Chapter 34 Spinal Injury

When performing a cranial nerve assessment of a patient with a suspected spinal injury, you note that the patient's pupil is constricted and the upper eyelid droops. This indicates an injury to:

C3

Following a spinal injury, a patient presents with abdominal breathing and use of accessory muscles in the neck. This suggests injury at or above:

C3-C4

In which of the following situations would it be MOST appropriate to apply a vest-type extrication device to a patient who is seated in his or her crashed in his or her crashed motor vehicle.

Conscious with neck pain stable vital signs.

Which of the following statements regarding the Hangman's fracture is MOST correct?

Its a fracture of C2 that is secondary to significant distraction of the neck.

You would MOST likely have several blankets or pillows under a patient's upper back prior to immobilization if he or she has:

Kyphosis PG.22-23

What spinal nerve tract carries information regarding pain and temperature?

Lateral spinothalamic

A compression or burst fracture of the spine would MOST likely occur following:

a significant fall in which the patient lands head first.

When performing the standing takedown technique to immobilize a patient's spine, the patient is secured to the long backboard with straps:

after he or she is lowered to the ground.

Displacement of bony fragments into the anterior portion of the spinal cord results in:

anterior cord syndrome.

The afferent and efferent nerves:

are responsible for the somatic functions of the spinal cord.

When assigning a Glasgow Coma Scale (GCS) score to a patient who has limb paralysis due to a spinal cord injury, you should:

ask the patient to blink or move a facial muscle.

When immobilizing a sitting patient with a

assess distal pulse and sensory and motor functions.

If the mechanism of injury indicates that your patient may have sustained a spinal cord injury:

assume that a spine injury, regardless of the neurologic findings.

In contrast to secondary spinal cord injury, primarily spinal cord injury occurs:

at the moment of impact.

a 39 year old man crashed his vehicle into a wooden area and was found for approximately 8 hours. When you arrive at the scene and assess him, you note that he is conscious but anxious. He is unable to feel or move below his mid-thoracic area and complains of a servere headache. His blood pressure is 210/130 mm/hg, heart rate is 48 beats/min, and respirations are 22 breaths/min. This patient's clinical presentation is MOST consistent with:

autonomic dysreflexia

A spinal cord concussion is :

caused by a short-duration shock or pressure wave within the cord.

The phrenic nerve arises from the ________ plexus and the innervates the _________.

cervical, diaphragm

Patients with evidence of trauma above the __________ should be considered at risk for an associated spine injury?

clavicles

although extremely painful, injuries to the ________ spine are typically the LEAST significant.

coccygeal

The FIRST step in any neurologic assessment involves:

determining the patients level of consciousness.

Sign of neurogenic shock include all of the following,EXCEPT:

diaphoresis

When immobilizing a patient to a longboard, you should take appropriate BSI precautions and then:

ensure that the patient's head is stabilized manually

Spinal cord injuries that cause neurologic shock generally produce:

flaccid paralysis and complete loss of sedation distal to the injury.

You are assessing a patient who sustained blunt trauma to the center of his back. He is conscious, but is unable to feel or move his lower extremities. His blood pressure is 80/50 mm Hg, pulse is 40 beats/min and weak, and respirations are 24 breaths/min and shallow. If IV fluids do not adequately improve perfusion, you should:

give 0.5 mg of atropine and consider a dopamine infusion.

An injured patient's head should be secured to the long-board only after:

his or her torso has been secured adequately.

Hyperacute pain to touch is called:

hyperesthesia

A skier wiped out while skiing down a large hill. He is conscious and alert and complains of being very cold; he also complains of neck stiffness and numbness and tingling in all of his extremities. A quick assessment reveals that his airway is patent and his breathing is adequate. You should:

immobilize his spine and quickly move him to a warmer environment.

The main advantage of using a scoop stretcher to transfer a patient to a long board is:

inability to conduct a visual exam of the back for injuries.

Modification of your physical examination of a patient with a suspected spinal cord injury following a two-car motor vehicle crash is based on all of the following factors, except

injuries to patients in the other vehicle.

The upper thoracic spinal nerves:

innervate the muscles of the chest that help in breathing and coughing.

Which of the following factors would be the LEAST likely to result in secondary spinal cord injury?

Hyperglycemia

The ______ is the largest component of the central nervous system and contains billions of neuron that serve a variety of functions.

Brain

What spinal cord injury is characterized by motor loss on the same side of the injury, but below the lession

Brown-Sequard syndrome

The only area of the spine that allows for significant rotation is:

C-1 and C-2

The innermost meningeal layer that rests directly on the spinal cord is the:

PIA Mater

Which of the following conditions that can cause an airway obstruction is unique to patients with an injury to the upper cervical spine?

Retropharyngeal hematoma

A patient with diaphragmatic breathing WITHOUT intercostal muscle use has MOST likely experienced a spinal injury above the level of:

T-2

inability to feel or move below the level of the nipple line indicates injury to which spinal nerve root?

T4

Which of the following statements regarding the brain stem is MOST correct:

The brain stem connects the spinal cord to the BRAIN.

Which of the following statements regarding central cord syndrome is MOST correct?

The patient typically presents with greater loss of function in the upper extremities than than in the lower extremities.

Vagal tone remains intact following a spine injury because:

The vagus nerve originates outside the medulla and regulates the heart via the carotid arteries

The anterior weight bearing structure of the vertebra is the:

VERTEBRAL body

The Spine:

is the major structure component of the axial skeleton.

Spinal shock is a condition that:

is usually temporary and results from swelling of the spinal cord.

Regardless of the method spinal immobilization used, you must:

keep the neck, and trunk in alignment.

If methylprednisolone (solu-Medrol) is administered to a patient with a spinal cord injury, it should be given:

less than 3 hours after the injury.

As the body ages, the intervertebral disc:

lose water content and become thinner.

Hypotension that is associated with neurogenic shock is the result of:

loss of alpha receptor stimulation

Because of its weight bearing capacity, the __________ spine is especially susceptible to injury.

lumbar

A 21 year old woman was thrown from a Horse and landed on her head. Upon arrival at the scene, you find the patient lying supine. She is conscious and her head turned to the side. As you attempt to move her head to a neutral in-line position, she screams in pain. You should:

maintain her head in the position found and continue with your assessment.

If a trauma patient cannot be assessed properly in his or vehicle, you should:

maintain manual stabilization of the head, apply a cervical collar, and move the patient from the vehicle onto a long backboard.

Any motor or sensory deficits noted during the neurologic examination of the patient with a possible spinal cord injury:

make a note of any neurologic deficits or gross injuries up to that point.

Prior to the immobilization an anxious patient with a suspected spinal injury on a backboard, it is MOST important to:

make note of any neurologic deficit or gross injuries up to that point.

A 40-year old unrestrained man ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your initial assessment reveals that he is unconscious and has sonorous respirations and a rapid pulse. Your initial actions should include:

manually stabilizing his head and opening his airway with the jaw-thrust maneuver.

According to the National Spinal Cord Injury Database, most spinal cord injuries are caused by:

motor vehicles crashes.

The LEASE common cause of death in spinal cord injury patients who are discharged from the hospital is:

muscular atrophy

You are dispatched to a senior citizen's center where an elderly woman apparently fainted. When you arrive, you find the patient sitting in a chair. An employee of the center tells you that the caught the patient before she fell to the ground. Your initial assessment reveals that the patients is conscious and alert and is breathing adequately. You should

obtain vital signs and assess her blood glucose level.

When applying a vest-type extrication device to a seated patient, his or her head should be secure to the device:

only after the torso is fastened securely..

The MOST significant complications associated with prolonged immobilization of a patient on a long backboard is:

pressure lesion development

Treatment for a patient with neurogenic shock would LEAST likely include:

prevention of hyperthermia

The Most effective method for decreasing morbidity and mortality associated with spinal cord injury (SCI) is:

public education and prevention strategies.

Flexion injuries to the spine would MOST likely result from:

rapid deceleration forces.

Upon arrival at the scene of a motor vehicle crash, you find the driver of the car still seated in her two-door vehicle. The passenger side of the vehicle has sustained severe damage and is inaccessible. The driver is conscious and alert and complains only of lower back pains. The backseat passenger, a young child who was unrestrained, is bleeding from the head and appears to be unconscious. You should:

rapidly extricate the driver so you can gain access to the child in the backseat.

You have just completed spinal immobilization of hemodynamically stable patient with a possible spinal injury. Prior to moving the patient to the ambulance, it is MOST important to:

reassess pulse, motor, and sensory functions in all extremities.

In addition to the supporting muscles and ligaments founds in the vertebral column, the thoracic spine is further stabilized by the:

rib attachments.

An anxious trauma patient whose head and neck are passively rotated to one side:

should be maintained in this positioning unless breathing is compromised

The detail exam for a trauma patient with a significant mechanism of injury and signs of a spinal cord injury:

should be perfomed en route to the hospital.

The _______ is a continuation of the central nervous system and exits the skull through the ________.

spinal cord, foramen magnum

The MOST effective way for the Paramedic to minimize further injury in a patient with a spinal injury is:

spinal motion restriction and prevention of heat loss.

Following traumatic injury, a 19 year old woman presents with confusion, tachycardia, and significant hypotension. Her skin is cool, clammy, and pale. Further assessment reveals abdominal rigidity and deformity with severe pain over her thoracic vertebrae. In addition to administrating high flow oxygen and immobilizing her spine, you should:

start at least one large bore IV line and give crystalloid boluses as needed to maintain adequate perfusion.

Herniation of the intervertebral disc occurs when:

stress on the vertebral column forces a disc into the spinal canal.

The cervical spine:

supports the weight of the head and permits a high degree of mobility in the multiple planes.

In which of the following situations would spinal motion restriction precautions likely NOT be necessary

syncopal episode in which the patient was already seated or supine.

Proprioception is MOST accurately defined as:

the ability to perceive the position and movement of one's body.

A motorcycle or football helmet should be removed if:

the patient is breathing shallowly and access to the airway is difficult.

A positive Babinski reflex is observed when the:

toes move upward in response to stimulation of the foot.

When moving an injured patient from the ground onto a long backboard, it is generally preferred that you:

use the four-person log roll technique

Beta receptor stimulation results in all of the following effects, EXCEPT:

vascular smooth muscle contraction.

You have intubated an unconscious, apneic patient with a suspected spinal injury, After confirming proper ET tube placement and securing the tube,you should:

ventilate at 10 to 12 breaths/min and monitor end-tidal CO2

A complete spinal cord injury to the upper cervical spine:

will result in permanent loss of all cord-mediated functions below the level of the injury.