Chapter 32 pre, post and Chapter test

Assuming no evidence of spinal​ injury, a patient who has suffered which of the following should not be immobilized on a​ backboard?

Gunshot wound to the neck

The steps in immobilizing a supine patient to a long backboard​ include:

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

A male patient experienced an injury that completely severed his spinal cord in the thoracic spine. Which presentation would be associated with this​ injury?

He will experience paralysis to the legs

Injury to the sensory and motor tracts located in the anterior portion of the spinal cord is​ called:

anterior cord syndrome.

You are in the process of applying spine motion restriction to a patient who was ambulatory upon your arrival. After the patient lies down on the​ stretcher, you​ should:

secure the patient to the stretcher.

A spinal column injury typically and primarily damages which of the following​ (but as a result may also damage one or more of the other​ three)?

The vertebrae

You have been called for a patient with severe back pain. When you are obtaining a medical​ history, the patient tells you that he has a history of damaged disks in his vertebrae. As a knowledgeable​ EMT, you should recognize​ that:

The​ fluid-filled structures between the vertebrae have been injured

In which area of the spinal column do the ribs​ originate?

Thoracic spine

Which instruction would you provide to your team immediately after securing a patient with​ head, neck, and back pain to the long backboard with appropriate spine motion restriction​ equipment?

"Let's check for extremity PMS before we move the patient to the​ stretcher.

A trauma patient is unable to push down with his feet. This may indicate damage in the area​ of:

. S1.

Which of the following findings in a patient with a traumatic mechanism of injury is sufficient to prevent the EMT from​ "clearing the​ spine" and necessitate the implementation of spine motion restriction​ precautions?

GCS score of 12

The EMT arrives at a call for a patient who sustained injuries after being ejected from a motorcycle. Which assessment finding indicates the need for spine motion restriction​ (SMR)?

Glasgow Coma Scale score of 7

All of the following would indicate the need of spinal motion restriction for a trauma​ patient, EXCEPT:

Glasgow Coma Scale​ (GCS) is 15.

Spine motion restriction may not be indicated in which of the​ following?

Glasgow Coma Scale​ (GCS) of 15

Based on the structure of the nervous​ system, which statement is​ true?

A deep laceration to the arm can sever peripheral nerves

Which of the instructions from one EMT to another shows the correct application of a cervical​ collar?

​"Keep his head in neutral position while I apply the cervical​ collar."

In order from top to​ bottom, how many vertebrae are in each section of the spinal​ column?

​7, 12,​ 5, 5, 4

What desired minimal pulse oximeter reading does the EMT want to maintain in a patient with a spinal cord​ injury?

​94% or more

An injury to a hemisection of the spinal cord that disrupts the spinal tracts on only one side of the cord​ is:

​Brown-Sequard syndrome

Which choice best describes what the underlying pathophysiology is in a patient with spinal​ shock?

Dilation of the blood vessels resulting in reduction of perfusion to tissues

Which 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

The medical director for EMS is providing a presentation regarding stabilizing spinal cord injuries. Which information should be included to prevent further trauma to the spinal​ cord?Focus on spinal motion restriction techniques.

Focus on spinal motion restriction techniques.

Which device can be used to replace the long spine board when providing full spine motion restriction precautions to an​ adult?

Full vacuum mattress

When it is necessary to secure a patient to a long spine board during a spine motion restriction​ process, which of these regions is typically secured last to the spine​ board?

Head and neck region

A​ 43-year-old male fell from a roof and cannot move or feel his arms or legs. When assessing the​ patient, which sign would lead the EMT to suspect the patient is developing spinal​ shock?

Heart rate of 62​ beats/min

While transporting a​ 38-year-old female who fell from a​ second-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

A​ 25-year-old male jail inmate was pushed over the railing of a walkway 20 feet above the ground. He is unresponsive and has an open fracture of the left upper arm. How would you determine if the patient has sensation in his​ legs?

Pinch his foot and look for movement on the leg

Which statement 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 spine motion restriction precautions and the identification of​ life-threatening conditions

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.

Assessment of a young girl who was hit by a car while riding her bike reveals her to be responsive to painful stimuli with flexion of the​ extremities; she is also 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 cervical spine motion restriction is being maintained and a cervical collar has been applied by fire department EMRs. Given the critical nature of this​ patient, which action is most appropriate for her​ care?

Quickly but carefully provide full spine motion restriction precautions on scene prior to rapid transport to the hospital

When applying a cervical collar to a young boy who fell out of a​ tree, the EMT realizes the main purpose of the collar is​ to:

Remind the patient not to move his head or neck

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:

SCIWORA.

Which of the following tools is NOT recommended for removing the face mask from a football​ helmet?

Screwdriver

A patient is being extricated from a car using a short​ vest-type device. After the patient has been​ extricated, the EMT​ should:

Secure the patient with the​ vest-type device to a long backboard

A patient has just been log rolled and positioned onto the long backboard. Which care measure should be performed​ next, assuming it was not previously​ completed?

Secure the​ patient's torso with straps

How many vertebrae form the cervical​ spine?

Seven

Question Help 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?

Slowing of the heart rate

A neurological deficit is an indicator of which​ injury?

Spinal cord injury

A male patient fell 20 feet from a cliff to a trail below while hiking with his girlfriend. The primary assessment shows him to be​ confused, with an open airway and shallow breathing. His pulse is 72​ beats/min and his blood pressure is​ 78/50 mmHg. The skin is warm and flushed. The patient has no motor ability or sensation in his legs. What is the most likely cause of this​ patient's presentation?

Spinal shock

What is a temporary​ concussion-like insult to the spinal cord that causes effects below the level of the​ injury?

Spinal shock

A patient who was involved in a diving accident is found with his head positioned so that his left cheek is touching his left shoulder. He states that he has severe pain in his neck and it hurts to move his head. He denies​ numbness, tingling, or decreased strength in his arms or legs. What is the​ EMT's best course of​ action?

Stabilize and maintain the head in the position in which the patient is holding it

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

The EMT should recognize a possible spinal column injury with no spinal cord involvement when he discovers which assessment​ finding?

Tenderness to the thoracic spine with intact motor and sensory abilities to each extremity

Which of the following was the original thought behind spinal​ immobilization?

The backboard would protect against any further injury.

Which statement is most accurate regarding the processes needed for a patient to clench the hand into a​ fist?

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.

The first seven vertebrae are referred to as the

cervical spine.

The vertebrae are divided into five areas. From top to​ bottom, these areas​ are:

cervical, thoracic,​ lumbar, sacral, and coccygeal.

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.

Until​ recently, the indication to provide spinal immobilization was solely based​ on:

the mechanism of injury.

There are some situations in which you may move the patient with a suspected spinal injury before immobilizing him to a long or short spinal device. These situations include​ when:

the scene is not safe.

It is more common for spine injuries to cause​ paralysis:

to all four extremities​ (quadriplegia) or to only the lower body and legs​ (paraplegia)

You are maintaining manual cervical spine motion restriction for a patient who is being log​ rolled, transferred, and secured to a long backboard. At which point will you release the manual spine motion restriction​ hold?

After the patient has been properly secured with straps to the long board

A​ 47-year-old male patient has been involved in motor vehicle collision. He denies symptoms and has no signs of spinal injury. In which of the following situations would spine motion restriction be​ required?

Altered mental status

An elderly patient fell down a flight of basement stairs and is found at the bottom by family members about 20 minutes later. Your assessment reveals that the patient cannot feel painful stimuli to his hips and​ legs, nor can he move his​ legs, but he can feel you lightly touching the skin of his legs. Which type of injury may this​ be?

Anterior cord syndrome

You have been called for an​ 87-year-old male who fell in his kitchen while making breakfast. The patient states that he hit his forehead but managed to catch himself on the way down and did not hit the ground​ "too hard." Your assessment reveals him to have kyphosis of the thoracic and cervical​ spine, but no neurologic deficits. His​ legs, however,​ "feel weaker." Which action is appropriate given these assessment​ findings?

Apply a cervical collar and prepare the patient for any discomfort that the collar may cause

A patient complains of lower back pain after falling down five stairs. Assessment of the​ patient's cervical spine reveals no​ displacement, tenderness, or instability. The patient does state that each leg has feelings of​ "electrical shocks" shooting through them. How should the EMT care for this​ patient?

Apply a properly sized cervical collar after initiating manual spine motion restriction

A patient complains 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 the legs of this​ patient?

As the secondary assessment is performed

A high school football player was hit from behind and now complains of severe back pain and numbness to his right leg. Manual spine motion restriction is being maintained by an assistant coach. The trainer has already removed the face mask from the helmet. Once at the​ patient's side, what should you do​ next?

Assess the airway and breathing

What is the MOST common cause of spinal​ injury?

Automobile accidents

The EMT is caring for a patient who sustained a spinal cord injury in a motor vehicle collision. Which assessment finding would indicate a spinal cord versus a spinal column​ injury?

Bilateral​ motor/sensory loss

Which of the following should be done when applying spine motion restriction to the ambulatory​ patient?

Bring the stretcher to the patient.

After an injury to the spinal cord a patient has differing effects on each side of the body. This is known​ as:

Brown-Séquard syndrome.

Telling a trauma patient to​ "flex your​ arms" tests motor function​ at:

C6.

After sustaining a fall from a​ roof, your patient presents with an inability to move his​ arms, but he can still move his legs just fine. What type of partial cord injury is​ this?

Central cord syndrome

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

As you approach a motorcyclist who was thrown from his​ bike, you hear him saying that he cannot feel or move his legs. You note obvious deformity to both femurs as well as to his left wrist and forearm. Emergency Medical Responders are holding manual cervical spine motion restriction and have already assessed the PMS in the extremities. Given this​ information, which assessment should be done​ next?

Check the​ patient's rate and effort of breathing

An elderly patient fell down a flight of stairs and now complains 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 cervical spine motion restriction is being maintained. What should the EMT do​ next?

Complete the secondary​ assessment, looking for additional injuries

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 mechanism as most likely responsible for this​ injury?

Compression

A​ 22-year-old woman dove into the shallow end of the pool and injured her neck. Which of the following spinal injuries is most​ likely?

Compression

Which of the following is an accurate statement regarding spine motion restriction​ (SMR)?

Decisions to utilize SMR should be based on the assessment

Conflicting or confusing signs of spinal cord injury are typically the result​ of:

incomplete cord injury.

You arrive on the scene of a motor vehicle collision. Walking toward you is the unrestrained driver of the vehicle that sustained moderate​ front-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 neurologic deficits. Although he answers your questions​ appropriately, he keeps asking​ you, "What​ happened?" What is your initial action in caring for this​ patient?

Initiate spine motion restriction precautions

You have arrived at the scene of a shooting where a​ middle-aged male sustained a single gunshot wound to the abdomen. As you approach the​ patient, you note that he is sitting up and attempting to talk with the police officers while holding a​ blood-soaked towel over the left upper quadrant of his abdomen. Once you get beside the​ patient, you realize he is speaking in a different language that neither you nor the officers understand. Your initial action in caring for this patient is​ to Initiate spine motion restriction precautions

Initiate spine motion restriction precautions

At a scene where a vehicle was involved in a​ single-car accident, you find the driver walking around at the scene. As you​ approach, the driver states that he felt fine when he exited the vehicle but is now concerned that his legs feel like they are​ "going to​ sleep." What is your first step in treating the​ driver?

Instruct him to hold his head in a neutral inline position

A football player was struck in the head during a hard​ tackle, and is reportedly demonstrating retrograde amnesia to the event. Currently the patient complains of a headache and nausea and reports that he has pain to his upper back and tingling in his left hand. The EMT is providing proper care for the patient when​ he:

Leaves the helmet in place but removes the face mask first

A​ 2-year-old boy fell down a flight of​ stairs, is crying​ loudly, and is very difficult to communicate with. Because you are unable to clear the​ spine, you elect to initiate spine motion restriction precautions. Which instruction would you provide to other EMTs who are initiating this care for the​ patient?

Let's place a folded towel under his shoulders and back to help maintain head​ alignment."

A patient was ejected from a car during a rollover collision at a moderate to high rate of speed. Which presentation in this patient is most characteristic of the incomplete spinal cord injury referred to as a​ "central cord​ syndrome"?

Loss of motor function to the arms with intact motor function to the legs

An Emergency Medical Responder reports that a male​ patient, who was injured while playing​ football, has bruising to the lumbar region of the body. 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

What has studying the historical approach to spinal immobilization​ revealed?

Numerous patients without spinal injury were immobilized.

A​ 24-year-old male patient fell from a roof. He denies neck or back pain. Which of the following would indicate the need for spine motion restriction​ (SMR)?

Open femur fracture

You are assessing distal pulses on a trauma patient. Which pulse should be assessed in the lower​ extremity?

Pedal

A​ 42-year-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

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.

A patient was struck in the back by a heavy piece of wood that was being bent to make a form for a concrete arch. He is​ responsive, but cannot feel or move his legs. He has bruising to his back and is incontinent of urine. The skin below the injury site is red and warm. As a knowledgeable​ EMT, you should realize​ that:

The paralysis may resolve

What is the MOST accurate statement about the ability of a patient to breathe when she has suffered a spinal cord​ injury?

The patient may be able to breathe adequately or inadequately or may not be able to breathe at all.

Which patient should be rapidly extricated from a car after an​ MVC

The patient who is unresponsive

Which sign or symptom best indicates the patient has experienced a spinal cord injury to the thoracic​ spine?

Tingling in the legs

Which type of alternative to a long backboard may be used for spine motion​ restriction?

Vacuum mattress

A window washer fell 20 feet from scaffolding while washing the windows on an office building. He is alert and​ oriented, but states that he cannot move or feel his legs.​ Additionally, because his blood pressure is​ 72/48 mmHg, you suspect spinal shock. Which other assessment finding reinforces your suspicion of spinal​ shock?

Warm and dry skin

A patient is ambulatory after a motor vehicle collision. Spinal tenderness is noted during the assessment. After placing a cervical​ collar, you should​ nextdirect the patient to sit on the stretcher.

direct the patient to sit on the stretcher.

You determine that an ambulatory patient requires spine motion restriction. You should​ first:

instruct the patient to maintain​ self-restriction.

The vertebrae that combine to form the lower back are called​ the:

lumbar spine.

When performing spine motion​ restriction, the patient should​ be:

made comfortable.

Which of these assessments must be done BEFORE the​ others?

mental status

A​ 32-year-old male patient has a penetrating injury to the neck. The assessment reveals no indication of spinal injury. You​ should:

not place the patient on a backboard.

An involuntary erection of the​ penis, caused by a spinal cord​ injury, is called

priapism.

The application of spine motion restriction usually requires securing the patient to​ a(n)

stretcher.