You arrive on the scene and find an elderly patient who is complaining of severe weakness to her…

You arrive on the scene and find an
elderly patient who is complaining of severe weakness to her upper extremities.
She is alert and responding appropriately to your questions. Her respirations
are 22 per minute with a good tidal volume. Her radial pulse is present at a
rate of 92 bpm. Her skin is warm and dry. Her SpO2 reading is 95% on room air.
The patient states that she fell while coming down the stairs and struck her
face on the floor. You note a contusion to the bottom of her chin. She is also
complaining of pain to her neck and cervical region of the spine. She has a
history of
»

You arrive on the scene and find an
elderly patient who is complaining of severe weakness to her upper extremities.
She is alert and responding appropriately to your questions. Her respirations
are 22 per minute with a good tidal volume. Her radial pulse is present at a
rate of 92 bpm. Her skin is warm and dry. Her SpO2 reading is 95% on room air.
The patient states that she fell while coming down the stairs and struck her
face on the floor. You note a contusion to the bottom of her chin. She is also
complaining of pain to her neck and cervical region of the spine. She has a
history of arthritis and atrial fibrillation. She takes Coumadin for the atrial
fibrillation. She last ate approximately 20 minutes prior to her fall. She
denies getting dizzy or light-headed or passing out. Her fall was caused by
tripping over her slipper. The patient’s pupils are equal and reactive to
light. Her anterior and posterior neck areas are tender. No deformities are
noted. Her breath sounds are equal and clear bilaterally. Her abdomen is soft
and nontender. Her pelvis is stable. Her radial pulses are present. She has
severe weakness in the upper extremities, but she is moving her lower
extremities with no problem. Her BP is 168/88 mmHg, HR 92 and irregular, R 22.

1. What initial emergency care
would you provide to the patient? 2. What would you assess in your neurological
exam on the patient? 3. Based on the presentation, what type of spinal cord
injury do you suspect? 4. What other assessment findings would confirm the type
of spinal injury suspected? 5. How would you manage the spinal injury?

»