Adult Critical Care Specialty (ACCS) Practice Exam

A 26 y.o. female in a motor vehicle crash shows signs of neck pain and altered sensation. What potential issue should be addressed?

1. Closed head injury with cerebral edema

2. Stroke

3. Spinal cord injury

4. Subluxation of C-5 with phrenic nerve damage

The correct answer is: Spinal cord injury

In this scenario, the key factors to consider are the patient's age, mechanism of injury (motor vehicle crash), and symptoms (neck pain and altered sensation). These indicators strongly suggest the possibility of a spinal cord injury. The neck pain points toward a potential injury in the cervical spine, and altered sensation can imply involvement of neural structures, possibly due to compression or damage to the spinal cord. Spinal cord injuries can lead to a variety of neurological deficits depending on the level and extent of the injury, including motor and sensory deficits in the limbs. Additionally, the mechanism of the injury—motor vehicle crashes—commonly results in rapid deceleration forces that can lead to direct trauma to the cervical spine, potentially causing fractures or dislocations that compromise spinal integrity. With the clinical presentation showing significant symptoms related to potential spinal compromise, addressing spinal cord injury becomes critical. While other options could initially seem plausible, they do not align as closely with the clinical signs presented. Closed head injuries, strokes, and subluxation of cervical vertebrae may have overlapping symptoms but would not primarily address the concerning signs of neck pain and altered sensory perception as effectively as the evaluation for spinal cord injury. Thus, focusing on spinal cord injury is the most appropriate action to ensure the