PHTLS Spinal Trauma Management 4 — Questions and Answers
Question 1: A patient with a cervical collar in place develops increasing respiratory distress after trauma. What complication related to the cervical collar should be considered?
- Cervical collar causing jugular vein compression increasing ICP (Correct answer)
- Collar migrating into the airway
- Collar inducing vagal bradycardia
- Pressure from the collar causing esophageal rupture
Correct 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.
Question 2: Which mechanism of injury carries the HIGHEST risk of unstable cervical spine injury according to PHTLS?
- Low-speed rear-end collision at less than 15 mph
- Axial loading with flexion (diving into shallow water) (Correct answer)
- Ground-level fall in an elderly patient
- Isolated facial laceration from a blunt object
Correct 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.
Question 3: When managing a patient with suspected spinal injury who requires airway intervention, what is the PREFERRED prehospital airway technique?
- Blind nasotracheal intubation without any stabilization
- Orotracheal intubation with manual in-line stabilization (Correct answer)
- Surgical cricothyrotomy as the first line
- Jaw thrust with BVM while awaiting hospital arrival
Correct 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.
Question 4: A conscious trauma patient has priapism. In the context of spinal trauma, this sign indicates:
- Hemorrhagic shock with pelvic fracture
- Autonomic dysfunction from spinal cord injury (Correct answer)
- Bladder rupture causing fluid redistribution
- Normal physiologic stress response to pain
Correct 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.
Question 5: During rapid extrication of a critically injured patient, which condition JUSTIFIES accelerating the process despite potential spinal risk?
- Patient is anxious and uncooperative
- Scene is becoming unsafe or patient has a life-threatening condition requiring immediate intervention (Correct answer)
- Family members are pressuring the crew to move faster
- Transport time to the hospital is long
Correct 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.
Question 6: What is the significance of a 'chance fracture' in the context of prehospital spinal trauma?
- A fracture with no neurologic deficit, considered benign in the field
- A horizontal fracture through the vertebral body, pedicles, and spinous process often from lap-belt restraint (Correct answer)
- A hairline fracture visible only on CT imaging
- A fracture occurring only in osteoporotic patients
Correct 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.
Question 7: A patient is immobilized on a long spine board and complains of pain at the occiput and heels. After 30 minutes en route, the BEST action is:
- Reassure the patient that discomfort is expected on a spine board
- Document the complaint and reassess upon hospital arrival
- Pad the bony prominences without removing the board or straps (Correct answer)
- Remove the spine board immediately to relieve pressure
Correct answer: Pad the bony prominences without removing the board or straps
Padding bony prominences such as the occiput and heels reduces pressure injury risk while maintaining spinal immobilization during transport.
PHTLS Spinal Trauma Management 4
A patient with a cervical collar in place develops increasing respiratory distress after trauma.
What complication related to the cervical collar should be considered?