Trauma Nurse Core Course (TNCC) Practice Exam

Which assessment finding in a patient brought in by EMS after a fall would indicate the need for spine clearance?

1. Alert with no neurologic deficits

2. Multiple abrasions to the extremities

3. Multiple requests for water

4. Smell of alcohol on breath

The correct answer is: Smell of alcohol on breath

The assessment finding that indicates the need for spine clearance is the presence of the smell of alcohol on the breath. This finding suggests potential impairment in the patient's cognitive function and judgment, which can be critical when assessing for spinal injuries. In a trauma setting, any patient who may have reduced awareness or altered mental status due to intoxication raises concerns for possible undetected spinal injuries. Alcohol can mask pain or neurologic deficits the patient might otherwise express, making comprehensive evaluation essential. Additional considerations include the risk of injuries sustained during a fall which could have gone unnoticed because of the patient's altered state. Given the potential for significant vascular or neurologic compromise that can arise from undiagnosed cervical or spinal injuries, further spinal assessment and imaging are warranted to investigate and rule out injuries before the spine can be cleared. Other assessment findings, such as being alert with no neurologic deficits, presence of multiple abrasions, or simply requesting water, do not carry the same implications for spinal injury concern as the smell of alcohol does. These findings may suggest less immediate risk without the added complicating factor of impaired judgment. Therefore, the smell of alcohol is a clear indicator for the necessity of spine clearance in this scenario.