PHTLS - Prehospital Trauma Life Support Spinal Trauma Management Questions and Answers — Questions and Answers
Question 1: A 22-year-old male is involved in a high-speed motorcycle collision. He is found wearing a full-face helmet. He is unconscious, breathing spontaneously, and has a strong radial pulse. According to PHTLS principles, what is the most appropriate action regarding the helmet?
- Leave the helmet in place to provide initial stabilization and transport immediately.
- Immediately remove the helmet using a single-rescuer technique to assess the airway.
- Remove the helmet only if it interferes with airway management or breathing. (Correct answer)
- Cut the chin strap and perform a jaw-thrust maneuver with the helmet on.
Correct answer: Remove the helmet only if it interferes with airway management or breathing.
PHTLS guidelines recommend helmet removal when it prevents a thorough assessment or management of the airway and breathing. Since the patient is unconscious, the airway is at risk and cannot be fully assessed with the helmet on. Removal should be performed by two trained rescuers to maintain manual spinal stabilization.
Question 2: You are assessing a patient who fell 15 feet from a ladder. The patient is hypotensive with a blood pressure of 80/50 mmHg, has a heart rate of 58 bpm, and their skin is warm and dry. Which of the following conditions is MOST likely responsible for this presentation?
- Hypovolemic shock due to internal bleeding.
- Neurogenic shock from a spinal cord injury. (Correct answer)
- Cardiogenic shock from a myocardial contusion.
- Septic shock from a delayed presentation.
Correct answer: Neurogenic shock from a spinal cord injury.
The classic presentation of neurogenic shock is hypotension combined with bradycardia (or a normal heart rate) and warm, dry skin. This occurs due to the loss of sympathetic tone below the level of a high spinal cord injury (typically above T6), leading to vasodilation and an unopposed parasympathetic response on the heart. Hypovolemic shock would typically present with tachycardia and cool, clammy skin.
Question 3: Which of the following findings in a conscious adult patient with blunt trauma is an absolute indication for initiating spinal motion restriction (SMR)?
- A significant mechanism of injury, such as a vehicle rollover.
- The presence of a painful and distracting long bone fracture. (Correct answer)
- Intoxication with alcohol or drugs.
- An isolated gunshot wound to the lower leg.
Correct answer: The presence of a painful and distracting long bone fracture.
A distracting injury is a condition thought to be producing pain significant enough to distract the patient from a second (e.g., spinal) injury. PHTLS guidelines, based on consensus statements, indicate that a distracting injury makes the spinal assessment unreliable, thus mandating the application of spinal motion restriction. While a significant MOI and intoxication are risk factors that increase suspicion, a distracting injury is a specific criterion that necessitates SMR in an otherwise assessable patient. SMR is generally not indicated for penetrating trauma without neurologic deficit.
Question 4: A 68-year-old female experiences a syncopal episode and falls down two stairs. She is now alert, oriented, and denies any neck pain. She has no palpable tenderness along her spine, no focal neurologic deficits, and no evidence of intoxication. However, she has a large, painful hematoma on her forehead. What is the most appropriate spinal management for this patient?
- Apply a cervical collar and secure her to a long backboard for transport.
- Allow the patient to ambulate to the stretcher without any spinal precautions.
- Apply a cervical collar and secure her to the ambulance cot. (Correct answer)
- Assist the patient to the stretcher and transport in a position of comfort.
Correct answer: Apply a cervical collar and secure her to the ambulance cot.
This patient meets criteria for spinal motion restriction (SMR) due to a distracting injury (painful forehead hematoma) and age (>65), which make her clinical exam unreliable for ruling out a spine injury. Current PHTLS principles emphasize spinal motion restriction, which involves applying a cervical collar and securing the patient to the ambulance cot, rather than routine use of a long backboard for transport. The long backboard is primarily an extrication device.
Question 5: A patient involved in a rear-end motor vehicle collision is complaining of neck pain. Your assessment reveals marked weakness and numbness in both arms and hands, but he is able to move his legs and wiggle his toes with good strength. This pattern of neurologic deficit is most characteristic of which spinal cord injury syndrome?
- Anterior Cord Syndrome
- Brown-Séquard Syndrome
- Cauda Equina Syndrome
- Central Cord Syndrome (Correct answer)
Correct answer: Central Cord Syndrome
Central Cord Syndrome is the most common incomplete spinal cord injury and is often caused by a hyperextension injury. It characteristically results in motor weakness that is more pronounced in the upper extremities compared to the lower extremities, with variable sensory loss.
Question 6: According to PHTLS guidelines, the use of a long spine board for trauma patients is PRIMARILY indicated for which purpose?
- Providing comfort during long transports.
- Facilitating patient extrication from a vehicle or confined space. (Correct answer)
- Routine immobilization for all patients with a significant mechanism of injury.
- Maintaining a definitive airway in an unconscious patient.
Correct answer: Facilitating patient extrication from a vehicle or confined space.
Modern trauma guidelines, including those in PHTLS, have shifted away from the routine use of long spine boards for immobilization during transport. Their primary role is now recognized as an extrication and patient movement device, used to move a patient from the point of injury to the ambulance cot while minimizing spinal movement. Once on the cot, the board should be removed if possible.
PHTLS - Prehospital Trauma Life Support Spinal Trauma Management Questions and Answers
A 22-year-old male is involved in a high-speed motorcycle collision.
He is found wearing a full-face helmet.
He is unconscious, breathing spontaneously, and has a strong radial pulse.
According to PHTLS principles, what is the most appropriate action regarding the helmet?