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.