Spinal Trauma Management Flashcards

A patient involved in a high-speed MVC is found ambulatory at the scene but complains of neck pain. What is the PHTLS-recommended approach to spinal motion restriction (SMR)?

Answer: Apply a cervical collar and consider full SMR based on mechanism and symptoms

PHTLS recommends applying a cervical collar and evaluating for full SMR when significant mechanism is combined with neck pain, even in ambulatory patients.

Which vertebral region is MOST commonly injured in blunt trauma due to its transitional anatomy?

Answer: Thoracolumbar junction (T12-L1)

The thoracolumbar junction (T12-L1) is the most common site of blunt spinal injury because the rigid thoracic spine meets the more mobile lumbar spine here.

During extrication of a seated vehicle crash victim, which technique best maintains spinal alignment?

Answer: Manual in-line stabilization throughout the move

Manual in-line stabilization must be maintained throughout extrication to prevent secondary spinal cord injury.

A patient with a cervical spinal cord injury presents with bradycardia and hypotension but warm, dry skin. This pattern is MOST consistent with:

Answer: Neurogenic shock

Neurogenic shock from high cervical cord injury causes loss of sympathetic tone, producing hypotension and bradycardia with warm, dry (vasodilated) skin.

When applying a cervical collar to a trauma patient, what is the FIRST step?

Answer: Apply manual in-line stabilization

Manual in-line stabilization must be established before any device is applied to prevent movement during sizing and collar placement.

A PHTLS provider assesses a patient with a stab wound to the posterior neck at C4. The patient has bilateral arm weakness but intact leg function. This pattern suggests injury to the:

Answer: Central cord

Central cord syndrome produces greater weakness in the upper extremities than the lower extremities, often from hyperextension injuries or penetrating wounds near the cord center.

Which finding would SUPPORT withholding spinal motion restriction in a conscious, alert trauma patient per PHTLS selective SMR criteria?

Answer: No midline spinal pain or tenderness and no neurologic deficit

PHTLS selective SMR criteria allow withholding immobilization when the patient is alert, has no midline pain or tenderness, and has no neurologic deficits.

A football player sustains an axial loading injury to the cervical spine and is found prone on the field. The FIRST priority in management is:

Answer: Establish manual in-line stabilization and assess airway

Airway and breathing are always the first priorities; manual in-line stabilization is maintained while the airway is assessed and managed.

In a helmet-wearing athlete with suspected cervical spine injury, PHTLS recommends leaving the helmet in place UNLESS:

Answer: The helmet prevents adequate airway assessment or management

Helmets should remain in place unless they prevent airway assessment/management, are improperly fitted, or the patient is in cardiac arrest.

Which spinal cord injury pattern produces ipsilateral motor loss and contralateral loss of pain and temperature below the injury level?

Answer: Brown-Séquard syndrome

Brown-Séquard syndrome results from hemicord injury (often penetrating), causing ipsilateral motor/proprioception loss and contralateral pain/temperature loss.

During a long spine board (LSB) application, a patient complains of difficulty breathing when strapped. The MOST appropriate action is:

Answer: Loosen chest straps slightly while maintaining head and pelvic securing

Chest straps that are too tight can restrict respiratory excursion; they should be loosened enough to allow adequate ventilation while the head and pelvis remain secured.

A patient with suspected thoracic spine fracture has absent sensation below the nipple line bilaterally. Which dermatome level does this MOST closely correspond to?

Answer: T4

The T4 dermatome corresponds to the nipple line; absent sensation below this level bilaterally suggests a cord injury at approximately T4.

What is the primary goal of PHTLS spinal motion restriction compared to traditional full spinal immobilization?

Answer: Limit harmful motion while allowing necessary movement for patient care

PHTLS SMR focuses on limiting potentially harmful motion rather than achieving absolute immobilization, acknowledging that some movement during care is unavoidable.

A patient is found supine with suspected lumbar spine injury after a fall. Which device provides the BEST immobilization for transport?

Answer: Vacuum mattress with straps

A vacuum mattress conforms to the patient's body contours, distributes pressure evenly, and provides excellent spinal immobilization with reduced pressure injury risk.

A patient with a cervical collar in place develops increasing respiratory distress after trauma. What complication related to the cervical collar should be considered?

Answer: Cervical collar causing jugular vein compression increasing ICP

Excessively tight cervical collars can compress the jugular veins, impairing venous drainage and raising intracranial pressure, which is especially dangerous in head-injured patients.

Which mechanism of injury carries the HIGHEST risk of unstable cervical spine injury according to PHTLS?

Answer: Axial loading with flexion (diving into shallow water)

Axial loading with flexion, such as diving into shallow water, creates compressive and flexion forces that commonly produce unstable burst or wedge fractures.

When managing a patient with suspected spinal injury who requires airway intervention, what is the PREFERRED prehospital airway technique?

Answer: Orotracheal intubation with manual in-line stabilization

Orotracheal intubation with manual in-line stabilization maintains the airway while minimizing cervical spine movement and is the preferred PHTLS approach.

A conscious trauma patient has priapism. In the context of spinal trauma, this sign indicates:

Answer: Autonomic dysfunction from spinal cord injury

Priapism in a male trauma patient indicates loss of inhibitory sympathetic control from a spinal cord injury, causing uncontrolled parasympathetic stimulation.

During rapid extrication of a critically injured patient, which condition JUSTIFIES accelerating the process despite potential spinal risk?

Answer: Scene is becoming unsafe or patient has a life-threatening condition requiring immediate intervention

PHTLS allows rapid extrication when the scene becomes unsafe or when the patient has an immediately life-threatening condition that cannot be managed in place.

What is the significance of a 'chance fracture' in the context of prehospital spinal trauma?

Answer: A horizontal fracture through the vertebral body, pedicles, and spinous process often from lap-belt restraint

A Chance fracture is a flexion-distraction injury through all three columns of the vertebra, classically associated with lap-belt use in MVCs, and is highly unstable.