Prehospital Trauma Life Support Spinal Trauma Management 1 Flashcards

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?

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.

Which combination of signs and symptoms is most consistent with neurogenic shock following a high cervical spinal cord injury?

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.

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?

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.

A trauma patient is wearing a well-fitted football helmet with complementary shoulder pads. What does PHTLS recommend regarding helmet management?

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.

What is the primary disadvantage of leaving a trauma patient immobilized on a rigid long backboard for an extended period during transport?

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.

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?

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.