EMT Basic Chapter 28 Head and Spine Injuries, EMT Basic Chapter 27 Face and Neck Injuries

care for injuries to the ear

. Injuries of the ear 1. The ear is complex and associated with hearing and balance. 2. Divided into three parts: a. External ear b. Middle ear c. Inner ear 3. Ears are often injured, but they do not usually bleed very much. a. If local pressure does not control bleeding, apply a roller dressing. 4. In case of an ear avulsion, wrap the avulsed part in a moist, sterile dressing and put it in a plastic bag labeled with the patient's name. 5. Tympanic membrane rupture a. Sudden changes in pressure created by a blast wave may cause rupture. b. Signs and symptoms c. May be caused by insertion of objects too far into the ear d. Management 6. Children place foreign bodies in the external auditory canal. a. All foreign bodies should be removed by a physician. b. Do not try to manipulate the foreign body; you may push it further into the ear. 7. Clear fluid coming from the ear may indicate a skull fracture.

Peripheral nervous system

1. 31 pairs of spinal nerves a. Conduct impulses from the skin and other organs to the spinal cord b. Conduct motor impulses from the spinal cord to the muscles 2. 12 pairs of cranial nerves a. Transmit information directly to or from the brain 3. There are two major types of peripheral nerves. a. Sensory nerves i. Carry only one type of information from the body to the brain via the spinal cord b. Motor nerves i. Carry information from the CNS to the muscles 4. The connecting nerves are found only in the brain and spinal cord. a. Connect the sensory and motor nerves with short fibers b. Allow the exchange of simple messages

Concussion

1. A blow to the head or face may cause concussion of the brain. 2. Classified as mild TBIs 3. It is a closed injury with a temporary loss or alteration of part or all of the brain's abilities to function without demonstrable physical damage to the brain. 4. Approximately 90% of patients who sustain a concussion do not experience a loss of consciousness. 5. A patient with a concussion may be confused or have amnesia. 6. Usually a concussion lasts only a short time. a. Ask about symptoms of concussion in any patient who has sustained an injury to the head. 7. Assume that a patient with signs or symptoms of concussion has a more serious injury until proven otherwise by a CT scan at the hospital or by evaluation by a physician.

Intracranial pressure

1. Accumulation of blood within the skull or swelling of the brain can rapidly lead to an increase in intracranial pressure (ICP). a. Increased ICP squeezes the brain against bony prominences within the cranium. 2. Signs of increased intracranial pressure: a. Abnormal respiratory patterns such as Biot and Cheyne-Stokes b. Decreased pulse rate, headache, nausea, vomiting, decreased alertness, bradycardia, sluggish or nonreactive pupils, decerebrate posturing, and increased or widened blood pressure c. Cushing reflex: the symptom triad of increased systolic blood pressure, decreased pulse rate, and irregular respirations 3. Intracranial hemorrhage a. Bleeding inside the skull also increases the ICP. b. Bleeding can occur between the skull and dura mater, beneath the dura mater but outside the brain, or within the tissue of the brain itself. 4. Epidural hematoma a. Accumulation of blood between the skull and dura mater b. Nearly always the result of a blow to the head that produces a linear fracture of the thin temporal bone c. Arterial bleeding into the epidural space will result in rapidly progressing symptoms. d. Often, the patient loses consciousness immediately following the injury. e. This is often followed by a brief period of consciousness (lucid interval), after which the patient lapses back into unconsciousness. i. Death will follow very rapidly without surgery to evacuate the hematoma

What is a Vacuum mattress and how is it used?

1. An alternative to the long backboard is a vacuum mattress. a. The mattress molds to the specific contours of the patient's body, reducing pressure-point tenderness and therefore providing better comfort. b. It also provides thermal insulation. c. Excellent for the elderly or a patient with abnormal curvature of the spine d. Drawback to the device is its thickness e. Cannot be used for patients who weigh more than 350 lb f. Can be used on a supine, sitting, or standing patient g. Patient can be moved onto the vacuum mattress with a scoop stretcher or a log roll.

The nervous system includes:

1. Brain 2. Spinal cord 3. Several billion nerve fibers that carry information to and from all parts of the body

Contusion

1. Bruising of the brain tissue resulting from blunt trauma 2. A contusion is far more serious than a concussion. a. Involves physical injury to the brain tissue b. May produce long-lasting and even permanent damage 3. A patient who has sustained a brain contusion may exhibit any or all of the signs of brain injury.

The nervous system is divided into two anatomic parts

1. Central nervous system 2. Peripheral nervous system

Emergency Medical Care of Head Injuries -Three general principles are designed to protect and maintain the critical functions of the CNS:

1. Establish an adequate airway. 2. Control bleeding and provide adequate circulation to maintain cerebral perfusion. 3. Assess the patient's baseline level of consciousness, and continuously monitor it.

how do you Immobilize the cervical spine for a spinal injury

1. Immobilize the head and trunk so that bone fragments do not cause further damage. 2. Even small movements can cause significant injury to the spinal cord. 3. Follow the steps in Skill Drill 28-1. 4. Assess the pulse, motor functions, and sensations in all extremities. 5. Assess the cervical spine area and neck. 6. Never force the head into a neutral, in-line position; do not move the head any farther if the patient reports any of the following symptoms: a. Muscle spasms in the neck b. Substantial increased pain c. Numbness, tingling, or weakness in the arms or legs d. Compromised airway or ventilations 7. In these situations, stabilize the patient in his or her current position

Standing patients (how to prep for transport)

1. Immobilize the patient to a long backboard before proceeding with assessment. 2. This process will require three EMTs. a. Begin by establishing manual, in-line stabilization and applying a cervical collar. b. Position the board upright directly behind the patient. The EMTs should be positioned with one on either side of the patient, and the third directly behind the patient, maintaining in-line stabilization. c. The two EMTs at the patient's sides grasp the handholds at shoulder level or slightly above by reaching under the patient's arms, and carefully lower the patient as a unit. d. The EMT at the head must ensure that the patient's head stays against the board and must carefully rotate his or her hands as the patient is being lowered to maintain in-line stabilization. ¬

Central nervous system (CNS)

1. Includes the brain and spinal cord. 2. The brain controls the body and is the center of consciousness. 3. The brain is divided into three major areas: a. Cerebrum b. Cerebellum c. Brainstem 4. The cerebrum controls a wide variety of activities, including most voluntary motor function and conscious thought. 5. The cerebellum coordinates balance and body movements. 6. The brainstem controls most functions necessary for life, including the cardiac and respiratory systems and nerve function transmissions. 7. The spinal cord is mostly made up of fibers that extend from the brain's nerve cells. a. Carries messages between the brain and the body via the gray and white matter of the spinal cord 8. Protective coverings a. The brain and spinal cord are covered with thick, bony structures. b. The CNS is further protected by the meninges, three distinct layers of tissue that suspend the brain and the spinal cord within the skull and the spinal canal. i. The outer layer, the dura mater, is a tough, fibrous layer that forms a sac to contain the CNS. ii. The inner two layers, called the arachnoid mater and the pia mater, contain the blood vessels that nourish the brain and spinal cord. c. Cerebrospinal fluid (CSF) is produced in a chamber inside the brain, called the third ventricle. i. CSF primarily acts as a shock absorber. ii. When an injury does penetrate all the protective layers, clear, watery CSF may leak from the nose, the ears, or an open skull fracture.

Remove a helmet if:

1. It is a full-face helmet. 2. It makes assessing or managing airway problems difficult, and removal of a face guard to improve airway access is not possible. 3. It prevents you from properly immobilizing the spine. 4. It allows excessive head movement. 5. The patient is in cardiac arrest.

Traumatic brain injuries (TBI)

1. Most serious of all head injuries 2. Classified into two broad categories: primary (direct) injury and secondary (indirect) injury a. Primary brain injury results instantaneously from impact to the head. b. Secondary brain injury increases the severity of the primary injury, and may be caused by: i. Cerebral edema ii. Intracranial hemorrhage iii. Increased intracranial pressure iv. Cerebral ischemia v. Infection c. Hypoxia and hypotension are the two most common causes of secondary brain injury. 3. Can result from blunt or penetrating trauma 4. Coup-countercoup injury a. The initial impact injures the front part of the brain. b. The head falling back against the headrest then injures the rear part of the brain. 5. Cerebral edema (swelling of the brain) may not develop until several hours following the initial injury. 7. Low blood oxygen levels aggravate cerebral edema and can be minimized by maintaining high oxygen saturations. 8. Monitor the patient for any seizure activity.

Emergecny care for spinal injuries -managing airway

1. Perform the jaw-thrust maneuver to open the airway. 2. Consider inserting an oropharyngeal airway. 3. Have a suctioning unit available. 4. Provide supplemental oxygen if needed.

What are Cervical collars and what do they do?

1. Provide preliminary, partial support 2. Should be applied to every patient who has a possible spinal injury based on the MOI, history, or signs and symptoms. 3. To be effective, a rigid cervical collar must be the correct size for the patient. 4. Follow the steps in Skill Drill 28-2. 5. Once the patient's head and neck have been manually stabilized, assess the pulse, motor functions, and sensation in all extremities. Then, assess the cervical spine area and neck.

Preferred method of removing a helmet is...

1. Removing a helmet should always be at least a two-person job. 2. However, the technique for helmet removal depends on the actual type of helmet worn by the patient. 3. You and your partner should not move at the same time. 4. You should first consult with medical control about your decision to remove a helmet.

A helmet that fits well prevents the patient's head from moving and should be left on, provided:

1. There are no impending airway or breathing problems. 2. It does not interfere with assessment and treatment of airway or ventilation problems. 3. You can properly immobilize the spine. 4. There is any chance that removing it will further injure the patient.

Sitting patients (how to prep for transport)

1. Use a short backboard or other short spinal extrication device to restrict movement of the cervical and thoracic spine. 2. Then secure the short board to the long board. 3. The exceptions to this rule are situations in which you do not have time to first secure the patient to the short board, including the following situations: a. You or the patient is in danger b. You need to gain immediate access to other patients c. The patient's injuries justify urgent removal

emergency care for blunt trauma to the eye

10. Blunt trauma a. Injuries range from the ordinary black eye to a severely damaged globe. b. Hyphema (bleeding into the anterior chamber of the eye) obscures all or part of the iris. c. Orbit fracture (blow-out fracture) i. Common causes ii. Management d. Retinal detachment i. Common causes ii. Management

The peripheral nervous system has _____ pairs of spinal nerves.

31

Subdural hematoma

5. Subdural hematoma a. An accumulation of blood beneath the dura mater but outside the brain b. Usually occurs after falls or injuries involving strong deceleration forces c. More common than epidural hematomas and may or may not be associated with a skull fracture d. A subdural hematoma is associated with venous bleeding, so the signs typically develop more gradually than with an epidural hematoma. e. The patient often experiences a fluctuating level of consciousness or slurred speech. f. Any patient with a suspected subdural hematoma needs to be evaluated by a physician.

Emergency care for foreing objects in the eyes

7. Foreign objects a. The orbit protects the eye from the penetration of large objects. b. Even a very small object may produce severe irritation. c. Irrigation with a sterile saline solution will frequently flush away loose, small particles. 1. Eye injuries are common, particularly in sports. a. Can produce lifelong complications, including blindness b. Proper emergency treatment will minimize pain and may prevent a permanent loss of vision. 2. In a normal, uninjured eye, the entire circle of the iris is visible. a. The pupils are round, usually equal in size, and react equally when exposed to light. b. Both eyes move together in the same direction when following your moving finger. 3. After an injury, pupil reaction or shape and eye movement are often disturbed. a. Abnormal pupil reactions sometimes are a sign of brain injury rather than an eye injury. 4. Treatment starts with a thorough examination. 5. Always use standard precautions. a. Take care not to aggravate any problems. 6. Look for specific abnormalities or conditions that may suggest the nature of the injury. a. A damaged cornea quickly loses its smooth, wet appearance. d. A foreign body will leave a small abrasion on the conjunctiva. e. Gentle irrigation usually will not wash out foreign bodies stuck to the cornea or lying under the upper eyelid. If you spot a foreign object on the surface of the eyelid, you may be able to remove it with a moist, sterile, cotton-tipped applicator. Follow the steps in Skill Drill 27-1. f. Foreign bodies may be impaled in the eye and must be removed by a physician. g. Your care involves stabilizing the object and preparing the patient for transport. Follow the steps in Skill Drill 27-2. h. When you see or suspect an impaled object(s) in the eye, bandage both eyes with soft, bulky dressings to prevent further injury.

Blow-out fracture

A blow-out fracture is caused by blunt injury to the bones around the globe. Suspect this in any patient who reports pain, double vision, or decreased vision following a blunt injury about the eye.

concussion

A temporary loss or alteration of part or all o the brain'a abilities to function without actual physical damage to the brain.

When a patient has a chemical burn to the eye, you should irrigate the eye for at least 5 minutes; however, if the burn was caused by an alkali or strong acid, you should irrigate for: A. 20 minutes B. 15 minutes C. 10 minutes D. 25 minutes

A. 20 minutes

A patient with a head injury presents with abdominal flexion of his extremities. What nymeric value should you assign to him for motor response? A. 3 B. 4 C. 2 D. 5

A. 3

In a(n) ________, CSF flows freely from the patient's ear; this type of injury can be difficult to diagnose with a radiograph. A. Basilar skull fracture B. Intracerebral hematoma C. Linear skull fracture D. Subdural hematoma

A. Basilar skull fracture

Which of the following fractures is associated with bruising around the ears and blood coming from the nose? A. Basilar skull fracture B. Orbit fracture C. Mandibular fracture D. Maxilla fracture

A. Basilar skull fracture In a basilar skull fracture, you are likely to see bruising around the ears and blood or fluid draining from the ears and nose.

You are treating a patient who went face-first through a windshield. She has extensive head injuries and is displaying hypertension, bradycardia, and Cheyne-Stokes respirations. Which of the following should you suspect? A. Cushing triad B. C6 herniation C. Concussion D. Cerebral edema

A. Crushing triad Cushing triad presents with hypertension, bradycardia, and Cheyne-Stokes respirations.

When securing a patient to a backboard, what area of the body should you secure last? A. Head B. Upper torso C. Pelvis D. Upper legs

A. Head When securing a patient to a long backboard, you secure the patient's head last.

A patient who is complaining of seeing flashing lights, specks, or "floaters" in his or her field of vision has MOST likely experienced: A. a detached retina B. acute hyphema C. a blowout fracture D. conjunctivitis

A. a detached retina

When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his right ear. This indicates: A. a rupture of the tympanic membrane following diffuse impact to the head B. a linear skull fracture and a significant increase in intracranial pressure C. fractures to the internal structures of the ear following direct trauma D. significant pressure and bleeding in between the skull and dura mater

A. a rupture of the tympanic membrane following diffuse impact to the head

A man jumped from the roof of his house and landed on his feet. He complains of pain to this heels, knees, and lower back. This mechanism of injury is an example of: A. axial loading B. hyperextension C. distraction D. hyperflexion

A. axial loading

You are assessing a patient who was hit in the face by a baseball bat. There are multiple contusions on his face, and he reports double vision. His left eye does not track with his right eye. What should you suspect? A. Blow-out fracture B. Corneal burn C. Retinal detachment D. Foreign object entrapment

A. blow-out fracture A blow-out fracture is caused by blunt injury to the bones around the globe. Suspect this in any patient who reports pain, double vision, or decreased vision following a blunt injury about the eye.

Unequal pupils most likely indicate what type of injury? A. Brain B. Skull C. Chest D. Spine

A. brain Unequal pupils indicate an injury of the brain (or the eye).

Injury to the head and neck may indicate injury to the: A. cervical spine B. thoracic spine C. lumbar spine D. sacral spine

A. cervical spine

a 39-year-old female experienced a severe closed head injury. She is unresponsive with her eyes slightly open' her pupils are bilaterally dilated and slow to react. In addition to managing problems with airway, breathing, and circulation, you should: A. close her eyes and cover them with a moist dressing B. irrigate her eyes with water to prevent mucosal drying C. secure her eyes open so you can reassess her pupils D. inspect her eyes and gently remove impaled objects

A. close her eyes and cover them with a moist dressing

Rapid deceleration of the head, such as when it impacts the windshiled causes A. compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior of the brain B. primary impacy to the posterior aspect of the brain resulting in compression injuries, bruising or torn blood vessels C. stretching or tearing of the anterior aspect of the brain and compression injuries or bruising to the posterior aspect of the brain D. compression injuries and contusions to the anterior, posterior, and lateral aspects of the brain

A. compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior of the brain

Which of the following breathing patterns is MOST indicative of increased intracranial pressure? A. irregular rate, pattern, and volumne of breathing with intermittent periods of apnea B. slow, shallow, occasional gasps that progress to prolonged periods of apnea C. increased rate and depth with the distinct odor of acetone on the patients breath D. increased rate with a normal respiratory time and a prolonged expiratory time

A. irregular rate, pattern, and volumne of breathing with intermittent periods of apnea

The ________ is a prominent bony mass at the base of the skull 1 inch posterior to the external opening of the ear. A. Mastoid process B. Sternocleidomastoid muscle C. Sclera D. Temporomandibular joint

A. mastoid process

The optic nerve endings are located within the: A. retina B. sclera C. cornea D. pupil

A. retina

The white portion of the eye is called the: A. sclera B. retina C. cornea D. iris

A. sclera

Significant trauma to the face should increase the EMT's index of suspicion for a(n): A. spinal column injury B. airway obstruction C. basilar skull fracture D. displaced mandible

A. spinal column injury

When stabilizing a large foreign object in the eye, you should first cover the eye with a moist dressing then: A. surround the object with a doughnut-shaped collar made from gauze B. apply tape around the object and then secure the tape to the forehead C. place and ice pack over the eye to reduce swelling D. irrigate the eye with saline

A. surround the object with a doughnut-shaped collar made from gauze

If you do not have the appropriate-size cervical collar, you should: A. use rolled towels to immobilize the patients head B. place sandbags on either side of the patients head C. defer cervical immobilization and apply lateral head blocks D. ask the patient to keep his or her head iin a neutral position

A. use rolled towels to immobilize the patients head

Subdural hematoma

An accumulation of blood beneath the dura mater but outside the brain.

The mastoid process is located approximately: A. 1 inch posterior to the angle of the mandible B. 1 inch posterior to the external opening of the ear C. half an inch anterior to the external opening of the ear D. 1 inch inferior to the external opening of the ear

B. 1 inch posterior to the external opening of the ear

What is an air embolism? A. A crackling sensation felt when palpating the neck resulting from air in the soft tissues B. A clinical situation in which a vein is punctured and air is sucked into the heart C. A swelling or enlargement of the wall of a blood vessel that results from weakening of the vessel wall D. A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow

B. A clinical situation in which a vein is punctured and air is sucked into the heart An air embolism is a clinical situation in which a vein is punctured and air is sucked into the heart.

Which of the following acts as a shock absorber for the CNS? A. Dura mater B. Cerebrospinal fluid C. Fascia D. Pia mater

B. Cerebrospinal fluid Cerebrospinal fluid (CSF) serves as a shock absorber. The brain and spinal cord essentially float in this fluid, buffered from injury.

what do you do to Manage the airway for head injuries

B. Managing the airway 1. The most important step is establishing and maintaining adequate airway. a. Once the airway is open, maintain the head and cervical spine in a neutral, in-line position until you have placed a cervical collar and have secured the patient on a backboard. b. Remove any foreign bodies, secretions, or vomitus from the airway. 2. Once you have cleared the airway, check ventilation. 3. Give supplemental oxygen to any patient with suspected head injury, particularly anyone who is having trouble breathing.

Which area of the body are you palpating if you feel subcutaneous emphysema? A. Chest B. Neck C. Abdomen D. Spine

B. Neck You are palpating the neck if you feel subcutaneous emphysema.

Neck

B. Neck 1. Contains many important structures 2. Supported by the cervical spine a. First seven vertebrae in the spinal column (C1 through C7) b. The spinal cord exits from the foramen magnum and lies within the spinal canal formed by the vertebrae. 3. The upper part of the esophagus and the trachea lie in the midline of the neck. a. The carotid arteries are found on either side of the trachea, along with the jugular veins and several nerves. 4. The larynx a. The Adam's apple is located in the center of the anterior of the neck. b. The other portion of the larynx is the cricoid cartilage, a firm ridge of cartilage below the thyroid cartilage. c. Cricothyroid membrane 5. The trachea a. Below the larynx b. The trachea connects the oropharynx and the larynx with the main passages of the lungs (the bronchi). c. On either side of the lower larynx and the upper trachea lies the thyroid gland. 6. Sternocleidomastoid muscles a. Originate from the mastoid process of the cranium and insert into the medial border of each collarbone and the sternum at the base of the neck b. Allow movement of the head

A female patient with a suspected head injury has slow, shallow breathing. The MOST appropriate treatment for her includes: A. ventilation assistance to maintain an oxygen saturation of 90% B. Ventilation assistance to maintain an ETCO2 of 30 to 35 mm HG C. administering oxygen via a nonrebreathing mask D. hyperventilating her at 30 breaths/min

B. Ventilation assistance to maintain an ETCO2 of 30 to 35 mm HG

Common signs and symptoms of a serious head injury include all of the following EXCEPT: A. decerebrate posturing B. a rapid, thready pulse C. widening pulse pressure D. CSF leakage from the ears

B. a rapid, thready pulse rate

a young female experienced a laceration to her left eyeball from flying glass when her boyfriend broke a soda bottle aginst the wall. There is moderate bleeding and the patient states that she cannot see out of the injured eye. You should A. carefully examine her eye and remove any foreign objects if needed B. avoid applying pressure to the globe when you are covering her eye C. apply firm direct pressure to the injured eye and cover the opposite eye D. ask her to move the injured eye to assess the integrity of the optic nerve

B. avoid applying pressure to the globe when you are covering her eye

What is hyphema? A. Nosebleed B. Bleeding into the anterior chamber of the eye C. When air is sucked into the heart D. Pain or difficulty swallowing

B. bleeding into the anterior chamber of the eye Hyphema is bleeding into the anterior chamber of the eye, obscuring part or all of the iris.

The__________ is the best-protected part of the CNS and controls the functions of the cardiact and respiratory systems A. cerebral cortex B. brain stem C. cerebellum D. spinal cord

B. brain stem

Bleeding from soft-tissue injuries to the face is MOST effectively controlled with: A. ice packs and elevation of the patients head B. direct pressure using dry, sterile dressings C. digital pressure to an adjacent pulse point D. pressure dressings and chemical ice packs

B. direct pressure using dry, sterile dressings

The brain connects to the spinal cord through a large opening at the base of the skull known as the: A. spinous process B. foremen magnum C. vertebral foramina D. eustachian tube

B. foremen magnum

Hyperextension injuries of the spine are MOST commonly the result of: A. compression B. hangings C. falls D. diving

B. hangings

A 45-year-old male was working on his roof when he fell approximately 12 feet, landing on his feet. He is conscious and alert and complains of an ache in his lower back. He is breathing adequately and has stable vital signs. You should: A. perform a rapid head-to-toe exam and immobilize his spine B. immobilize his spine and perform a focused secondary exam C. allow him to refuse transport if his vital signs remain stable D. obtain a Glasgow Coma Score value and give him oxygen

B. immobilize his spine and perform a focused secondary exam.

The cricoid cartilage: A. is easier to see and palpate than the thyroid cartilage B. is the only complete circular cartilage of the trachea C. lies superior to the cricothyroid membrane in the neck D. lied superior to the thyroid cartilage in the neck

B. is the only complete circular cartilage of the trachea

Which of the following statements regarding the vitreous humor is correct? A. it is a clear fluid that is produced bby the lacriminal glands and cannot be replaced if it is lost B. it is a clear, jellylike fluid near the back of the eye that cannot be replaced if it is lost C. it is a clear, watery fluid that is located in front of the lends and can be replaced if it is lost D. it is a clear watery fluid surrounding the eye and can be replaced if it is lost

B. it is a clear, jellylike fluid near the back of the eye that cannot be replaced if it is lost

Which of the following is NOT a symptom of a concussion? A. visual changes B. muscle tremors C. dizziness D. weakness

B. muscle tremors

When activated, the sympathetic nervous system produces all of the following effects, EXCEPT: A. shunting of blood to vital organs B. pupillary constriction C. dilation of the bronchiole smooth muscle D. increase in heart rate

B. pupillary constriction

The Adam's apple is: A. below the thyroid cartilage and forms the upper part of the trachea B. the upper part of the larynx that is formed by the thyroid cartilage C. the lower part of the larynx that is formed by the cricoid cartilage D. the small indentation in between the thyroid and cricoid cartilages

B. the upper part of the larynx that is formed by the thyroid cartilage

A 4-year-old female has a peanut lodged in the external auditory canal of her right ear. You should: A. remove the peanut with a cotton-tipped swab B. transport her to the mergency department C. thoroughly flush her ear with sterile saline D. use tweezers to try to remove the object

B. transport her to the mergency department

Which of the following is not a sign or symtom of a laryngeal injurry? A. subcutaneous emphysema B. wheezing C. difficulty breathing D. hoarseness

B. wheezing

What is a hematoma? A. A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissue B. A flap of skin that is separated from the underlying muscle and fascia C. A collection of blood within the tissues D. A rupture of the eye

C A hematoma is a collection of blood within the tissues.

When transporting a patient with a facial injury, it is MOST important to be as descriptive as possible with the hospital regarding the patient's injuries because: A. it saves time on repeat assessments at the hospital B. they must make arrangments for an ICU bed C. they may need to call a specialist to see the patient D. most patients with facial trauma will need surgery

C, they may need to call a specialist to see the patient

In supine patients with a head injury, the head should be elevated _____ to help reduce intracranial pressure. Select one: A. 10 degrees B. 20 degrees C. 30 degrees D. 40 degrees

C. 30 degrees

When performing a full body scan, you should assess for___________ A. OPQRST B. SAMPLE C. DCAP-BTLS D. AVPU

C. DCAP_BTLS

You are reassessing a patient and you find that her left pupil is dilated and fixed. What does this indicate? A. Decreased blood pressure B. Increased blood pressure C. Increased intracranial pressure D. Drug abuse

C. Increased intracranial pressure A fixed, dilated pupil indicates increased ICP.

You are treating a patient with significant bruising to her face and a broken nose. She is conscious, but her LOC is significantly altered and her breathing is labored. What should you do to manage this patient's airway? A. Give oxygen via a nasal cannula at 4 L/min. B. Insert a nasopharyngeal airway. C. Insert an oropharyngeal airway. D. Apply high-flow oxygen via a nonrebreathing mask

C. Insert an oropharyngeal airway. Because the patient's breathing is labored and her LOC is altered, you should insert an oropharyngeal airway.

Accounting for approximately 80% of all skull fractures, which of the following often present with no physical signs? A. Basilar skull fractures B. Depressed skull fractures C. Linear skull fractures D. Open skull fractures

C. Linear skull fractures Linear skull fractures (nondisplaced skull fractures) account for approximately 80% of all skull fractures. Radiographs are required to diagnose a linear skull fracture because there are often no physical signs, such as deformity.

The time between an initial period of unconsciousness and a subsequent loss of consciousness is referred to as what? A. Coherent stage B. Danger zone C. Lucid interval D. Recognition period

C. Lucid interval The time between periods of unconsciousness is known as the lucid interval.

You are treating a patient who might have a skull fracture. What should you do if a dressing you have applied to a head wound becomes soaked? A. Replace the dressing with a fresh one. B. Remove the dressing and apply an occlusive dressing. C. Place a clean dressing over the bloody one. D. Apply direct pressure and add a compression dressing.

C. Place a clean dressing over the bloody one You should simply apply a clean dressing over the soaked dressing so that you do not risk contaminating the wound.

The eye

C. The eye 1. Globe-shaped, approximately 1 inch in diameter 2. Located within a bony socket in the skull called the orbit a. The orbit is composed of adjacent bones of the face and skull. b. In adults, the orbit protects over 80% of the eyeball. c. Between and below the orbits are the nasal bone and the sinuses. 3. The eyeball, or globe, keeps its shape as a result of pressure from the fluid contained within its two chambers. a. Clear, jellylike fluid near the back of the eye is called the vitreous humor. b. In front of the lens is a clear fluid called the aqueous humor. 4. The conjunctiva is the membrane that covers the eye. 5. The lacrimal glands, often called tear glands, produce fluid to keep the eyes moist. a. When a person blinks, fluid is swept from the lacrimal glands over the surface of the eye, cleaning it. b. The tears drain on the inner side of the eye through two lacrimal ducts into the nasal cavity. 6. The sclera is the white, fibrous tissue that helps maintain the globular shape and protects the more delicate inner structures. 7. On the front of the eye, the sclera is replaced by a clear, transparent membrane called the cornea. a. Allows light to enter the eye b. The iris is a circular muscle behind the cornea. 8. The pupil is the opening in the center of the iris. a. Allows light to move to the back of the eye b. Anisocoria is a condition in which a person is born with different-sized pupils. 9. The lens lies behind the iris. a. The lens focuses images on the retina at the back of the globe. 10. The retina contains nerve endings, which respond to light by transmitting nerve impulses through the optic nerve to the brain. a. The retina is nourished by a layer of blood vessels between it and the back of the globe. b. Retinal detachment is when the retina detaches from the underlying choroid and sclera and can cause blindness.

In which instance would you consider removing an impaled object? A. When the object is impaled in the eye and threatens vision B. When the object is impaled in the ear and creates basilar trauma C. When the object is impaled in the cheek and compromises the airway D. When the object is impaled in the neck into or near the carotid artery

C. When the object is impaled in the cheek and compromises the airway One of the rare times you should consider removing an impaled object is when the object is impaled in the cheek and compromises the airway.

An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is: A acute unilateral paralysis followinig the injury B. a progressively lowering blood pressure C. a rapid deterioration of neurologic signs D. an acute increase in the patient"s pulse rate

C. a rapid deterioration of neurologic signs

A reflex arc occurs when: the motor nervies function automatically without receiving a message from the CNS B. a sensory nerve sends a message to the brain but the motor nerve fails to send the appropriate response to the body C. a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the motor nerve D. the brain interprets sensory information that it receives from peripheral and cranial nerves and sends signals to the muscles

C. a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the motor nerve

An epidural hematoma is MOST accurately defined as: A. bleeding between the dura mater and brain B. an injury caused by a damaged cerebral artery C. bleeding between the skull and dura mater D. venous lacerations that occur within the brain

C. bleeding between the skull and dura mater

You respond to a 71-year-old woman who is unresponsive. You try to get her to respond but have no success. Her airway is open, and she is breathing at a rate of 14 breaths/min. What structure on her neck should you locate to take a pulse? A. subclavian arteries B. hypothalamus C. carotid arteries D. cricoid cartilage

C. carotid arteries

A temporary loss or alteration of part or all of the brain's abilities to function without physical damage to the brain MOST accurately describes a(n): A. cerebral contusion B. intracerebral hematoma C. cerebral concussion D. intracranial hemorrhage

C. cerebral concussion

The five sections of the spinal column, in decending order are the: A. coccygeal, sacral, lumbar, thoracic, and cervical B. cervical, coccygeal, thoracic, sacral, and lumbar C. cervical, thoracic, lumbar, sacral, and coccygeal D. thoracic, cervical, lumbar, coccygeal, and sacral

C. cervical, thoracic, lumbar, sacral, and coccygeal

The inner surface of the eyelids and the exposed surface of the eye itself are covered by a delicate membrane called the: A. sclera B. retina C. conjunctiva D. cornea

C. conjunctiva

A 30-year-old female presents with redness, inflamation, and pain to her left eye. During your assessment, you note that she is having difficulty keeping her eyes open. You should suspect that she is experiencing: A. acute retinitis B. detached retina C. conjunctivitis D. a corneal abrasion

C. conjunctivitis

The GCS is used to assess: A. mental status, eye opening, and respiratory rate B. verbal response, eye opening, and mental status C. eye opening, verbal response, and motor response D. sensory response, pupil reaction, and heart rate

C. eye opening, verbal response, and motor response

The eyeball itself is reffered to as: A. cornea B. sclera C. globe D. orbit

C. globe

Which of the following statements regarding secondary brain injury is correct? A. because cerebral edema developes quickly, it is considered to be a primary brain injury B. it results from direct brain trauma following an impact to the head C. hypoxia and hypotension are the two most common causes of secondary brain injury D. signs are often present immediately after an impact to the head

C. hypoxia and hypotension are the two most common causes of secondary brain injury

Bleeding within the brain tissue itself is called a(n) A. subarachnoid hemorrhage B. subdural hematoma C. intracranial hematoma D. epidural hematoma

C. intracranial hematoma

Cushing triad in a patient is a sign of which of the following? A. Spinal cord damage B. Concussion C. Intracranial pressure D. Blood clot in the brain

C. intracranial pressure Cushing triad is a sign of intracranial pressure.

A factory worker was splashed in the eyes with a strong acid chemical. He complains of intense pain and blurred vision. Your ambulance does not carry bottles of sterile saline or water. You should: A. flush both eyes with an alcohol-based solution and transport B. neutralize the acid chemical in his eye with an alkaline chemical C. irrigate both eyes continuously for 20 minutes with plain water D.mix baking soda with water and irrigate his eyes with the solution

C. irrigate both eyes continuously for 20 minutes with plain water

A tight-fitting motorcycle helmet should be left in place unless: A. the patient must be places onto a long backboard B. the patient complains of severe neck or back pain C. it interferes with your assessment of the airway D. the helmet is equiped with a full face shield or visor

C. it interferes with your assessment of the airway

The superficial temporal artery can be palpated: A. slightly above the ear B. over the mastoid process C. just anterior to the tragus D. at the angle of the jaw

C. just anterior to the tragus

The upper jawbones are called the: A .zygoma B. mandible C. maxillae D. mastoid

C. maxillae

Battle sign is an indication of which of the following? A. Concussion B. Contusion C. Skull fracture D. Secondary injury

C. skull fracture Battle sign is bruising behind an ear over the mastoid process that may indicate a skull fracture.

During your primary assessment of a 19-year-old male who experienced severe head trauma, you note that his respirations are rapid, irregular, and shallow. He has bloody secretions draining from his mouth and nose. You should: A. pack his nostrils to stop the drainage of blood B. assist his ventilations with a BVM C. suction his oropharynx for up to 15 seconds D. immobilize his spine and transport immediately

C. suction his airway for up to 15 seconds

Which of the following statements regarding anterior nosebleeds is correct? A. they cause blood to drain into the posterior pharynx B. they are usually caused by a fracture of the basilar skull C. they usually originate from the septum area and bleed slowly D. they are usually severe and require aggressive treatment to control

C. they usually originate from the septum area and bleed slowly

If your patient swallows blood following facial trauma, there is an increased risk of ________. A. altered LOC B. GI Trauma C. vomiting D. hypotension

C. vomiting

When carrying a patient with an open facial injury, the EMT"s immediate priority should be to: A. closely assess the patient's airway B. consider the MOI C. wear gloves and facial protection D. manually stabilize the patients head

C. wear gloves and facial protection

Helmets must be removed in all of the following cases, EXCEPT: A. when cardiac arrest is involved. B. when the helmet allows for excessive movement. C. when there are no impending airway or breathing problems. D. when a shield cannot be removed for access to the airway.

C. when there are no impending airway or breathing problems.

managing circulation for head injuries includ:

Circulation 1. Begin CPR if the patient is in cardiac arrest. 2. Active blood loss aggravates hypoxia by reducing the available number of oxygen-carrying red blood cells. a. Bleeding inside the skull may cause the ICP to rise to life-threatening levels. 3. You can almost always control bleeding from a scalp laceration by applying direct pressure over the wound. a. If you suspect a skull fracture, do not apply excessive pressure to the open wound. b. If the dressing becomes soaked, do not remove it. Instead, place a second dressing over the first. 4. Shock a. Usually the result of hypovolemia caused by bleeding from other injuries b. Transport immediately to a trauma center. 5. Cushing's triad a. Increased blood pressure (hypertension), decreased heart rate (bradycardia), and irregular respirations (Cheyne-Stokes or Biot) b. If this process is allowed to continue, it is a fatal injury. c. Perform controlled hyperventilation of your patient via positive-pressure ventilations at a rate of 20 breaths/min.

While performing a secondary assessment of a patient who was hit with a tire iron on the side of the head, you find a depressed area above the patient's left ear. This indicates that the patient could have which of the following? A. An intracerebral hematoma B. A subdural hematoma C. A subarachnoid hemorrhage D. An epidural hematoma

D. An epidural hematoma An epidural hematoma is nearly always the result of a blow to the head that produces a linear fracture.

care for facial fractures

D. Facial fractures 1. Typically result from blunt impact 2. You should assume that any patient who has sustained a direct blow to the mouth or nose has a facial fracture. 3. Signs and symptoms 4. Facial fractures alone are not acute emergencies unless there is serious bleeding. a. In addition to external hemorrhage, there is the danger of blood clots lodging in the upper airway and causing an obstruction. 5. Plastic surgeons can repair the damage to the face and mouth if the injuries are treated within 7 to 10 days. a. Remove and save loose teeth or bone fragments from the mouth because it is often possible to replant them. b. Remove any loose dentures or dental bridges to protect against airway obstruction. 6. Another source of airway obstruction is swelling, which can be extreme within the first 24 hours after injury.

What part of the nervous system controls the body's voluntary activities? A. central B. sensory C. autonomis D. somatic

D. Somatic

followinig blunt trauma to the face, a 21 year old male complains of a severe headache and decreased ability to move his eyes. This patient's clinical presentation is MOST consistent with: A. optic vessel compression B. a ruptured eyeball C. a lacerated globe D. a blowout fracture

D. a blowout fracture

The cerebrospinal fluid (CSF) that circulates in between each meningeal layer: A. produces leukocytes that protect the brain from infection B. regenerates breain cells after they have been damaged C. deliveres oxygen directly to the CNS D. acts as a shock absorber for the brain and sinal cord

D. acts as a shock absorber for the brain and sinal cord

The MOST significant complication associated with facial injuries is: A. cervical spine injury B. mandibular immobility C. damage to the eyes D. airway compromise

D. airway compromise

Which of the following is or are found in the middle ear? A. Pinna B. Tympanic membrane C. Eustachian tube D. Anvil, hammer, and stirrup

D. anvil, hammer, and stirrup The anvil, hammer, and stirrup are found in the middle ear. These bones move in response to sound waves hitting the tympanic membrane (eardrum).

A short backboard or vest-style immobilization device is indicated for patients who: A. require prompt extrication from an automobile B. are sitting in their car and are clinically unstable C. are found supine and have stable vital signs D. are in a sitting position and are clinically stable

D. are in a sitting position and are clinically stable

After your partner assumes manual in-line stabilization of the patient's head, you should: A. use four people to log roll the patient onto a backboard B. thoroughly palpate the patiuents head for deformities C. apply an appropriately sized rigid cervical collar D. assess distal neurovascular status in the extremeties

D. assess distal neurovascular status in the extremeties

The central nervous system (CNS) is composed of the: A. meninges and spinal cord B. cerebellum and brain C. cerebrum and meninges D. brain and spinal cord

D. brain and spinal cord

The __________ contain(s) about 75% of the brain's total volume A. meninges B. cerebellum C. brain stem D. cerebrum

D. cerebrum

It would be MOST appropriate to perform a focused secondary assessment on a patient who: A. was restrained during a high-speed MVC B. has blood draining from the ears following a head injury C. struck his or her head and is experiencing nausea or vomiting D. fainted and fell to the ground from a standing position

D. fainted and fell to the ground from a standing position

A 52-year-old unrestrained female struck the steering wheel with her face when her truck collided with another vehicle. She has obvious swelling to her face and several dislodged teeth. A visual exam of her mouth reveals minimal bleeding. She is conscious and alert with a blood pressure of 130/80 mm Hg, a pulse of 110 beats/min, and respirations of 22 breaths/min with adequate tidal volume. You should: A. fully immobilize her spine, irrigate her empty tooth sockets, attempt to locate the dislodged teeth, and transport B. apply oxygen via a nonrebreathing mask, suction her airway as needed, disregard the dislodged teeth, and transport C. assist ventilations with a BVM device, immobilize her spine, suction her oropharynx for 30 seconds, and transport D. fully immobilize her spine, attempt to locate the dislodged teeth, suction as needed, and transport

D. fully immobilize her spine, attempt to locate the dislodged teeth, suction as needed, and transport

You are assessing a 59-year-old male and note that his pupils are unequal. He is conscious and alert. When obtaining his medical history, it is MOST pertinent to ask him if he: A. is allergic to any medications B. regularly sees a family physician C. noticed the change during a meal D. has a history of eye surgeries

D. has a history of eye surgeries

In a patient with a head injury, hypertension, bradycardia, and biot respirations indicate: A. an underlying skull fracture B. internal bleeding in the chest C. decreased cerebral blood flow D. herniation of the brain stem

D. herniation of the brain stem

You respond to a 38-year-old man who fell while rock climbing. He is unconscious with an open airway. The respiration and pulse rates are within normal limits. His distal pulses are intact. You check his pupils and find that they are unequal. You know this could be a sign of: A. hypoxia B. chronic hypertension C. seizure activity D. increased intracranial pressure

D. increased intracranial pressure

In contrast to a cerebral conctusion: A. does not cause pressure within the skull B. usually does not cause a loss of consciousness C. results from a laceration to the brain tissue D. involves physical injury to the brain tissue

D. involves physical injury to the brain tissue

Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless: A. lateral immobilization has been applied B. sensory and motor functions remain intact C. the patient adamantly denies neck pain D. it causes a problem managing the airway

D. it causes a problem managing the airway

When a light is shone into the pupil: A. both pupils should dilate together B. it should become larger in size C. the opposite pupil should dilate D. it should become smaller in size

D. it should become smaller in size

The lower jawbone is called the: A. mastoid B. zygoma C. maxillae D. mandible

D. mandible

In which of the following situations would the EMT be the Least likely to immobilize a patients spine? A. pain to the c-spinem but no numbness or tingling B. unresponsive, but moving all extremities equally C. no spinal pain, but tingling in the extremities D. no distracting injuries or evidence of intoxication

D. no distracting injuries or evidence of intoxication

The nervous system is divided into the central nervous system and the: A. somatic nervous system B. sympathetic nervous system C. autonomic nervous system D. peripheral nervouse system

D. peripheral nervouse system

A 6-year-old female was riding her bicycle and struck a clothesline with her throat. She is breathing, but with obvious difficulty. Your assessment reveals a crackling sensation in the soft tissues of her neck and facial cyanosis. In addition to the appropriate airway management, the intervention that will MOST likely improve her chance of survival is: A. careful monitoring her vitals signs B. requesting a paramedic ambulance C. quickly immobilizing her spinal column D. rapidly transporting her to the hospital

D. rapidly transporting her to the hospital

You should be MOST suspicious that a patient had experienced a significant head injury if his or her pulse is: A. weak B. irregular C. rapid D. slow

D. slow

Neck rigidity, bloody cerebrospinal fluid, and headache are associated with what kind of bleeding in the brain? A. subdural hematoma B. intracranial hematoma C. epidural hematoma D. subarachoid hemorrhage

D. subarachoid hemorrhage

The ideal procedure for moving an injured patient from the ground to a backboard is: A. the use of a scoop stretcher B. the direct patient carry C. the clothes drag D. the four-person log roll

D. the four-person log roll

Whem immobilizing a trauma patient's spine, the EMT manually stabilizing the head should not let go until: A. an appropriately sized cervical collar has been applied B. the head has been stabilized with lateral immobilization C. the patient has been secured to the ambulance stretcher D. the patient has been completely secured to the backboard

D. the patient has been completely secured to the backboard

When assessing a patient with a suspected head or spine injury, which of the following should you do? A. Administer high-flow oxygen. B. Hyperventilate the patient. C. Remove the cervical collar during secondary assessment to facilitate reassessment of vital signs. D. Assess the patient in the position found. E. Answers A and D

E. A and D

Which of the following are signs of Cushing triad? A. Loss of sensation B. Hypertension C. Bradycardia D. Irregular respirations E. B,C and D F. A,C, and D

E. B,C, and D

care for dental injuries

E. Dental injuries 1. Dental injuries can be traumatic to the patient. a. The injury may be traumatic and the patient's permanent teeth may be lost. 2. Bleeding will occur whenever a tooth is violently displaced from its socket. a. Apply direct pressure to stop the bleeding. b. Perform suctioning if needed. c. Cracked or loose teeth are possible airway obstructions. 3. Management

care for cheek injuries

F. Injuries of the cheek 1. You may encounter an object impaled in the patient's cheek. a. If you are unable to control the bleeding and it compromises the airway, consider removing the object. b. Then provide direct pressure both on the inside and outside of the cheek. c. The amount of bandaging should not be so overwhelming that it occludes the mouth and makes it difficult to breathe.

care for injuries to the neck

G. Injuries of the neck 1. The neck contains many structures vulnerable to injury by blunt trauma 2. Blunt injuries a. Any crushing injury of the upper part of the neck is likely to involve the larynx or trachea. b. Once the cartilages of the upper airway and larynx are fractured, they do not spring back to their normal position. i. Signs and symptoms ii. Management c. It is possible that these incidents involving an injury to the throat may also have caused a cervical spine injury. 3. Penetrating injuries a. Penetrating injuries to the neck can cause profuse bleeding from laceration of the great vessels in the neck. b. Injuries to the carotid and jugular veins in the neck can cause the body to bleed out, also known as exsanguination. If a vein is punctured, an air embolism may result. c. The airway, the esophagus, and the spinal cord can be damaged by a penetrating injury. d. Direct pressure over the bleeding site will control most neck bleeding. Follow the steps in Skill Drill 27-3.

care for laryngeal injuries

H. Laryngeal injuries 1. Blunt force trauma to the larynx can occur when: a. Unrestrained driver strikes the steering wheel b. Snowmobile rider or off-road biker strikes a clothesline or a fixed wire 2. The larynx becomes crushed against the cervical spine, resulting in soft-tissue injury, fractures, and/or separation of the fascia. a. These strangulation injuries can also be found in either intentional or unintentional hangings. b. Any time there is a suspected injury to the larynx, suspect possible cervical spine injury. 3. Penetrating or impaled objects in the larynx should not be removed unless they are obstructing the airway or interfere with cardiopulmonary resuscitation. a. Stabilize all impaled objects if they are not obstructing the airway. b. See Skill Drill 26-1 from Chapter 26, "Soft-Tissue Injuries." 4. Significant injuries to the larynx pose an immediate risk of airway compromise. a. Signs and symptoms of larynx injuries b. Management of a laryngeal injury

Anterograde amnesia

Inability to remember events after an injury.

Emergency care for Lacerations to the eye

Lacerations a.Lacerations of the eyelids require very careful repair to restore appearance and function. b.If there is a laceration of the globe itself, apply no pressure to the eye. c.Management d.On rare occasions, the eyeball may be displaced from its socket. i. Management

Most common MOI for head injury is___________

MVC

Posterior epistaxis

Posterior nosebleeds are usually more severe and often cause blood to drain into the patient's throat.

Long backboards

Provide full body spinal immobilization and motion restriction to the head, neck, torso, pelvis, and extremities Used to immobilize patients found in any position

Spinal immobilization devices (what are they?)

Short backboards, long backboards, cervical collar

Transporting supine patients (how to)

Supine patients 1. Immobilize a supine patient by securing the patient to a long backboard or vacuum mattress. 2. Another procedure to move a patient from the ground to a backboard is the four-person log roll. 3. You may also slide the patient onto a backboard or vacuum mattress. 4. To secure a patient to a backboard, follow the steps in Skill Drill 28-3.

Retrograde amnesia

The inability to remember events leading up to a head injury.

Short backboards

Used to immobilize seated patients a. The most common short backboards are the vest-type device and the rigid short board. b. These devices are designed to immobilize and restrict movement of the head, neck, and torso. c. Used to immobilize noncritical patients who are found in a sitting position and have possible spinal injuries

Linear skull fractures

a. Account for approximately 80% of all fractures to the skull b. Radiographs are often required to diagnose a linear skull fracture because there are often no physical signs such as deformity.

Cranium

a. Also referred to as the skull b. Contains the brain c. The most posterior portion of the cranium is called the occiput. d. On each side of the cranium, the lateral portions are called the temples or temporal regions. e. The forehead is called the frontal region. f. Anterior to the ear, in the temporal region, you can feel the pulse of the superficial temporal artery.

Basilar skull fractures

a. Associated with high-energy trauma, but usually occur following diffuse impact to the head b. These injuries generally result from extension of a linear fracture to the base of the skull and can be difficult to diagnose without radiography. c. Signs of a basilar skull fracture include CSF drainage from the ears, raccoon eyes, and Battle's sign.

Subarachnoid hemorrhage

a. Bleeding occurs into the subarachnoid space, where the CSF circulates b. Results in bloody CSF and signs of meningeal irritation c. Common causes include trauma or rupture of an aneurysm. d. A sudden, severe subarachnoid hemorrhage usually results in death; survivors often have permanent neurologic impairment.

Face

a. Components b. The face has six major bones. c. The components of the orbit of the eye d. The bony orbit protects the eye from injury. e. Only the proximal third of the nose is formed by bone. f. The exposed portion of the ear is composed entirely of cartilage covered by skin. g. About 1 inch posterior to the external opening of the ear is the mastoid process. h. The mandible forms the jaw and chin.

Intracerebral hematoma

a. Involves bleeding within the brain tissue itself b. Can occur following a penetrating injury to the head or rapid deceleration forces c. Many small, deep intracerebral hemorrhages are associated with other brain injuries. d. Intracerebral hematomas have a high mortality rate, even if the hematoma is surgically evacuated.

Open skull fractures

a. Often associated with trauma to multiple body systems b. Brain tissue may be exposed to the environment, which significantly increases the risk of a bacterial infection. c. High mortality rate

Signs of skull fracture include:

a. Patient's head appears deformed b. Visible cracks in the skull c. Ecchymosis (bruising) under the eyes (raccoon eyes) d. Ecchymosis behind one ear over the mastoid process (Battle's sign)

The nervous system controls virtually all of the body's activities, including:

a. Reflex activities b. Voluntary activities (consciously performed) c. Involuntary activities (not under conscious control)

Depressed skull fractures

a. Result from high-energy direct trauma to the head by a blunt object b. The frontal and parietal bones of the skull are most susceptible. c. Bony fragments may be driven into the brain, resulting in injury. d. Patients often present with neurologic signs (such as loss of consciousness).

emergency care for burns of the eye

a. Your role is to stop the burn and prevent further damage. b. Chemical burns i. Usually caused by acid or alkaline solutions ii. Management c. Thermal burns i. During a fire, the eyes will close to protect from heat. ii. Eyelids are frequently burned and require specialized care. iii. Management d. Light burns i. Infrared rays, eclipse light, and laser beams all can cause significant damage to the sensory cells of the eye. ii. Retinal injuries caused by exposure to extremely bright light are generally not painful but may result in permanent damage. iii. Superficial burns of the eye can result from ultraviolet rays from an arc welding unit; light from prolonged exposure to a sunlamp; or reflected light from a bright, snow-covered area. iv. May not be painful at first, but may become so 3 to 5 hours later v. Severe conjunctivitis usually develops with redness, swelling, and excessive tear production. vi. Management

A(n) ______________results when an open vein sucks air into it and the air travels to the heart

air embolism

Open head injuries

an opening from the brain to the outside world exists

The _______ and pia mater are the inner two layers of the meninges and are much thinner than the dura mater.

arachnoid

Compression injuries can result from.......

can result from a fall or a direct blow to the crown of the skull, coccyx, or on the top of the head.

pupil

circular opening in the middle of the iris that admits light to the back of the eye

When dealing with an avulsed tooth, handle it by its______________

crown

globe

eyeball

The autonomic nervous system

handles the body functions that occur without conscious effort.

The somatic nervous system

handles voluntary activities

Retina

light-sensitive area of the eye where images are projected

Iris

muscle and surrounding tissue behind the cornea that dilate and constrict the pupil

epistaxis

nosebleed

Injuries about the face and neck can often lead to partial or complete _____________ of the ___________ ____________.

obstruction of the upper airway

Treat soft-tissue injuries to the face and neck the ________________as soft-tissue injuries elsewhere on the body.

same

Upon completion of spinal immobilization, reassessment of pulse, motor, and _____ function in each extremity is necessary.

sensory

Cerebral edema

swelling of the brain

The___________region of the cranium are located on the lateral portion of the head

temporal

Closed head injuries

the brain has been injured but there is no opening into the brain

lens

the transparent part of the eye through which images are focused on the retina

cornea

transparent tissue layer in front of the pupil and iris

sympathetic and parasympathetic nervous systems. what do they do and what are they part of?

two parts of the autonomic nervous system i. When confronted with a threatening situation, the sympathetic nervous system reacts to the stress with a fight-or-flight response. ii. The parasympathetic nervous system has the opposite effect on the body, causing blood vessels to dilate, slowing the heart rate, and relaxing the muscle sphincters.

anterior epistaxis

usually originate from the area of the septum and bleed fairly slowly.