PHTLS - Prehospital Trauma Life Support Spinal Trauma Management 2 — Questions and Answers
Question 1: What is the current PHTLS terminology for managing the spine of a trauma patient?
- Spinal immobilization
- Spinal motion restriction (Correct answer)
- Spinal fixation
- Spinal stabilization
Correct answer: Spinal motion restriction
PHTLS has adopted the term 'spinal motion restriction' to more accurately describe the goal of limiting spinal movement rather than true immobilization.
True immobilization of the spine is not achievable with field equipment. SMR acknowledges this reality and focuses on limiting harmful movement. This also reflects the move toward selective application based on clinical criteria rather than universal application.
Question 2: Which clinical decision tool does PHTLS reference for determining the need for spinal motion restriction?
- Wells Criteria
- NEXUS criteria and Canadian C-spine Rule (Correct answer)
- Ottawa Ankle Rules
- Centor Criteria
Correct answer: NEXUS criteria and Canadian C-spine Rule
PHTLS references the NEXUS criteria and Canadian C-spine Rule to help determine which patients can safely be cleared of cervical spine injury.
The NEXUS criteria clear the c-spine when ALL of the following are absent: midline cervical tenderness, focal neurologic deficit, altered consciousness, intoxication, and distracting injury. Both tools have high sensitivity (>99%) for detecting significant cervical spine injuries.
Question 3: What is the preferred device for transporting a trauma patient requiring spinal motion restriction?
- Long backboard for the entire transport duration
- Vacuum mattress or padded scoop stretcher transferred to ambulance stretcher (Correct answer)
- Short backboard for all patients
- No device; just apply a cervical collar
Correct answer: Vacuum mattress or padded scoop stretcher transferred to ambulance stretcher
PHTLS has moved away from prolonged long backboard use toward vacuum mattresses and scoop stretchers that provide better immobilization with less complication risk.
Prolonged backboard use causes pressure injuries, significant pain, respiratory compromise, and increased combativeness. Current recommendations favor using the backboard as an extrication device only, then transferring to a vacuum mattress or padded stretcher.
Question 4: How should the cervical spine be managed during intubation of a trauma patient?
- Remove the cervical collar completely and extend the neck normally
- Have an assistant provide manual inline stabilization while the front of the collar is removed for mouth opening (Correct answer)
- Cancel intubation if a c-spine injury is suspected
- Apply traction to the neck during intubation
Correct answer: Have an assistant provide manual inline stabilization while the front of the collar is removed for mouth opening
The front of the cervical collar is removed to allow adequate mouth opening, while a second provider maintains manual inline stabilization.
One provider maintains manual inline stabilization keeping the head in neutral alignment. The anterior portion of the collar is removed for jaw opening while the posterior portion remains. Traction should NEVER be applied; MILS is neutral stabilization only.
Question 5: What is the significance of neurogenic shock in spinal cord injury?
- It is identical to spinal shock
- It results from loss of sympathetic tone below the injury causing vasodilation, bradycardia, and hypotension (Correct answer)
- It only occurs with lumbar spine injuries
- It always resolves within minutes
Correct answer: It results from loss of sympathetic tone below the injury causing vasodilation, bradycardia, and hypotension
Neurogenic shock results from disruption of sympathetic pathways below the spinal cord injury level.
Neurogenic shock must be distinguished from spinal shock, which is loss of reflexes below the injury level. Neurogenic shock typically occurs with injuries above T6. CRITICALLY, hemorrhage must be ruled out first before attributing hypotension solely to neurogenic causes.
Question 6: According to PHTLS, what finding during assessment most strongly suggests a cervical spine injury?
- Headache alone
- Midline cervical tenderness with a significant mechanism of injury (Correct answer)
- Mild neck stiffness without trauma history
- Shoulder pain only
Correct answer: Midline cervical tenderness with a significant mechanism of injury
Midline cervical tenderness in the context of a significant mechanism is the most reliable clinical indicator of potential cervical spine injury.
Midline cervical tenderness is assessed by palpating each spinous process from C1 to T1. Other important findings include focal neurologic deficits, priapism, diaphragmatic breathing without chest injury, and loss of rectal tone.
PHTLS - Prehospital Trauma Life Support Spinal Trauma Management 2
What is the current PHTLS terminology for managing the spine of a trauma patient?