
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?
Incomplete spinal cord transection
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?
Provide manual in-line stabilization of the head.
What is a temporary concussion-like insult to the spinal cord that causes effects below the level of the injury?
Spinal shock
What is NOT considered to be an indication for providing rapid extrication to a patient who was involved in an MVC?
Suspected high-impact collision speed
Assessment of a young girl who was hit while riding her bike reveals her to be responsive to painful stimuli with flexion of the extremities and in respiratory distress. There is marked deformity to her thoracic spine and bruising noted to her anterior chest and abdomen. She does not move her legs when a noxious stimulus is applied to the lower extremities. Manual inminus−line spinal stabilization is being held and a cervical collar has been applied. Given the critical nature of this patient, which one of the following is most appropriate for her care?
Take time to completely immobilize her to the long board on scene prior to rapid transport to the hospital.
Fracture of the cervical spine at the atlas and axis is responsible for half of the fatal spine injuries. Why?
The atlas and axis form the transition from the spinal cord to the brainstem.
For a person to make a fist, which one of the following must occur?
The central nervous system must send a message through the spinal cord and then to the peripheral nerves.
When should the EMT remove the helmet of an injured patient?
The helmet interferes with your ability to assess the airway.
As a backup unit on a multiple-car collision, you are assigned to care for an infant who is still in his car seat, locked into the backseat of the car. As you prepare this patient for transport, which statement is MOST accurate?
The infant should be removed from the car seat and immobilized to a backboard.
Which patient should be rapidly extricated from a car after an MVC?
The patient who is unresponsive
Which statement accurately reflects the effect of anterior cord syndrome?
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
You have been called for an 87minus−yearminus−old male who fell in his kitchen while making breakfast. He states that he did hit his forehead but managed to catch himself on the way down and did not hit the ground hard. Your assessment reveals him to have kyphosis of the thoracic and cervical spine, but no neurological deficits. Which action is appropriate given these assessment findings?
Apply a rigid collar and prepare the patient for any discomfort that the collar may cause.
A patient is complaining of back pain and numbness to both legs after being thrown from a bicycle. When should the EMT first check the motor function, sensory function, and pulses in this patient?
As the secondary assessment is performed
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?
Axial loading of the cervical spine
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?
Close your eyes.
An elderly patient has fallen down a flight of stairs and is complaining of neck and back pain as well as weakness to both legs. The primary assessment reveals no life threats to the airway, breathing, or circulation. Manual inminus−line spinal stabilization is being maintained. Which of the following would the EMT do next?
Complete the secondary assessment looking for injuries.
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?
Compression
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?
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
This form of spinal injury is most common in hangings.
Distraction
Which injury that may result in spinal cord damage would you be most likely to encounter while treating a teenager who attempted to hang himself in his garage?
Distraction injury to the cervical spine
What tool is recommended for removing the plastic clips of a football helmet so that the face mask can be removed?
Gardening pruning tool
How should the EMT properly assess muscle strength in the upper extremities?
Have the patient grip your hands simultaneously
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?
Hyperflexion of the cervical spine
What are two critical findings in a patient who has a spinal cord injury in the cervical region of the spinal cord?
Hypotension and inadequate breathing
All known spinal cord injuries should receive which of the interventions?
Immobilization
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?
Low cervical or high thoracic
An Emergency Medical Responder reports that a male patient, injured while playing football, has bruising to the lumbar area of the back. Based on this statement, the EMT should expect to find bruising in which area?
Lower back
Which presentation would MOST likely be consistent with a patient possibly having a spinal injury?
Male patient found lying unresponsive under a tree
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?
Manually stabilize the spine.
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.
Mid nipple line
Which of the following is TRUE regarding the body's nervous system?
Motor impulses from the brain only travel down the spinal cord.
What disorder results in warm, dry skin; a normal pulse rate; and relative hypovolemia?
Neurogenic hypotension
When is it appropriate to use a cervical spine collar as the only immobilization device for a known spinal injury patient?
Never
A male driver was ejected from his vehicle after it rolled several times at a high rate of speed. As you approach the patient you note that he is unresponsive and struggling to breathe. He also has a laceration to the left side of his face and multiple contusions to his legs. After assigning another EMT to take manual inminus−line spinal stabilization, what should you do?
Open the airway using the jawminus−thrust maneuver.
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?
Open the airway with a jaw-thrust maneuver.
A patient dove into a shallow pool and struck his head on the bottom. Your assessment findings indicate that he has no motor or sensation ability in his legs, but he can move his arms. The EMT should recognize which of the following conditions?
Paraplegia
A 42minus−yearminus−old man has called 911 because of severe back pain. He informs you that his back pain is related to a recent fracture of his coccyx. Based on this information, where should the EMT expect the patient to be complaining of pain?
Pelvic area
You have been called to a public building for a 32minus−yearminus−old male patient who fell down a flight of stairs. As you pull up, he walks to the ambulance and states that he would like to be looked at because his shoulder and lower back hurt. You immediately take inminus−line manual spinal stabilization and examine his back, which reveals no sign of injury. How should you immobilize this patient?
Place a long board behind the patient and immobilize in a standing position.
What is the oxygenation guideline for a patient with a suspected spinal cord injury?
Provide oxygen to keep the pulse ox greater than or equals≥ 94 percent.
The spinal column is the principal support system of the body. Which of the following is TRUE about the spinal column?
Ribs originate from the spinal column, and the ribs are directly or indirectly attached to it.
Which of the following tools is NOT recommended for removing the face mask from a football helmet?
Screwdriver
A patient has just been log rolled and positioned onto the long backboard. Which one of the following care measures should be performed next?
Secure the patient's chest with straps.
Where should the pulse be evaluated at, during the PMS assessment of a patient who fell from the bed of a pickup?
Wrist and ankle
Which of the following is a TRUE statement regarding the relationship between a spinal cord injury and a spinal column injury?
You can have a cord injury without a column injury.
If your patient is wearing a helmet, you should leave it in place if:
there are no impending airway or breathing problems.
You arrive on the scene of a twominus−car motor vehicle collision. The patient was the unrestrained driver of a car that struck another from behind at 25 mph. In the course of the collision, the patient flew forward and struck the windshield with his head. No air bags were deployed. The patient extricated himself and denies head, neck, or back pain; however, you do note a small cut on his hand, which occurred as he was getting out of the car. When asked about preexisting medical problems he tells you that he did have herniated disks in his lumbar spine that were surgically repaired several years ago. Based on this, your strongest reason to fully immobilize this patient would be:
mechanism of injury.
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:
muscle spasms or tenderness.
Shock, or hypoperfusion, caused by a spinal cord injury is classified as:
neurogenic.
Emergency medical care of the patient with suspected spinal injury includes:
palpating the cervical region for any deformities or tenderness.
A motorcyclist wearing a full helmet was thrown from his motorcycle after hitting a patch of oil. The bike had been traveling at a high rate of speed. Manual inminus−line spinal stabilization is being held by an offminus−duty EMT. The primary assessment reveals the patient to be responsive to painful stimuli and breathing rapidly. His radial pulse is weak and fast. As you quickly scan his body, you note deformity to the left femur and lower leg. Your immediate action should be to
remove his helmet.
A temporary condition in which the patient loses the ability to move voluntary muscles and typically loses bowel and bladder control is called:
spinal shock.
A teenage boy was found by friends as he attempted to hang himself in a garage using chains suspended from the ceiling. As you approach, you note that the patient is conscious, struggling to breathe, and has contusions that encircle his neck from the chains. After taking manual inminus−line spinal stabilization and opening the airway, your next action would be to:
start positive pressure ventilation.
You have arrived on a shooting where a middleminus−aged male has suffered a single gunshot wound to the abdomen. As you approach the patient, you note that he is sitting up and talking with the police officer holding a bloodminus−soaked towel over the left upper quadrant of his abdomen. Your initial action in caring for this patient is to:
take manual inminus−line spinal stabilization.
When immobilizing infants and children, it is important to remember:
that if an automobile collision involves a child in a car seat, you cannot use that car seat to stabilize the child for transport.
Which one of the following statements about the care and treatment of a patient with a spinal injury in the prehospital setting is true?
"Prehospital care for the patient with a spine injury involves immobilization and the identification of lifeminus−threatening conditions."
What may be the circulatory findings in a patient with a spinal cord injury at the level of C6 or C7?
Warm, dry skin with poor tissue perfusion
You are securing a patient to the long backboard. The appropriate order for securing the straps would be:
chest, pelvis, head, legs.
Common mechanisms of injury for the spine include:
compression, when the weight of the body is driven against the head.
