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.