PHTLS Spinal Trauma Management 3 — Questions and Answers
Question 1: 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:
- Remove the helmet immediately
- Establish manual in-line stabilization and assess airway (Correct answer)
- Log-roll to supine and apply a cervical collar
- Check for helmet removal guidelines before touching the patient
Correct 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.
Question 2: In a helmet-wearing athlete with suspected cervical spine injury, PHTLS recommends leaving the helmet in place UNLESS:
- The helmet prevents adequate airway assessment or management (Correct answer)
- The patient is responsive and cooperative
- Bystanders have already partially removed it
- The event occurred during a contact sport
Correct 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.
Question 3: Which spinal cord injury pattern produces ipsilateral motor loss and contralateral loss of pain and temperature below the injury level?
- Central cord syndrome
- Anterior cord syndrome
- Posterior cord syndrome
- Brown-Séquard syndrome (Correct answer)
Correct answer: Brown-Séquard syndrome
Brown-Séquard syndrome results from hemicord injury (often penetrating), causing ipsilateral motor/proprioception loss and contralateral pain/temperature loss.
Question 4: During a long spine board (LSB) application, a patient complains of difficulty breathing when strapped. The MOST appropriate action is:
- Tighten the straps to secure the patient fully
- Loosen chest straps slightly while maintaining head and pelvic securing (Correct answer)
- Remove the LSB and use a vacuum mattress instead
- Reassure the patient that mild discomfort is expected
Correct 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.
Question 5: A patient with suspected thoracic spine fracture has absent sensation below the nipple line bilaterally. Which dermatome level does this MOST closely correspond to?
- T4 (Correct answer)
- T6
- T10
- T12
Correct answer: T4
The T4 dermatome corresponds to the nipple line; absent sensation below this level bilaterally suggests a cord injury at approximately T4.
Question 6: What is the primary goal of PHTLS spinal motion restriction compared to traditional full spinal immobilization?
- Eliminate all spinal movement using rigid devices
- Limit harmful motion while allowing necessary movement for patient care (Correct answer)
- Reduce scene time by skipping spinal assessment
- Immobilize only penetrating spinal injuries
Correct 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.
Question 7: A patient is found supine with suspected lumbar spine injury after a fall. Which device provides the BEST immobilization for transport?
- Cervical collar alone
- Long spine board with head blocks and straps
- Scoop stretcher without additional securing
- Vacuum mattress with straps (Correct answer)
Correct 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.
PHTLS Spinal Trauma Management 3
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: