Exam 32: Spinal Column and Spinal Cord Trauma

A male patient fell 20 feet from a cliff to a trail below. The primary assessment shows him to be confused, with an open airway and shallow breathing. His pulse is 72 beats per minute and his blood pressure is 78/50 mmHg. The skin is warm and flushed. The patient has no motor ability or sensation in his legs. Which one of the following is the most likely cause of this patient's presentation?

The EMT should recognize a possible spinal column injury with no spinal cord involvement when he discovers what assessment finding?

A motorcyclist wearing a full helmet was thrown from his motorcycle after hitting a patch of oil. The bike had been traveling at a high rate of speed. Manual in-line spinal stabilization is being held by an off-duty EMT. The primary assessment reveals the patient to be responsive to painful stimuli and breathing rapidly. His radial pulse is weak and fast. As you quickly scan his body, you note deformity to the left femur and lower leg. Your immediate action should be to:

You and your partner are preparing to extricate a patient from a car using a vest-type short spine immobilization device. After ensuring that in-line manual spinal stabilization is being maintained, your next instruction should be:

You arrive on the scene of a two-car motor vehicle collision. The patient was the unrestrained driver of a car that struck another from behind at 25 mph. In the course of the collision, the patient flew forward and struck the windshield with his head. No air bags were deployed. The patient extricated himself and denies head, neck, or back pain; however, you do note a small cut on his hand, which occurred as he was getting out of the car. When asked about preexisting medical problems he tells you that he did have herniated disks in his lumbar spine that were surgically repaired several years ago. Based on this, your strongest reason to fully immobilize this patient would be:

A young intoxicated male patient cannot move his left arm and leg after diving into the shallow end of a pool and hitting the bottom head first. The EMT would recognize which of the following mechanisms as most likely responsible for this injury?

Which injury is possible based on the anatomy of the spine?

While transporting a 38-year-old female who fell from a second-story window, you note that she is becoming confused and her pulse rate is increasing. Additionally, her blood pressure has dropped and her skin is now cool and clammy. Based on these assessment findings you would recognize:

A patient is being extricated from a car using a vest-type short immobilization device. After the patient has been extricated, the EMT should:

As you approach a motorcyclist who was thrown from his bike, you hear him saying that he cannot feel or move his legs. You note obvious deformity to both femurs as well as his left wrist and forearm. Emergency Medical Responders are holding manual in-line spinal stabilization. Of the following, which should be done first?

You arrive on the scene of a motor vehicle collision. Walking toward you is the unrestrained driver of the vehicle that sustained moderate front-end damage. The patient complains of some back pain, but is walking around after the crash and does not appear to be suffering from any neurological deficits. What is your initial action in caring for this patient?

A teenage boy was found by friends as he attempted to hang himself in a garage using chains suspended from the ceiling. As you approach, you note that the patient is conscious, struggling to breathe, and has contusions that encircle his neck from the chains. After taking manual in-line spinal stabilization and opening the airway, your next action would be to:

You are maintaining manual in-line stabilization of the cervical spine for a patient being log rolled, transferred, and secured to a long backboard. At what point will you release the manual in-line spinal stabilization?

You have been called for an 87-year-old male who fell in his kitchen while making breakfast. He states that he did hit his forehead but managed to catch himself on the way down and did not hit the ground hard. Your assessment reveals him to have kyphosis of the thoracic and cervical spine, but no neurological deficits. Which action is appropriate given these assessment findings?

What instruction would you provide to your team immediately after securing a patient with head, neck, and back pain to the long backboard?

You pull up to the scene of a single-car motor vehicle collision. Emergency Medical Responders (EMRs) are maintaining in-line manual spinal stabilization of the 56-year-old driver who was unrestrained when she struck a tree at a high rate of speed. As you approach the vehicle, you note that she appears unresponsive with blood coming from her nose and ears. Which one of the following instructions to the EMRs is most appropriate?

Which one of the following statements about the care and treatment of a patient with a spinal injury in the prehospital setting is true?

A high school football player was hit from behind and is complaining of severe back pain and numbness to his right leg. Manual in-line spinal stabilization is being maintained by an assistant coach. Once at the patient's side, what should you do next?

Assessment of the cervical spine of a patient, complaining of lower back pain after falling down five stairs, reveals no displacement, tenderness, or instability. Accordingly, the EMT should: