NREMT Paramedic Cognitive ExamTraumaEasy
A 35-year-old male falls 20 feet from a ladder, landing on his back. He is conscious and complaining of severe back pain. Assessment reveals tenderness and crepitus over his mid-thoracic spine. His lower extremities are weak with diminished sensation. Vital signs are stable. Which of the following is the MOST critical immediate intervention for this patient?
- ATransport rapidly to a trauma center.
- BAdminister analgesia for pain management.
- CInitiate IV fluids to maintain blood pressure.
- DApply spinal immobilization.
Show answer & explanationAnswer & explanation
Correct answer: D. Apply spinal immobilization.
Given the mechanism of injury (fall from height, landing on back) and the patient's symptoms (severe back pain, tenderness/crepitus, lower extremity weakness/diminished sensation), a spinal cord injury is highly suspected. Immediate spinal immobilization is crucial to prevent further neurological damage during extrication and transport.
Why the other options are wrong
- A. Rapid transport is necessary, but only after appropriate stabilization, with spinal immobilization being the most critical immediate step.
- B. Pain management is important but takes secondary priority to preventing further injury in suspected spinal trauma.
- C. IV fluids are not immediately indicated as vital signs are stable; fluid administration without hypotension could worsen brain injury if present.
Spinal Immobilization Indications
Use of devices to restrict movement of the head, neck, and torso to protect the spinal cord from further injury.
- Required for suspected spinal trauma based on MOI or symptoms.
- Includes manual stabilization, C-collar, and long backboard/vacuum mattress.
- Goal is to prevent secondary injury to the spinal cord.
Memory trick: Spine Safe: Secure, Protect, Immobilize Now, Everyone!