Prehospital Trauma Life Support (PHTLS) Practice Test

In a trauma patient who has fallen 20 feet, which injury should be suspected with cool, pale upper extremities and hypotension?

1. Aortic dissection

2. Liver laceration

3. Fractured pelvis

4. Spinal cord injury

The correct answer is: Spinal cord injury

When assessing a trauma patient who has fallen from a height of 20 feet and presents with cool, pale upper extremities and hypotension, the signs may indicate a spinal cord injury. In such cases, the sympathetic nervous system can be affected, potentially leading to disrupted blood flow regulation and vasodilation, which may result in hypotension. Additionally, injuries to the cervical spine can lead to decreased blood flow to the extremities as the body struggles to maintain homeostasis, which contributes to the cool and pale appearance of the upper extremities. In contrast, while options like aortic dissection, liver laceration, and fractured pelvis could also result from high falls, the specific combination of symptoms such as hypotension and the cool, pale upper extremities is more indicative of a spinal cord injury. Aortic dissection typically presents with severe, tearing chest pain and may not directly cause cooling and pallor in the upper extremities without other significant signs. Liver laceration generally leads to internal bleeding rather than a specific extremity response, and while pelvic fractures can cause hypotension due to significant blood loss, they typically do not present with the specific vascular response seen in spinal cord injuries.