ATLS - Advanced Trauma Life Support Spine and Spinal Cord Trauma Questions and Answers 1 — Questions and Answers
Question 1: A 28-year-old is involved in a motorcycle crash and presents with a blood pressure of 85/45 mmHg, a heart rate of 55 bpm, and warm, dry extremities. There is no obvious external hemorrhage. Which type of shock is most likely responsible for this clinical picture?
- Hemorrhagic shock
- Cardiogenic shock
- Neurogenic shock (Correct answer)
- Septic shock
Correct answer: Neurogenic shock
The patient's presentation of hypotension with paradoxical bradycardia and peripheral vasodilation (warm, dry skin) is the classic triad for neurogenic shock. This results from the loss of sympathetic tone due to a spinal cord injury, typically above T6. Hemorrhagic shock would typically present with hypotension and tachycardia, with cool, clammy skin.
Question 2: A patient with a flexion injury to the cervical spine demonstrates complete paralysis and loss of pain and temperature sensation below the level of the injury. However, their sense of vibration and proprioception remains intact. Which incomplete spinal cord syndrome do these findings represent?
- Brown-SĂ©quard syndrome
- Central cord syndrome
- Posterior cord syndrome
- Anterior cord syndrome (Correct answer)
Correct answer: Anterior cord syndrome
Anterior cord syndrome results from damage to the anterior two-thirds of the spinal cord, affecting the corticospinal tracts (motor function) and spinothalamic tracts (pain and temperature). The posterior columns, which carry vibration and proprioception signals, are spared.
Question 3: A 30-year-old trauma patient is alert (GCS 15), not intoxicated, and has no focal neurological deficits. According to the NEXUS low-risk criteria for clinical clearance of the cervical spine, which of the following findings would mandate radiographic imaging?
- Presence of a painful wrist fracture (Correct answer)
- History of a brief loss of consciousness
- Patient is over 60 years of age
- Complaint of minor anterior neck pain
Correct answer: Presence of a painful wrist fracture
The NEXUS criteria require five conditions to be met for clinical clearance: no posterior midline cervical tenderness, no evidence of intoxication, a normal level of alertness, no focal neurologic deficit, and no painful distracting injury. A painful wrist fracture is considered a distracting injury that could mask the pain from a significant cervical spine injury, thus requiring imaging.
Question 4: During the secondary survey of a patient with paraplegia following a severe fall, the examiner assesses for sacral sparing. Which of the following findings indicates an incomplete spinal cord injury?
- Absence of deep tendon reflexes in the lower extremities
- Presence of priapism
- Voluntary anal contraction (Correct answer)
- Flaccid paralysis below the lesion
Correct answer: Voluntary anal contraction
Sacral sparing refers to the preservation of sensory or motor function in the lowest sacral segments (S4-S5). Evidence of this, such as voluntary anal contraction, perianal sensation, or great toe flexion, indicates that the spinal cord injury is incomplete and carries a better prognosis for recovery. The other options are signs associated with spinal shock or a complete injury.
Question 5: A patient suffers a penetrating stab wound to the right side of the neck, resulting in a Brown-SĂ©quard syndrome at the C7 level. Which pattern of neurological deficits would be expected below the injury?
- Paralysis and loss of proprioception on the left; loss of pain and temperature on the right
- Paralysis and loss of proprioception on the right; loss of pain and temperature on the left (Correct answer)
- Bilateral loss of motor function with preserved sensation
- Bilateral loss of pain and temperature sensation with preserved motor function
Correct answer: Paralysis and loss of proprioception on the right; loss of pain and temperature on the left
Brown-SĂ©quard syndrome is caused by hemisection of the spinal cord. This damages the ipsilateral (same side) corticospinal tracts (motor) and posterior columns (proprioception/vibration). It also damages the spinothalamic tracts, which cross over; therefore, the loss of pain and temperature sensation occurs on the contralateral (opposite) side.
Question 6: Which statement best reflects the current ATLS-aligned principle of managing a patient with a potential spinal injury in the prehospital and emergency department setting?
- All trauma patients should be fully immobilized on a rigid longboard until imaging is complete.
- The primary goal is spinal motion restriction, using a rigid collar and securing the patient to a firm surface to minimize gross movement. (Correct answer)
- Forcing a patient's head into a neutral position is mandatory to ensure proper collar fit.
- Spinal motion restriction is not indicated for patients with penetrating trauma, regardless of neurologic deficits.
Correct answer: The primary goal is spinal motion restriction, using a rigid collar and securing the patient to a firm surface to minimize gross movement.
Modern trauma care has shifted from the concept of 'spinal immobilization' to 'spinal motion restriction' (SMR). This acknowledges that complete immobilization is impossible and potentially harmful (e.g., pain, pressure sores, respiratory compromise). The goal is to minimize gross movement of the spine by using a cervical collar and securing the patient to the cot or another surface, while removing rigid backboards as soon as feasible.
ATLS - Advanced Trauma Life Support Spine and Spinal Cord Trauma Questions and Answers 1
A 28-year-old is involved in a motorcycle crash and presents with a blood pressure of 85/45 mmHg, a heart rate of 55 bpm, and warm, dry extremities.
There is no obvious external hemorrhage.
Which type of shock is most likely responsible for this clinical picture?