PHTLS - Prehospital Trauma Life Support Prehospital Trauma Life Support Spinal Trauma Management 1 — Questions and Answers
Question 1: According to PHTLS guidelines, what is the recommended approach to spinal motion restriction for a patient with penetrating trauma to the torso and NO neurological deficits?
- Apply full spinal motion restriction due to the high-energy mechanism
- Spinal motion restriction is NOT indicated, as it delays transport without proven benefit (Correct answer)
- Apply a cervical collar only and transport supine
- Defer the decision to medical direction before moving the patient
Correct answer: Spinal motion restriction is NOT indicated, as it delays transport without proven benefit
PHTLS updated guidelines indicate that routine SMR for penetrating trauma (gunshot wounds, stab wounds) is not recommended in the absence of neurological deficits. Studies show it delays definitive care without improving outcomes, and the mechanism rarely produces unstable spinal injuries amenable to field stabilization.
Question 2: Which combination of signs and symptoms is most consistent with neurogenic shock following a high cervical spinal cord injury?
- Hypotension and tachycardia
- Hypertension and bradycardia
- Hypotension and bradycardia (Correct answer)
- Hypertension and tachycardia
Correct answer: Hypotension and bradycardia
Neurogenic shock results from disruption of descending sympathetic pathways, causing loss of vasomotor tone (hypotension) and unopposed parasympathetic activity (bradycardia). This distinguishes it from hemorrhagic shock, which typically presents with hypotension and a compensatory tachycardia.
Question 3: A conscious, cooperative trauma patient denies neck pain, has no midline spinal tenderness, and has a normal neurological exam but was involved in a high-speed rollover. According to PHTLS clinical decision criteria, which additional factor would most support withholding spinal motion restriction?
- Blood alcohol level is elevated
- Patient has a laceration to the scalp
- Patient has no distracting painful injuries and a normal level of consciousness (Correct answer)
- Patient is under 40 years of age
Correct answer: Patient has no distracting painful injuries and a normal level of consciousness
PHTLS relies on clinical decision tools that consider reliability of the patient exam. A patient with a normal LOC, no midline tenderness, no neurological deficits, and no distracting injuries may not require SMR even with a significant mechanism. Distracting injuries or altered mentation reduce exam reliability and would prompt SMR.
Question 4: A trauma patient is wearing a well-fitted football helmet with complementary shoulder pads. What does PHTLS recommend regarding helmet management?
- Remove the helmet immediately to allow full cervical spine assessment
- Leave both the helmet and shoulder pads in place, as they maintain neutral spinal alignment (Correct answer)
- Remove only the face mask and leave the rest of the equipment in place
- Remove the helmet but leave the shoulder pads to allow airway access
Correct answer: Leave both the helmet and shoulder pads in place, as they maintain neutral spinal alignment
When a well-fitted helmet is worn with complementary shoulder pads, PHTLS recommends leaving both in place. The combination maintains the head and neck in a neutral anatomical position. Removing only the helmet while leaving shoulder pads would force the cervical spine into extension, potentially worsening an injury.
Question 5: What is the primary disadvantage of leaving a trauma patient immobilized on a rigid long backboard for an extended period during transport?
- It provides insufficient restriction of lateral spinal motion
- It is incompatible with standard ambulance cot mounting systems
- It increases the risk of pressure injuries and respiratory compromise (Correct answer)
- It prevents accurate blood pressure measurement in the field
Correct answer: It increases the risk of pressure injuries and respiratory compromise
While long backboards are useful for extrication and short-term movement, prolonged immobilization causes significant patient discomfort, pressure injuries (decubitus ulcers) over bony prominences, and can restrict chest wall expansion and ventilation. PHTLS recommends transferring patients off backboards as soon as feasible after extrication.
Question 6: Before applying a rigid cervical collar to a trauma patient with a suspected spinal injury, what is the most critical first step the provider must perform?
- Select the correct collar size by measuring the patient's neck
- Establish IV access to prepare for potential neurogenic shock
- Manually stabilize the head and neck in a neutral in-line position (Correct answer)
- Obtain a baseline Glasgow Coma Scale score to document neurological status
Correct answer: Manually stabilize the head and neck in a neutral in-line position
Manual in-line stabilization (MILS) must be established before and maintained throughout collar sizing and application. Moving or sizing the collar without first stabilizing the head risks producing or worsening a spinal cord injury. MILS is only released once mechanical stabilization is confirmed.
PHTLS - Prehospital Trauma Life Support Prehospital Trauma Life Support Spinal Trauma Management 1
According to PHTLS guidelines, what is the recommended approach to spinal motion restriction for a patient with penetrating trauma to the torso and NO neurological deficits?