TNCC Spinal cord and vertebral column trauma
Anterior cord syndrome - ANSLoss of pain and temp sensation with weakness,
paraesthesia, and urinary retention
Babinski or plantar reflex in adult - ANSDysfunction in upper motor neurons
Brown-Sequard syndrome - ANSContralateral loss of pain and temp sensation, and
ipsilateral paralysis with reduced touch sensation
C5 to c7 - ANSExtend and flex arms
Central cord syndrome - ANSDecreased function of upper extremities >lower
extremities, sacral sparing
Complete spinal cord lesion - ANSLose all motor and sensory function at and below the
level of injury
Index of suspicion - ANSUnwitnessed near drowning, MOI obvious, MOI unclear
Injury between T1 and T11 - ANSHypoventillation
L2 to l4 - ANSExtend and flex legs
L4 to l5 - ANSFlexion of foot, extension of toes
Methylprednisone - ANSPrevents edema to spinal cord caused by inflammatory
response, thus saving spinal tissue
Post resus care - ANSMaintain cervial spinal immobilzation, monitor breathing, monitor
sensation and motor function, monitor temp
Reeval adjuncts - ANSCT, MRI, steroids,
S3 to s5 - ANSTighten anus
Spinal shock - ANSAt and below the level of spinal injury normal activity ceases,
flaccidity, incontinence
Spinal shock cause - ANSInjury to spinal cord at any level
Spinal stabil - ANSNo potential for progressive injury, displacement of injury bony area
during healing, or displacement from normal physiologic loading
A patient arrives at the emergency department by private vehicle after sustaining an
injury to the right lower extremity while using a saw. There is a large gaping wound to
the right thigh area with significant bleeding. What is the priority intervention?
, TNCC Spinal cord and vertebral column trauma
A. Elevate the extremity to the level of the heart
B. Initiate direct pressure
C. Apply a tourniquet
D. Cover the open wound with sterile saline dressings - ANSB. Initiate direct pressure
Rationale: The first step inn controlling any bleeding is application of direct pressure.
A patient fell two weeks ago, striking their head. Today, the patient presented with a
persistent headache and nausea and was diagnosed with a small subdural hematoma.
The patient has been in the ED for 24 hours awaiting an inpatient bed. The night shift
nurse reports the patient has been anxious, restless, shaky, and vomited twice during
the night. The patient states they couldn't sleep because a young child kept coming into
the room. What is the most likely cause for these signs and symptoms?
A. Increased intracranial pressure
B. Alcohol withdrawal
C. Rhabdomyolysis
D. Pulmonary embolus - ANSB. Alcohol withdrawal
Rationale: Alcohol withdrawal is a common delayed condition because symptoms are
difficult to identify early. Signs include autonomic hyperactivity, hand tremors, nausea or
vomiting, psychomotor agitation, anxiety, insomnia, transient hallucinations, or seizures.
A patient involved in a MVC has sustained a fracture to the second rib of the anterior left
chest. Which concurrent injury is most commonly associated with this fracture?
A. Blunt cardiac injury
B. Brachial plexus injury
C. Pneumothorax
D. Hemothorax - ANSB. Brachial plexus injury
Rationale: First and second rib fractures are most commonly associated with great
vessel, head and spinal cord, and brachial plexus injuries.
A patient with a spinal cord injury at C5 is being cared for in the emergency department
while awaiting transport to a trauma center. Which of the following represents the
highest priority for ongoing assessment and management for this patient?
A. Maintain adequate respiratory status
B. Administer balanced resuscitation fluid
C. Perform serial assessments of neurologic function
D. Maintain core temperature - ANSA. Maintain adequate respiratory status
Anterior cord syndrome - ANSLoss of pain and temp sensation with weakness,
paraesthesia, and urinary retention
Babinski or plantar reflex in adult - ANSDysfunction in upper motor neurons
Brown-Sequard syndrome - ANSContralateral loss of pain and temp sensation, and
ipsilateral paralysis with reduced touch sensation
C5 to c7 - ANSExtend and flex arms
Central cord syndrome - ANSDecreased function of upper extremities >lower
extremities, sacral sparing
Complete spinal cord lesion - ANSLose all motor and sensory function at and below the
level of injury
Index of suspicion - ANSUnwitnessed near drowning, MOI obvious, MOI unclear
Injury between T1 and T11 - ANSHypoventillation
L2 to l4 - ANSExtend and flex legs
L4 to l5 - ANSFlexion of foot, extension of toes
Methylprednisone - ANSPrevents edema to spinal cord caused by inflammatory
response, thus saving spinal tissue
Post resus care - ANSMaintain cervial spinal immobilzation, monitor breathing, monitor
sensation and motor function, monitor temp
Reeval adjuncts - ANSCT, MRI, steroids,
S3 to s5 - ANSTighten anus
Spinal shock - ANSAt and below the level of spinal injury normal activity ceases,
flaccidity, incontinence
Spinal shock cause - ANSInjury to spinal cord at any level
Spinal stabil - ANSNo potential for progressive injury, displacement of injury bony area
during healing, or displacement from normal physiologic loading
A patient arrives at the emergency department by private vehicle after sustaining an
injury to the right lower extremity while using a saw. There is a large gaping wound to
the right thigh area with significant bleeding. What is the priority intervention?
, TNCC Spinal cord and vertebral column trauma
A. Elevate the extremity to the level of the heart
B. Initiate direct pressure
C. Apply a tourniquet
D. Cover the open wound with sterile saline dressings - ANSB. Initiate direct pressure
Rationale: The first step inn controlling any bleeding is application of direct pressure.
A patient fell two weeks ago, striking their head. Today, the patient presented with a
persistent headache and nausea and was diagnosed with a small subdural hematoma.
The patient has been in the ED for 24 hours awaiting an inpatient bed. The night shift
nurse reports the patient has been anxious, restless, shaky, and vomited twice during
the night. The patient states they couldn't sleep because a young child kept coming into
the room. What is the most likely cause for these signs and symptoms?
A. Increased intracranial pressure
B. Alcohol withdrawal
C. Rhabdomyolysis
D. Pulmonary embolus - ANSB. Alcohol withdrawal
Rationale: Alcohol withdrawal is a common delayed condition because symptoms are
difficult to identify early. Signs include autonomic hyperactivity, hand tremors, nausea or
vomiting, psychomotor agitation, anxiety, insomnia, transient hallucinations, or seizures.
A patient involved in a MVC has sustained a fracture to the second rib of the anterior left
chest. Which concurrent injury is most commonly associated with this fracture?
A. Blunt cardiac injury
B. Brachial plexus injury
C. Pneumothorax
D. Hemothorax - ANSB. Brachial plexus injury
Rationale: First and second rib fractures are most commonly associated with great
vessel, head and spinal cord, and brachial plexus injuries.
A patient with a spinal cord injury at C5 is being cared for in the emergency department
while awaiting transport to a trauma center. Which of the following represents the
highest priority for ongoing assessment and management for this patient?
A. Maintain adequate respiratory status
B. Administer balanced resuscitation fluid
C. Perform serial assessments of neurologic function
D. Maintain core temperature - ANSA. Maintain adequate respiratory status
