Question

You are on-scene with an unconscious adult patient. Bystanders report he fell from a third-story (> 40 ft) scaffolding while working on a building's exterior. His pulse is 120 beats per minute; his respirations are 16 per minute, and his blood pressure is within normal limits. The patient is lying supine with his arms flexed at the elbows and his hands in the anatomical position as if he were in the "hold up" position.

An injury at what level of the spinal cord is most likely to cause the limited findings above?

A) Spinal cord injury in the C1-C2 region
B) Spinal cord injury at the S1-S2 region
C) Spinal cord injury in the L4-L5 region
D) Spinal cord injury in the C5-C6 region

Answer 1

The patient most likely has a spinal cord injury in the C5-C6 region, which aligns with the symptoms presented. Immediate medical attention is required, including potential CPR, to maintain blood flow and prevent further damage.

Step-by-step explanation:

The patient in the scenario described has fallen from a significant height and is presenting with specific motor signs, specifically the arms flexed at the elbows with hands in an anatomical position resembling a 'hold-up' position. Based on these findings, the most likely level of spinal cord injury is in the C5-C6 region, which would be option D. This region of the spinal cord controls the wrist extensors, deltoids, and biceps; and its damage can result in the positioning described due to the preservation of certain muscle groups while others are paralyzed. Damage to C1-C2 would result in a more severe presentation including potential respiratory failure, injury to S1-S2 would affect the lower limbs and bowel/bladder control, and L4-L5 would also primarily affect the lower limbs.

This type of injury would need immediate medical attention, as CPR may be necessary if the patient's condition deteriorates and cardiac arrest occurs. It's vital to understand that urgent, trauma-informed care is essential in these scenarios to minimize further injury and provide critical support functions such as maintaining blood flow and oxygenation to vital tissues, including the brain.