Chapter 29: Head and Spine injuries:
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:
14.
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
3
head injury and hyperventilation every
3 seconds
The cervical spine is composed of _____ vertebrae.
7
The cervical spine is composed of _____ vertebrae. A. 5 B. 6 C. 7 D. 8
7
Which of the following statements regarding cervical collars is correct?
A cervical collar is used in addition to, not instead of, manual immobilization.
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.
A cervical collar is used in addition to, not instead of, manual immobilization.
When you secure this patient to a backboard, what area of the body should you secure last? A. Head B. Upper torso C. Pelvis D. Lower legs
A. Head
What part of the nervous system controls the body's voluntary activities? Select one: A. Somatic B. Autonomic C. Sensory D. Central
A. Somatic
Which of the following statements regarding motor nerves is correct? A. They carry information from the CNS to the muscles. B. They are part of the CNS and control reflexes. C. They perform special functions such as sight, smell, and hearing. D. They transmit information from the body to the brain via the spinal cord.
A. They carry information from the CNS to the muscles.
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 concussion. B. cerebral contusion. C. intracerebral hematoma. D. intracranial hemorrhage.
A. cerebral concussion.
The MOST common and serious complication of a significant head injury is: A. cerebral edema. B. acute hypotension. C. a skull fracture. D. a hypoxic seizure.
A. cerebral edema.
The Glasgow Coma Scale (GCS) is used to assess: A. eye opening, verbal response, and motor response. B. mental status, eye opening, and respiratory rate. C. sensory response, pupil reaction, and heart rate. D. verbal response, eye opening, and mental status.
A. eye opening, verbal response, and motor response.
In contrast to a cerebral concussion, a cerebral contusion: Select one: A. involves physical injury to the brain tissue. B. does not cause pressure within the skull. C. usually does not cause a loss of consciousness. D. results from a laceration to the brain tissue.
A. involves physical injury to the brain tissue.
During transport, the patient has a loss of consciousness. The time between the two periods of unconsciousness is referred to as the: A. lucid interval. B. recognition period. C. danger zone. D. coherent stage
A. lucid interval.
When activated, the sympathetic nervous system produces all of the following effects, EXCEPT: Select one: A. pupillary constriction. B. increase in heart rate. C. dilation of the bronchiole smooth muscle. D. shunting of blood to vital organs.
A. pupillary constriction.
When activated, the sympathetic nervous system produces all of the following effects, EXCEPT: A. pupillary constriction. B. dilation of the bronchiole smooth muscle. C. shunting of blood to vital organs. D. increase in heart rate.
A. pupillary constriction.
When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his right ear. This indicates: Select one: A. rupture of the tympanic membrane following diffuse impact to the head. B. fractures to the internal structures of the ear following direct trauma. C. a linear skull fracture and a significant increase in intracranial pressure. D. significant pressure and bleeding in between the skull and dura mater.
A. rupture of the tympanic membrane following diffuse impact to the head.
The ideal procedure for moving an injured patient from the ground to a backboard is: Select one: A. the four-person log roll. B. the direct patient carry. C. the use of a scoop stretcher. D. the clothes drag.
A. the four-person log roll.
When immobilizing a trauma patient's spine, the EMT manually stabilizing the head should not let go until: Select one: A. the patient has been completely secured to the backboard. B. an appropriately sized cervical collar has been applied. C. the patient has been secured to the ambulance stretcher. D. the head has been stabilized with lateral immobilization.
A. the patient has been completely secured to the backboard.
Subdural hematoma
Accumulation of blood beneath the dura mater but outside the brain
Epidural hematoma
Accumulation of blood between the skull and dura mater
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 what? An intracerebral hematoma A subdural hematoma A subarachnoid hemorrhage An epidural hematoma
An epidural hematoma
A patient with a head injury presents with abnormal flexion of his extremities. What numeric value should you assign to him for motor response? Select one: A. 5 B. 3 C. 2 D. 4
B. 3
Your transport time to the appropriate hospital is going to be 30 minutes. What support should you call for, based on your assessment and findings? A. Additional drivers B. An ALS intercept C. A police escort D. Another transport unit
B. An ALS intercept
Which of the following describes the initial signs of a head injury? A. Runny nose and watering eyes B. Decreased level of consciousness, confusion, nausea C. Dizziness and coughing D. Decrease in blood pressure, pulse, and respirations
B. Decreased level of consciousness, confusion, nausea
Which of the following statements regarding secondary brain injury is correct? Select one: A. Because cerebral edema develops quickly, it is considered to be a primary brain injury. B. Hypoxia and hypotension are the two most common causes of secondary brain injury. C. Signs are often present immediately after an impact to the head. D. It results from direct brain trauma following an impact to the head.
B. Hypoxia and hypotension are the two most common causes of secondary brain injury.
Which of the following breathing patterns is MOST indicative of increased intracranial pressure? Select one: A. Increased rate with a normal inspiratory time and a prolonged expiratory time B. Irregular rate, pattern, and volume of breathing with intermittent periods of apnea C. Increased rate and depth with the distinct odor of acetone on the patient's breath D. Slow, shallow, occasional gasps that progress to prolonged periods of apnea
B. Irregular rate, pattern, and volume of breathing with intermittent periods of apnea
Which of the following skull fractures would be the LEAST likely to present with palpable deformity or other outward signs? A. Depressed B. Linear C. Open D. Basilar
B. Linear
The meninges, along with the cerebrospinal fluid (CSF) that circulates in between each meningeal layer, function by: A. delivering oxygen directly to the CNS. B. acting as a shock absorber for the brain and spinal cord. C. regenerating brain cells after they have been damaged. D. producing leukocytes that protect the brain from infection.
B. acting as a shock absorber for the brain and spinal cord.
The tough, fibrous outer meningeal layer is called the: A. pia mater. B. dura mater. C. gray mater. D. arachnoid mater.
B. dura mater.
The Glasgow Coma Scale (GCS) is used to assess: Select one: A. verbal response, eye opening, and mental status. B. eye opening, verbal response, and motor response. C. sensory response, pupil reaction, and heart rate. D. mental status, eye opening, and respiratory rate.
B. eye opening, verbal response, and motor response.
It would be MOST appropriate to perform a focused secondary assessment on a patient who: A. has blood draining from the ears following a head injury. B. fainted and fell to the ground from a standing position. C. struck his or her head and is experiencing nausea or vomiting. D. was restrained during a high-speed motor vehicle crash.
B. fainted and fell to the ground from a standing position.
Hyperextension injuries of the spine are MOST commonly the result of: Select one: A. diving. B. hangings. C. falls. D. compression.
B. hangings.
The effectiveness of positive-pressure ventilations when treating a head-injured patient can ONLY be determined by: A. noting a decrease in the heart rate during ventilations. B. immediate reassessment following the intervention. C. a neurosurgeon or emergency department physician. D. reassessing the patient's blood pressure after 10 minutes.
B. immediate reassessment following the intervention.
Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless: Select one: A. sensory and motor functions remain intact. B. it causes a problem managing the airway. C. lateral immobilization has been applied. D. the patient adamantly denies neck pain.
B. it causes a problem managing the airway.
When caring for a patient with a possible head injury, it is MOST important to monitor the patient's: A. pupil size. B. level of consciousness. C. pulse regularity. D. blood pressure.
B. level of consciousness.
In an ________ CSF flows freely from the patient's ear; this type of injury can be difficult to diagnose with a radiograph.
Basilar skull fracture
Intracerebral hematoma
Bleeding within the brain tissue itself Can occur following a penetrating injury to the head or because of rapid deceleration forces
Controls most functions necessary for life
Brainstem
What actions should you take to help prevent secondary brain injuries?
By carefully monitoring your patient, recognizing hypoxia and/or hypotension, and properly managing your patient
Which of the following sets of vital signs depicts Cushing's triad? A. Blood pressure, 200/100 mm Hg; pulse, 140 beats/min; respirations, 28 breaths/min B. Blood pressure, 90/50 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min C. Blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min D. Blood pressure, 80/40 mm Hg; pulse, 30 beats/min; respirations, 32 breaths/min
C. Blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min
During transport when you reassess the patient you find the left pupil 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
In which of the following situations would the EMT be the LEAST likely to immobilize a patient's spine? A. Unresponsive, but moving all extremities equally B. Pain to the c-spine, but no numbness or tingling. C. No distracting injuries or evidence of intoxication D. No spinal pain, but tingling in the extremities
C. No distracting injuries or evidence of intoxication
Which of the following nerves carry information from the body to the brain via the spinal cord? A. Motor B. Somatic C. Sensory D. Central
C. Sensory
An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is: Select one: A. acute unilateral paralysis following 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.
Common signs and symptoms of a serious head injury include all of the following, EXCEPT: Select one: A. CSF leakage from the ears. B. decerebrate posturing. C. a rapid, thready pulse. D. widening pulse pressure.
C. a rapid, thready pulse.
Common signs and symptoms of a serious head injury include all of the following, EXCEPT: A. CSF leakage from the ears. B. decerebrate posturing. C. a rapid, thready pulse. D. widening pulse pressure.
C. a rapid, thready pulse.
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: Select one: A. distraction. B. hyperflexion. C. axial loading. D. hyperextension.
C. axial loading.
The _________ is the best-protected part of the CNS and controls the functions of the cardiac and respiratory systems. A. spinal cord B. cerebral cortex C. brainstem D. cerebellum
C. brainstem
When placing a patient onto a long backboard, the EMT at the patient's _________ is in charge of all patient movements. A. lower extremities B. chest C. head D. waist
C. head
A tight-fitting motorcycle helmet should be left in place unless: Select one: A. the patient complains of severe neck or back pain. B. the helmet is equipped with a full face shield or visor. C. it interferes with your assessment of the airway. D. the patient must be placed onto a long backboard.
C. it interferes with your assessment of the airway.
During your primary assessment of a 19-year-old unconscious 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: Select one: A. assist his ventilations with a BVM. B. pack his nostrils to stop the drainage of blood. C. suction his oropharynx for up to 15 seconds. D. immobilize his spine and transport immediately.
C. suction his oropharynx for up to 15 seconds.
The nervous system is divided into two anatomic parts.
Central nervous system Peripheral nervous system
Which of the following acts as a shock absorber for the CNS? Dura matter Cerebrospinal fluid Fascia Pia matter
Cerebrospinal fluid
Controls a wide variety of activities, including most voluntary motor function and conscious thought
Cerebrum
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? Cushing triad C6 herniation Concussion Cerebral edema
Cushing triad
An epidural hematoma is nearly always the result of a blow to the head that produces a linear fracture in what region of the cranium? A. Frontal B. Parietal C. Occipital D. Temporal
D. Temporal
While performing a secondary assessment of the patient you find a depressed area above the patient's left ear. This indicates that the patient could have: A. an intracerebral hemorrhage. B. a subdural hematoma. C. a subarachnoid hemorrhage. D. an epidural hematoma.
D. an epidural hematoma.
The five sections of the spinal column, in descending order, are the: Select one: A. thoracic, cervical, lumbar, coccygeal, and sacral. B. cervical, coccygeal, thoracic, sacral, and lumbar. C. coccygeal, sacral, lumbar, thoracic, and cervical. D. cervical, thoracic, lumbar, sacral, and coccygeal.
D. cervical, thoracic, lumbar, sacral, and coccygeal.
The five sections of the spinal column, in descending order, are the: A. thoracic, cervical, lumbar, coccygeal, and sacral. B. coccygeal, sacral, lumbar, thoracic, and cervical. C. cervical, coccygeal, thoracic, sacral, and lumbar. D. cervical, thoracic, lumbar, sacral, and coccygeal.
D. cervical, thoracic, lumbar, sacral, and coccygeal.
When immobilizing a child on a long backboard, you should: A. place the child's head in a slightly extended position. B. secure the head prior to securing the torso and legs. C. defer cervical collar placement to avoid discomfort. D. place padding under the child's shoulders as needed.
D. place padding under the child's shoulders as needed.
You should be MOST suspicious that a patient has experienced a significant head injury if his or her pulse is: Select one: A. irregular. B. weak. C. rapid. D. slow.
D. slow.
The ideal procedure for moving an injured patient from the ground to a backboard is: A. the clothes drag. B. the use of a scoop stretcher. C. the direct patient carry. D. the four-person log roll.
D. the four-person log roll.
Result from high-energy direct trauma to the head with a blunt object
Depressed skull fractures (frontal and parietal)
Which of the following statements regarding the cranium is correct?
Eighty percent of the cranium is occupied by brain tissue.
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.
Eighty percent of the cranium is occupied by brain tissue.
When securing a patient to a backboard, what area of the body should you secure last? Head Upper torso Pelvis Upper legs
Head
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.
Hypoxia and hypotension are the two most common causes of secondary brain injury.
You are reassessing a patient and you find that her left pupil is dilated and fixed. What does this indicate? Decreased blood pressure Increased blood pressure Increased intracranial pressure Drug abuse
Increased intracranial pressure
Cushing triad in a patient is a sign of what? Spinal cord damage Concussion Intracranial pressure Blood clot in the brain
Intracranial pressure
Which of the following skull fractures would be the LEAST likely to present with palpable deformity or other outward signs?
Linear
The time between an initial period of unconsciousness and a subsequent loss of consciousness is referred to as what? Coherent stage Danger zone Lucid interval Recognition period
Lucid interval
The entire CNS is contained within a protective framework called
Protective coverings
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? Replace the dressing with a fresh one. Remove the dressing and apply an occlusive dressing. Place a clean dressing over the bloody one. Apply direct pressure and add a compression dressing.
Replace the dressing with a fresh one.
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? Concussion Cerebral contusion Retrograde amnesia Anterograde amnesia
Retrograde amnesia
Battle sign is an indication of what? Concussion Contusion Skull fracture Secondary injury
Skull fracture
Made up of fibers that extend from the brain's nerve cells Carries messages between the brain and the body via the grey and white matter of the spinal cord
Spinal cord
Which of the following statements regarding a basilar skull fracture is correct? A. Bloody CSF commonly leaks from the nose. B. In most cases, mastoid bruising occurs. C. The absence of raccoon eyes or Battle's sign does not rule it out. D. They are typically the result of local, low-energy trauma to the head.
The absence of raccoon eyes or Battle's sign does not rule it out.
a complex network of nerve cells that enables all parts of the body to function.
The nervous system
Which of the following statements regarding motor nerves is correct? a) They perform special functions such as sight, smell, and hearing. b) They are part of the CNS and control reflexes. c) They transmit information from the body to the brain via the spinal cord. d) They carry information from the CNS to the muscles.
They carry information from the CNS to the muscles.
An alternative to the long backboard, Molds to the specific contours of patient's body
Vacuum mattress
The MOST reliable sign of a head injury is: A. a pulse that is rapid and thready. B. a decreased level of consciousness. C. an abnormally low blood pressure. D. decreased sensation in the extremities.
a decreased level of consciousness.
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 rapid deterioration of neurologic signs.
The meninges, along with the cerebrospinal fluid (CSF) that circulates in between each meningeal layer, function by: A. regenerating brain cells after they have been damaged. B. acting as a shock absorber for the brain and spinal cord. C. delivering oxygen directly to the CNS. D. producing leukocytes that protect the brain from infection.
acting as a shock absorber for the brain and spinal cord.
subdural hematoma
acts sometimes in days, venous bleeding in nature
When immobilizing a seated patient with a short backboard or vest-style immobilization device, you should apply a cervical collar: A. after the torso has been adequately secured. B. after moving the patient to a long backboard. C. after assessing distal neurovascular functions. D. before manually stabilizing the patient's head.
after assessing distal neurovascular functions.
Any unresponsive trauma patient should be assumed to have: a) an accompanying spinal injury. b) a history of diabetes mellitus. c) a severe intracranial hemorrhage. d) internal bleeding in the abdomen.
an accompanying spinal injury.
a primary (direct) brain injury
an injury to the brain and its associated structures that results instantaneously from impact to the head.
A short backboard or vest-style immobilization device is indicated for patients who: A. are found supine and have stable vital signs. B. are in a sitting position and are clinically stable. C. require prompt extrication from an automobile. D. are sitting in their car and are clinically unstable.
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. apply an appropriately sized rigid cervical collar. B. assess distal neurovascular status in the extremities. C. thoroughly palpate the patient's head for deformities. D. use four people to log roll the patient onto a backboard.
assess distal neurovascular status in the extremities.
A female patient with a suspected spinal injury is breathing with a marked reduction in tidal volume. The MOST appropriate airway management for her includes: A. hyperventilating her at 30 breaths/min. B. administering oxygen via a nonrebreathing mask. C. ventilation assistance to maintain an oxygen saturation of 90%. D. assisting ventilations at an age-appropriate rate.
assisting ventilations at an age-appropriate rate.
The body's functions that occur without conscious effort are regulated by the _________ nervous system.
autonomic
The body's functions that occur without conscious effort are regulated by the _________ nervous system. A. sensory B. somatic C. autonomic D. voluntary
autonomic
When controlling bleeding from a scalp laceration with a suspected underlying skull fracture, you should:
avoid excessive pressure when applying the bandage.
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) avoid excessive pressure when applying the bandage. c) apply firm compression for no longer than 5 minutes. d) apply manual pressure and avoid applying a bandage.
avoid excessive pressure when applying the bandage.
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:
bacterial meningitis.
Linear skull fracture at the base of the skull
bassilar skull fracture
An epidural hematoma is MOST accurately defined as: A. bleeding between the skull and dura mater. B. bleeding between the dura mater and brain. C. venous lacerations that occur within the brain. D. an injury caused by a damaged cerebral artery.
bleeding between the skull and dura mater.
As you are assessing a 24-year-old man with a large laceration to the top of his head, you should recall that: the scalp, unlike other parts of the body, has relatively fewer blood vessels. blood loss from a scalp laceration may contribute to hypovolemic shock in adults. any avulsed portions of the scalp should be carefully cut away to facilitate bandaging. most scalp injuries are superficial and are rarely associated with more serious injuries.
blood loss from a scalp laceration may contribute to hypovolemic shock in adults.
Which of the following sets of vital signs depicts Cushing's triad? A. blood pressure, 190/110 mm Hg pulse, 55 beats/min respirations, 30 breaths/min B.blood pressure, 90/50 mm Hg pulse, 120 beats/min respirations, 10 breaths/min C.blood pressure, 200/100 mm Hg pulse, 140 beats/min pulse, 140 beats/min respirations, 28 breaths/min D.blood pressure, 80/40 mm Hg pulse, pulse 30 beats/min respirations, 32 breaths/min
blood pressure, 80/40 mm Hg pulse, pulse 30 beats/min respirations, 32 breaths/min
The central nervous system (CNS) is composed of the: A. cerebellum and brain. B. brain and spinal cord. C. cerebrum and meninges. D. meninges and spinal cord.
brain and spinal cord.
The _________ is the best-protected part of the CNS and controls the functions of the cardiac and respiratory systems. A. brain stem B. cerebellum C. spinal cord D. cerebral cortex
brain stem
Coordination of balance and body movement is controlled by the:
cerebellum
Coordination of balance and body movement is controlled by the: A. medulla. B. cerebrum. C. cerebellum. D. brain stem.
cerebellum.
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. cerebral concussion. C. intracranial hemorrhage. D. intracerebral hematoma.
cerebral concussion.
The MOST common and serious complication of a significant head injury is: a) a hypoxic seizure. b) cerebral edema. c) a skull fracture. d) acute hypotension.
cerebral edema.
The _________ contain(s) about 75% of the brain's total volume. A. cerebrum B. cerebellum C. brain stem D. meninges
cerebrum
The brain, a part of the central nervous system (CNS), is divided into the: cerebrum, cerebellum, and brainstem. cerebrum, brainstem, and spinal cord. cerebellum, cerebrum, and spinal cord. spinal cord, cerebrum, and cerebral cortex.
cerebrum, cerebellum, and brainstem.
The five sections of the spinal column, in descending order, are the: A. thoracic, cervical, lumbar, coccygeal, and sacral. B. cervical, thoracic, lumbar, sacral, and coccygeal. C. coccygeal, sacral, lumbar, thoracic, and cervical. D. cervical, coccygeal, thoracic, sacral, and lumbar.
cervical, thoracic, lumbar, sacral, and coccygeal.
Rapid deceleration of the head, such as when it impacts the windshield, causes: a) primary impact to the posterior aspect of the brain, resulting in compression injuries, bruising, or torn blood vessels. b) stretching or tearing of the anterior aspect of the brain and compression injuries or bruising to the posterior aspect of the brain. c) compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain. d) compression injuries and contusions to the anterior, posterior, and lateral aspects of the brain.
compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain.
A blow to the head or face may cause concussion of the brain.
concussion
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): contusion. concussion. subdural hematoma. intracerebral hemorrhage.
concussion.
Which of the following nerves allow sensory and motor impulses to be sent from one nerve directly to another? A. somatic B. connecting C. peripheral D. autonomic
connecting
Common signs and symptoms of a serious head injury include all of the following, EXCEPT: A. constricted pupils. B. combative behavior. C. CSF leakage from the ears. D. decreased sensory function.
constricted pupils.
Increased blood pressure (hypertension) Decreased heart rate (bradycardia)
crushing triad
When assessing a conscious patient with an MOI that suggests spinal injury, you should:
determine if the strength in all extremities is equal.
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.
determine if the strength in all extremities is equal.
The tough, fibrous outer meningeal layer is called the: A. pia mater. B. arachnoid. C. gray mater. D. dura mater.
dura mater.
When immobilizing a patient on a long backboard, you should: A. have the patient exhale before fastening the torso straps. B. secure the torso and then center the patient on the board. C. follow the commands of the person at the patient's torso. D. ensure that you secure the torso before securing the head.
ensure that you secure the torso before securing the head.
Which of the following head injuries would cause the patient's condition to deteriorate MOST rapidly? A. cerebral contusion B. subdural hematoma C. cerebral concussion D. epidural hematoma
epidural hematoma
A patient who experiences an immediate loss of consciousness followed by a lucid interval has a(n): epidural hematoma. subdural hematoma. concussion. contusion.
epidural hematoma.
The hormone responsible for the actions of the sympathetic nervous system is: A. insulin. B. thyroxine. C. epinephrine. D. aldosterone.
epinephrine.
The MOST important immediate treatment for patients with a head injury, regardless of severity, is to:
establish an adequate airway.
The Glasgow Coma Scale (GCS) is used to assess: A. mental status, eye opening, and respiratory rate. B. sensory response, pupil reaction, and heart rate. C. verbal response, eye opening, and mental status. D. eye opening, verbal response, and motor response.
eye opening, verbal response, and motor response.
It would be MOST appropriate to perform a focused secondary assessment on a patient who: A. fainted and fell to the ground from a standing position. B. was restrained during a high-speed motor vehicle crash. C. has blood draining from the ears following a head injury. D. struck his or her head and is experiencing nausea or vomiting.
fainted and fell to the ground from a standing position.
cerebral edema
fluid on the brain
A distraction injury to the cervical spine would MOST likely occur following: a diving accident. blunt neck trauma. hyperextension of the neck. hanging-type mechanisms.
hanging-type mechanisms.
Distraction injuries of the spine are MOST commonly the result of: A. falls. B. diving. C. hangings. D. compression.
hangings.
When placing a patient onto a long backboard, the EMT at the patient's _________ is in charge of all patient movements.
head
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
head
aneurysm of the brain that leads to bleeding
hemorrhagic stroke
The effectiveness of positive-pressure ventilations when treating a head-injured patient can ONLY be determined by: A. immediate reassessment following the intervention. B. a neurosurgeon or emergency department physician. C. reassessing the patient's blood pressure after at least 10 minutes. D. noting a decrease in the heart rate during ventilations.
immediate reassessment following the intervention.
epidural hematoma
immediately acts, arterial bleeding
A 45-year-old male was working on his roof when he fell approximately 12′,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. obtain a Glasgow Coma Score value and give him oxygen. B. immobilize his spine and perform a focused secondary exam. C. allow him to refuse transport if his vital signs remain stable. D. perform a rapid head-to-toe exam and immobilize his spine.
immobilize his spine and perform a focused secondary exam.
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:
instruct him to assist her ventilations while you perform a rapid assessment.
During your primary assessment of a semiconscious 30-year-old female with closed head trauma, you note that she has slow, shallow 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.
instruct him to assist her ventilations while you perform a rapid assessment.
Bleeding within the brain tissue itself is called a(n): A. epidural hematoma. B. intracerebral hematoma. C. subdural hematoma. D. intracranial hematoma.
intracerebral hematoma.
low blood pressure, high pulse rate
intracranial pressure
Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless: A. the patient adamantly denies neck pain. B. lateral immobilization has been applied. C. it causes a problem managing the ABCs. D. sensory and motor functions remain intact.
it causes a problem managing the ABCs.
A tight-fitting motorcycle helmet should be left in place unless: A. it interferes with your assessment of the airway. B. the patient must be placed onto a long backboard. C. the patient complains of severe neck or back pain. D. the helmet is equipped with a full face shield or visor.
it interferes with your assessment of the airway.
When opening the airway of a patient with a suspected spinal injury, you should use the:
jaw-thrust maneuver.
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:
leave his helmet and shoulder pads in place.
When caring for a patient with a possible head injury, it is MOST important to monitor the patient's:
level of consciousness.
connects bone to bone
ligament
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. compressed
linear
radiographs to diagnose
linear skull fracture
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: gently rotate his head to correct the deformity. carefully hyperextend his neck to open his airway. apply an extrication collar with his head in the position found. manually stabilize his head and move it to a neutral, in-line position.
manually stabilize his head and move it to a neutral, in-line position.
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: insert a nasal airway, assess his respirations, and give 100% oxygen. suction his airway and apply high-flow oxygen via a nonrebreathing mask. manually stabilize his head, log roll him onto his side, and suction his mouth. apply a cervical collar, suction his airway, and begin assisting his ventilations.
manually stabilize his head, log roll him onto his side, and suction his mouth.
Lacerations to the scalp:
may be an indicator of deeper, more serious injuries.
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.
may be an indicator of deeper, more serious injuries.
When a patient experiences a severe spinal injury, he or she: A. will likely be paralyzed from the neck down. B. may lose sensation below the level of the injury. C. most commonly has a palpable spinal deformity. D. often loses motor function on one side of the body.
may lose sensation below the level of the injury.
Patients with impaired airways, open head wounds, or abnormal vital signs may
need to be rapidly extracted from a motor vehicle and transported.
a secondary (indirect) brain injury
occurs as a result of the primary injury. Examples of secondary injuries include cerebral edema, intracerebral hemorrhage, infection, hypoxia, and increased intracranial pressure.
most common sign or symptom of spinal injury
pain
The _________ nervous system consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves.
peripheral
The _________ nervous system consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves. A. central B. somatic C. autonomic D. peripheral
peripheral
When immobilizing a child on a long backboard, you should:
place padding under the child's shoulders as needed.
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.
place padding under the child's shoulders as needed.
When activated, the sympathetic nervous system produces all of the following effects, EXCEPT: A. pupillary constriction. B. increase in heart rate. C. shunting of blood to vital organs. D. dilation of the bronchiole smooth muscle.
pupillary constriction.
A patient who cannot remember the events that preceded his or her head injury is experiencing:
retrograde amnesia.
A patient who cannot remember the events that preceded his or her head injury is experiencing: A. retrograde amnesia. B. anterograde amnesia. C. perigrade amnesia. D. post-traumatic amnesia.
retrograde amnesia.
When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his right ear. This indicates: a) fractures to the internal structures of the ear following direct trauma. b) rupture of the tympanic membrane following diffuse impact to the head. c) a linear skull fracture and a significant increase in intracranial pressure. d) significant pressure and bleeding in between the skull and dura mater.
rupture of the tympanic membrane following diffuse impact to the head.
When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his right ear. This indicates: a) significant pressure and bleeding in between the skull and dura mater. b) rupture of the tympanic membrane following diffuse impact to the head. c) fractures to the internal structures of the ear following direct trauma. d) a linear skull fracture and a significant increase in intracranial pressure.
rupture of the tympanic membrane following diffuse impact to the head.
Which of the following nerves carry information from the body to the brain via the spinal cord? A. motor B. central C. somatic D. sensory
sensory
Moderate elevation in intracranial pressure with middle brain stem involvement is characterized by: A. increased blood pressure, bradycardia, reactive pupils, and rapid respirations. B. sluggishly reactive pupils, widened pulse pressure, bradycardia, and posturing. C. ataxic respirations, unequal pupils, no response to pain, and an irregular pulse. D. fixed and dilated pupils, decreased blood pressure, and irregular respirations.
sluggishly reactive pupils, widened pulse pressure, bradycardia, and posturing.
What part of the nervous system controls the body's voluntary activities? A. central B. sensory C. somatic D. autonomic
somatic
The spinal cord is encased in and protected by the: A. spinal canal. B. vertebral body. C. vertebral arch. D. intervertebral disc.
spinal canal.
During your primary assessment of a 19-year-old unconscious 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. assist his ventilations with a bag-mask device. B. suction his oropharynx for up to 15 seconds. C. immobilize his spine and transport immediately. D. pack his nostrils to stop the drainage of blood.
suction his oropharynx for up to 15 seconds.
Common signs of a skull fracture include all of the following, EXCEPT: A. mastoid process bruising. B. ecchymosis around the eyes. C. noted deformity to the skull. D. superficial scalp lacerations.
superficial scalp lacerations.
connects muscle to bone
tendon
what does the brain control
the body and is the center of consciousness.
You should NOT remove an injured football player's helmet if: a cervical spine injury is suspected, even if the helmet fits loosely. the patient has a patent airway, even if he has breathing difficulty. he has broken teeth, but only if the helmet does not fit snugly in place. the face guard can easily be removed and there is no airway compromise.
the face guard can easily be removed and there is no airway compromise.
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. to use a scoop stretcher. D. the direct patient carry.
the four-person log roll.
When the parasympathetic nervous system is activated: a) hormones are released that prepare the body for stress. b) heart rate and blood pressure increase. c) the heart rate decreases and the blood vessels dilate d) blood is shunted away from the digestive organs.
the heart rate decreases and the blood vessels dilate
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.
the patient has been completely secured to the backboard.
During immobilization of a patient with a possible spinal injury, manual stabilization of the head must be maintained until: an appropriate-size extrication collar has been placed. the patient is fully immobilized on a long backboard. a range of motion test of the neck has been completed. pulse, motor, and sensory functions are found to be intact.
the patient is fully immobilized on a long backboard.
If you do not have the appropriate size cervical collar, you should: A. use rolled towels to immobilize the patient's head. B. place sandbags on either side of the patient's head. C. ask the patient to keep his or her head in a neutral position. D. defer cervical immobilization and apply lateral head blocks.
use rolled towels to immobilize the patient's head.
