A 30-year-old patient is injured in a motor vehicle collision. The patient cannot move their diaphragm, and they are apneic. In which of the following locations should the EMT suspect the spinal injury occurred?
The diaphragm is innervated by the phrenic nerve, which originates from spinal nerve roots C3–C5. NREMT teaching highlights the phrase: “C3, 4, and 5 keep the diaphragm alive.”
Option A (C4) is correct because an injury at or above this level can paralyze the diaphragm, resulting in apnea and immediate respiratory failure.
Option B (T1) and C (T3) affect intercostal muscles but not the diaphragm.
Option D (L4) affects lower extremity function only.
NREMT emphasizes that high cervical spine injuries are immediately life-threatening due to loss of ventilatory control.
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