PHTLS Spinal Trauma Management 5 — Questions and Answers
Question 1: According to PHTLS, spinal motion restriction is generally NOT indicated for which patient with a penetrating spinal injury?
- Gunshot wound to the neck with neurologic deficit
- Stab wound to the back with paresthesias in both legs
- Gunshot wound to the thorax without neurologic signs or symptoms (Correct answer)
- Any penetrating wound above the clavicle
Correct answer: Gunshot wound to the thorax without neurologic signs or symptoms
PHTLS does not recommend SMR for penetrating trauma without neurologic signs, as the device provides no benefit and delays transport to definitive care.
Question 2: An elderly patient is found after a ground-level fall with midline cervical tenderness. Her only other complaint is mild wrist pain. What is the correct SMR decision?
- No SMR because it is a low-energy mechanism
- Apply SMR because midline tenderness is present regardless of mechanism (Correct answer)
- SMR only if she is over 65 and has osteoporosis
- SMR is deferred because she is ambulatory
Correct answer: Apply SMR because midline tenderness is present regardless of mechanism
Midline spinal tenderness is an absolute indication for SMR regardless of mechanism, as it suggests possible spinal column injury.
Question 3: Which of the following BEST describes 'spinal shock' in the PHTLS context?
- Hypotension and bradycardia from disrupted sympathetic outflow
- Temporary complete loss of all spinal cord function below the injury level (Correct answer)
- Hemorrhage into the epidural space compressing the cord
- Swelling of the cord causing permanent functional loss
Correct answer: Temporary complete loss of all spinal cord function below the injury level
Spinal shock is a temporary physiologic state of complete flaccid paralysis and loss of reflexes below the injury level, which may mask the true degree of permanent injury.
Question 4: During a log-roll of a trauma patient, which team member is responsible for directing the movement?
- The rescuer at the patient's hips
- The rescuer maintaining in-line stabilization of the head (Correct answer)
- The most senior paramedic on scene regardless of position
- The rescuer at the patient's shoulders
Correct answer: The rescuer maintaining in-line stabilization of the head
The rescuer maintaining in-line head stabilization directs the log-roll to ensure the head, trunk, and pelvis move as a single unit.
Question 5: A patient with C5 spinal cord injury most likely retains which function?
- Full hand and finger dexterity
- Diaphragmatic breathing and shoulder shrug (Correct answer)
- Complete intercostal muscle activity
- Voluntary bowel and bladder control
Correct answer: Diaphragmatic breathing and shoulder shrug
C5 innervates the diaphragm (phrenic nerve C3-C5) and deltoid/shoulder muscles, so patients typically retain diaphragmatic breathing and limited shoulder movement.
Question 6: When caring for a patient with suspected spinal injury and an inadequate airway, the jaw-thrust maneuver is preferred over the head-tilt/chin-lift because:
- It provides better airway diameter than head-tilt/chin-lift
- It opens the airway with minimal cervical spine extension (Correct answer)
- It can be performed by a single rescuer more easily
- It is effective only in unconscious patients
Correct answer: It opens the airway with minimal cervical spine extension
The jaw-thrust maneuver opens the airway by advancing the mandible without requiring cervical extension, reducing the risk of cord injury in an unstable spine.
Question 7: A PHTLS provider notes that a patient immobilized on a long spine board has developed increasing anxiety, difficulty breathing, and worsening oxygen saturation. What is the MOST likely cause related to positioning?
- The supine position on the board restricts diaphragm excursion (Correct answer)
- The straps have compressed the femoral arteries
- The head block foam has caused an allergic reaction
- The cervical collar has displaced into the trachea
Correct answer: The supine position on the board restricts diaphragm excursion
Supine positioning on a rigid board can restrict diaphragm movement, especially in obese patients or those with abdominal injuries, impairing ventilation.
PHTLS Spinal Trauma Management 5
According to PHTLS, spinal motion restriction is generally NOT indicated for which patient with a penetrating spinal injury?