Chapter 28 Head and Spine Injuries

You are assessing a man who has a head injury and note that cerebrospinal fluid is leaking from his ear. You should recognize that this patient is at risk for: A. bacterial meningitis. B. hypovolemic shock. C. sudden hypotension D. permanent hearing loss.

A. bacterial meningitis.

Following a head injury, a 20-year-old female opens her eyes spontaneously, is confused, and obeys your commands to move her extremities. You should assign her a GCS score of: A. 12 B. 13 C. 14 D. 15

C. 14

The cervical spine is composed of ___________ vertebrae. A. 5 B. 6 C. 7 D. 8

C. 7

Which of the following statements regarding the cranium is correct? A. The skull is a subdivision of the cranium. B. Thirty percent of the cranium is occupied by blood. C. The cranium protects the structures of the face. D. Eighty percent of the cranium is occupied by brain tissue.

D. Eighty percent of the cranium is occupied by brain tissue.

When opening the airway of a patient with a suspected spinal injury, you should use the: A. tongue-jaw lift maneuver. B. head tilt-neck lift maneuver. C. head tilt-chin lift maneuver. D. jaw-thrust maneuver.

D. jaw-thrust maneuver.

When caring for a patient with a possible head injury, it is MOST important to monitor the patient's: A. pupil size. B. blood pressure. C. pulse regularity. D. level of consciousness.

D. level of consciousness.

The _________ nervous system consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves. A. central B. somatic C. autonomic D. peripheral

D. peripheral

When immobilizing a child on a long backboard, you should: A. secure the head prior to securing the torso and legs. B. defer cervical collar placement to avoid discomfort. C. place the child's head in a slightly extended position. D. place padding under the child's shoulders as needed.

D. place padding under the child's shoulders as needed.

When 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 patient has been secured to the ambulance stretcher. C. the head has been stabilized with lateral immobilization. D. the patient has been completely secured to the backboard.

D. the patient has been completely secured to the backboard.

When placing a patient onto a long backboard, the EMT at the patient's _________ is in charge of all patient movements. A. Head B. Chest C. Waist D. lower extremities

A. Head

Which of the following skull fractures would be the LEAST likely to present with palpable deformity or other outward signs? A. Linear B. Basilar C. Open D. Depressed

A. Linear

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

A. a rapid deterioration of neurologic signs.

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

A. a rapid, thready pulse.

When assessing a conscious patient with an MOI that suggests spinal injury, you should: A. determine if the strength in all extremities is equal. B. rule out a spinal injury if the patient denies neck pain. C. defer spinal immobilization if the patient is ambulatory. D. ask the patient to move his or her head to assess for pain.

A. determine if the strength in all extremities is equal.

A patient who cannot remember the events that preceded his or her head injury is experiencing: A. retrograde amnesia. B. anterograde amnesia. C. prograde amnesia. D. posttraumatic amnesia.

A. retrograde amnesia.

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

A. slow.

A patient who experiences an immediate loss of consciousness followed by a lucid interval has a(n): A.epidural hematoma. B.subdural hematoma. C.concussion. D.contusion.

Answer: A Rationale: Epidural hematomas are caused by injury to an artery—usually the middle meningeal artery—that lies in between the skull and brain. Patients with an epidural hematoma typically experience an immediate loss of consciousness followed by a brief period of consciousness (lucid interval) as intracranial pressure increases. Subdural hematomas are the result of injury to a vein; therefore, they tend to bleed slowly and usually cause a progressive decline in level of consciousness. Concussions and contusions may cause a loss of consciousness, but it is typically brief.

The brain, a part of the central nervous system (CNS), is divided into the: A.cerebrum, cerebellum, and brain stem. B.cerebrum, brain stem, and spinal cord. C.cerebellum, cerebrum, and spinal cord. D.spinal cord, cerebrum, and cerebral cortex.

Answer: A Rationale: The brain and spinal cord comprise the central nervous system (CNS). The brain is divided into three major regions: the cerebrum (the largest portion), the cerebellum, and the brain stem. Each region of the brain carries out specific functions.

A 44-year-old man was struck in the back of the head and was reportedly unconscious for approximately 30 seconds. He complains of a severe headache and "seeing stars," and states that he regained his memory shortly before your arrival. His presentation is MOST consistent with a(n): A.contusion. B.concussion. C.subdural hematoma. D.intracerebral hemorrhage.

Answer: B Rationale: A concussion occurs when the brain is jarred around inside the skull. It may result in a brief loss of consciousness and occasionally, amnesia. Seeing stars is a common finding following trauma to the back of the head (occiput), as this region is primarily responsible for vision. A concussion—the least severe of all closed head injuries—typically does not result in physical damage to the brain. Compared to a concussion, a contusion, subdural hematoma, and intracerebral hemorrhage are usually associated with a more prolonged loss of consciousness.

As you are assessing a 24-year-old man with a large laceration to the top of his head, you should recall that: A.the scalp, unlike other parts of the body, has relatively fewer blood vessels. B.blood loss from a scalp laceration may contribute to hypovolemic shock in adults. C.any avulsed portions of the scalp should be carefully cut away to facilitate bandaging. D.most scalp injuries are superficial and are rarely associated with more serious injuries.

Answer: B Rationale: Although the scalp is highly vascular and tends to bleed heavily when injured, scalp injuries are rarely the sole cause of hypovolemic shock in adults. However, they can contribute to hypovolemia caused by injuries elsewhere in the body. Scalp lacerations, whether deep or superficial, should prompt you to look for more serious underlying injuries, such as a skull fracture. If the injury involves an avulsion, the avulsed flap of skin should be carefully replaced to its original position, not cut away.

During immobilization of a patient with a possible spinal injury, manual stabilization of the head must be maintained until: A.an appropriate-size extrication collar has been placed. B.the patient is fully immobilized on a long backboard. C.a range of motion test of the neck has been completed. D.D. pulse, motor, and sensory functions are found to be intact.

Answer: B Rationale: Manual stabilization of the patient's head must be maintained until he or she is fully secured to the long backboard. This includes the application of an extrication collar, straps, and lateral immobilization (head blocks). Pulse, motor, and sensory functions must be checked before and after the immobilization process. Do not assess range of motion in a patient with a possible spinal injury; this involves moving the patient's neck and may cause further injury.

Your patient is a 21-year-old male who has massive face and head trauma after being assaulted. He is lying supine, is semiconscious, and has blood in his mouth. You should: A.insert a nasal airway, assess his respirations, and give 100% oxygen. B.suction his airway and apply high-flow oxygen via a nonrebreathing mask. C.manually stabilize his head, log roll him onto his side, and suction his mouth. D.apply a cervical collar, suction his airway, and begin assisting his ventilations.

Answer: C Rationale: Blood or other secretions in the mouth place the airway in immediate jeopardy and must be removed before they are aspirated. At the same time, you must protect the patient's spine due the mechanism of injury. Therefore, you should manually stabilize the patient's head, log roll him onto his side (allows drainage of blood from his mouth), and suction his mouth for up to 15 seconds. After ensuring that his airway is clear, assess his breathing and give high-flow oxygen or assist his ventilations. Nasal airways should not be used in patients with severe facial or head trauma.

A young male was involved in a motor vehicle accident and experienced a closed head injury. He has no memory of the events leading up to the accident, but remembers that he was going to a birthday party. What is the correct term to use when documenting his memory loss? A.Concussion B.Cerebral contusion C.Retrograde amnesia D.Anterograde amnesia

Answer: C Rationale: The term amnesia means loss of memory; it is common in patients who have experienced a cerebral concussion. Amnesia of events leading up to an injury is called retrograde amnesia. Anterograde amnesia—also called posttraumatic amnesia—is the inability to remember events that occurred—or will occur—after the injury.

A distraction injury to the cervical spine would MOST likely occur following: A.a diving accident. B.blunt neck trauma. C.hyperextension of the neck. D.hanging-type mechanisms.

Answer: D Rationale: Excessive traction on the neck, such as what occurs during hanging-type mechanisms, can cause a distraction injury of the cervical spine. Distraction injuries can cause separation of the vertebrae and stretching or tearing of the spinal cord.

You should NOT remove an injured football player's helmet if: A.a cervical spine injury is suspected, even if the helmet fits loosely. B.the patient has a patent airway, even if he has breathing difficulty. C.he has broken teeth, but only if the helmet does not fit snugly in place. D.the face guard can easily be removed and there is no airway compromise.

Answer: D Rationale: In general, you should leave a helmet on if it fits snugly and does not allow movement of the head within the helmet, the patient's airway is patent, no airway problems are anticipated, and the patient is breathing without difficulty. If you can easily remove the face guard (often the case with football helmets) and there are no airway problems, do so but leave the helmet on. If the helmet is loose, the airway is in anyway compromised, or the patient has difficulty breathing or is in cardiac arrest, the helmet must be removed.

A man is found slumped over the steering wheel, unconscious and making snoring sounds, after an automobile accident. His head is turned to the side and his neck is flexed. You should: A.gently rotate his head to correct the deformity. B.carefully hyperextend his neck to open his airway. C.apply an extrication collar with his head in the position found. D.manually stabilize his head and move it to a neutral, in-line position.

Answer: D Rationale: The patient's snoring sounds indicate an airway problem, which must be corrected or he may die. Manually stabilize his head; carefully move it to a neutral, in-line position; and reassess his breathing. Do not rotate or hyperextend the neck of a patient with a possible spinal injury; the results could be disastrous.

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

B. 3

Which of the following statements regarding cervical collars is correct? A. Once a cervical collar is applied, you can cease manual head stabilization. B. A cervical collar is used in addition to, not instead of, manual immobilization. C. Cervical collars are contraindicated in patients with numbness to the extremities. D. The patient's head should be forced into a neutral position to apply a cervical collar.

B. A cervical collar is used in addition to, not instead of, manual immobilization.

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

B. axial loading.

During your primary assessment of a semiconscious 30-year-old female with closed head trauma, you note that she has slow, irregular breathing and a slow, bounding pulse. As your partner maintains manual in-line stabilization of her head, you should: A. perform a focused secondary assessment of the patient's head and neck. B. instruct him to assist her ventilations while you perform a rapid assessment. C. apply 100% oxygen via a nonrebreathing mask and obtain baseline vital signs. D. immediately place her on a long backboard and prepare for rapid transport.

B. instruct him to assist her ventilations while you perform a rapid assessment.

A high school football player was injured during a tackle and complains of neck and upper back pain. He is conscious and alert and is breathing without difficulty. The EMT should: A. remove his helmet and shoulder pads. B. leave his helmet and shoulder pads in place. C. remove his helmet, but leave his shoulder pads in place. D. leave his helmet in place, but remove his shoulder pads.

B. leave his helmet and shoulder pads in place.

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

B. the four-person log roll.

Which of the following statements regarding secondary brain injury is correct? A. It results from direct brain trauma following an impact to the head. B. Because cerebral edema develops quickly, it is considered to be a primary brain injury. 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.

The body's functions that occur without conscious effort are regulated by the _________ nervous system. A. sensory B. somatic C. autonomic D. voluntary

C. autonomic

When controlling bleeding from a scalp laceration with a suspected underlying skull fracture, you should: A. elevate the patient's head and apply an ice pack. B. apply manual pressure and avoid applying a bandage. C. avoid excessive pressure when applying the bandage. D. apply firm compression for no longer than 5 minutes.

C. avoid excessive pressure when applying the bandage.

Coordination of balance and body movement is controlled by the: A. medulla. B. cerebrum. C. cerebellum. D. brain stem.

C. cerebellum.

The MOST important immediate treatment for patients with a head injury, regardless of severity, is to: A. immobilize the entire spine. B. administer high-flow oxygen. C. establish an adequate airway. D. transport to a trauma center.

C. establish an adequate airway.

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

C. hangings.

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

C. involves physical injury to the brain tissue.

Lacerations to the scalp: A. bleed minimally because the scalp has few vessels. B. uncommonly cause hypovolemic shock in children. C. may be an indicator of deeper, more serious injuries. D. are most commonly associated with skull fractures.

C. may be an indicator of deeper, more serious injuries.