PHTLS Spinal Trauma Management 2 — Questions and Answers
Question 1: 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)?
- Advise the patient to walk to the ambulance carefully
- Apply a cervical collar and consider full SMR based on mechanism and symptoms (Correct answer)
- Immobilize only if the patient is unconscious
- Spinal precautions are unnecessary if the patient is walking
Correct 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.
Question 2: Which vertebral region is MOST commonly injured in blunt trauma due to its transitional anatomy?
- Cervical-thoracic junction (C7-T1)
- Mid-thoracic (T5-T8)
- Thoracolumbar junction (T12-L1) (Correct answer)
- Lumbar-sacral junction (L5-S1)
Correct 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.
Question 3: During extrication of a seated vehicle crash victim, which technique best maintains spinal alignment?
- Rapid extrication without a collar to save time
- Manual in-line stabilization throughout the move (Correct answer)
- Allow the patient to self-extricate with verbal guidance
- Use a short backboard only if the patient is symptomatic
Correct answer: Manual in-line stabilization throughout the move
Manual in-line stabilization must be maintained throughout extrication to prevent secondary spinal cord injury.
Question 4: A patient with a cervical spinal cord injury presents with bradycardia and hypotension but warm, dry skin. This pattern is MOST consistent with:
- Hemorrhagic shock
- Neurogenic shock (Correct answer)
- Obstructive shock
- Cardiogenic shock
Correct answer: Neurogenic shock
Neurogenic shock from high cervical cord injury causes loss of sympathetic tone, producing hypotension and bradycardia with warm, dry (vasodilated) skin.
Question 5: When applying a cervical collar to a trauma patient, what is the FIRST step?
- Select the correct collar size
- Apply manual in-line stabilization (Correct answer)
- Log-roll the patient supine
- Assess for distracting injuries
Correct 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.
Question 6: 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:
- Anterior cord
- Posterior cord
- Central cord (Correct answer)
- Brown-Séquard (hemicord)
Correct 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.
Question 7: Which finding would SUPPORT withholding spinal motion restriction in a conscious, alert trauma patient per PHTLS selective SMR criteria?
- Tenderness over the spinous processes
- Intoxication with alcohol
- No midline spinal pain or tenderness and no neurologic deficit (Correct answer)
- Distracting painful injury to the extremity
Correct 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.
PHTLS Spinal Trauma Management 2
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)?