John Doe, a 19-year-old college student, was rockclimbing when she fell 30 feet to the ground. Paramedics arrivingat the scene found him lying in the supine position, unable to moveany extremities and complaining of neck pain. He was awake, alert,and oriented to his current location, the date and day of the week,and the details of his fall. His responses to questioning wereappropriate. He complained that he could not feel his arms andlegs. His pupils were equal and reactive to light. He showed noother signs of injury except for several scrapes on his arms. Hisvital signs revealed a blood pressure of 110 / 72, heart rate of 82beats per minute, respirations of 18 per minute. The paramedicsapplied a cervical collar, placed him on a back board, immobilizedhis head, and transported him to the trauma center byhelicopter.
Upon examination at the hospital, Doe had minimal biceps brachiistretch reflexes, but no triceps or wrist extensor reflexes. Allother muscle stretch reflexes in the upper and lower extremitieswere absent. His perception of sensory stimuli ended bilaterally atan imaginary line drawn across his chest about 3 inches above thenipples (i.e. everything below felt numb). He had some sensation inhis arms, but could not localize touch or describe texture with anyconsistency there. He was able to raise her shoulders and tightenhis biceps brachii slightly in each arm, but could not raise eitherarm against gravity. His lower extremities were flaccid, despiteattempts to move them. Vital signs were taken again at the hospitaland were as follows: blood pressure=94 / 55; heart rate=64;respiratory rate=24 (with shallow breathing). His oral temperaturewas 102.2 degrees F. His color was dusky and his skin was warm anddry to the touch.
X-rays taken upon arrival revealed a fractured vertebra at aparticular location. A chest X-ray showed a decreased lungexpansion upon inhalation. Blood tests were normal, with theexception of a respiratory acidosis (blood pH = 7.25). Theneurosurgeons immobilized her neck by inserting tongs into theskull above the ears to hold her neck in a position so that nofurther injury could occur. Joe was transferred to intensive careand her condition was stabilized.
A physical examination four days later revealed normal vital signsand no change in his arm strength or sensation, but also markedspasms and exaggerated stretch reflexes of the lower extremities.He also had urinary incontinence which required the placement of aFoley catheter connected to a urine collection bag.
Why did Doe's heart rate and blood pressure fall inthis time of emergency (i.e. at a time when you'd expect just theopposite homeostatic responses)?
Upon admission to the hospital, Doe's breathing was rapid andshallow. Can you explain why?
Why did Doe lose some sensation in his arms and all sensation fromthe upper trunk down?
Why did Doe have dry skin and a fever upon admission to thehospital?
Based upon the physical exam findings, which vertebral bone do youthink was fractured? Give reasons for your answer.
What is the normal pH of the blood? Why was Doe's blood pH belownormal?
