Chapter 29 EMT Head and Spine Injuries

An abnormal breathing pattern associated with increased intracranial pressure that is characterized by deep, rapid breathing; this pattern is similar to Kussmaul respirations, but without an acetone breath odor

central neurogenic hyperventilation

Swelling of the brain

cerebral edema

A head position in which the patient's eyes are looking straight ahead and the head and torso are in line

eyes forward position

The recommended procedure for moving a patient with a suspected spinal injury from the ground to a long backboard or other spinal precaution device

four-person log roll

Bleeding into the subarachnoid space, where the cerebrospinal fluid circulates

subarachnoid hemorrhage

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

subdural hematoma

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) axial loading B) hyperextension C) hyperflexion D) distraction

A) axial loading

The CNS is composed of the: A) brain and spinal cord B) cerebellum and brain C) meninges and spinal cord D) cerebrum and meninges

A) brain and spinal cord

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

A) cerebellum

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) immobilize his spine and perform a focused secondary exam B) allow him to refuse transport if his vital signs remain stable C) obtain a GCS value and give him oxygen D) perform a rapid head to toe exam and immobilize his spine

A) immobilize his spine and perform a focused secondary exam

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

A) it interferes with your assessment of the airway

What part of the nervous system controls the body's voluntary activities? A) somatic B) sensory C) Autonomic D) Central

A) somatic

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) 15 B) 14 C) 13 D) 12

B) 14

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

B) a sensory nerve detects and irritating stimulus and bypasses the brain by sending a direct message to the motor nerve

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

B) 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) assess distal neurovascular status in the extremities C) apply an appropriately sized rigid cervical collar D) thoroughly palpate the patient's head for deformities

B) assess distal neurovascular status in the extremities

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

B) cerebrum

When a patient experiences a severe spinal injury, he or she: A) will likely be paralyzed from the neck down B) might lose sensation below the level of the injury C) often loses motor function on one side of the body D) most commonly has a palpable spinal deformity

B) might lose sensation below the level of the injury

Signs and symptoms that might be found in a patient who has experienced a concussion include: A) hypotension and nosebleed B) nausea and ringing in the ears C) anxiety and restlessness D) tachycardia and diaphoresis

B) nausea and ringing in the ears

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

B) retrograde amnesia

The spinal cord is encased in and protected by the: A) vertebral arch B) spinal canal C) vertebral body D) intervertebral disc

B) spinal canal

Common signs of a skull fracture include all of the following except: A) ecchymosis around the eyes B) superficial scalp lacerations C) mastoid process bruising D) noted deformity to the skull

B) superficial scalp lacerations

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

B) the four person log roll

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

B) use rolled towels to immobilize the patient's head

The MOST reliable sign of a head injury is: A) an abnormally low blood pressure B) decreased sensation in the extremities C) a decreased LOC D) a pulse that is rapid and thready

C) a decreased LOC

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

C) a rapid, thready pulse

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) delivering oxygen directly to the CNS C) acting as a shock absorber for the brain and spinal cord D) producing leukocytes that protect the brain from infection

C) acting as a shock absorber for the brain and spinal cord

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

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

C) herniation of the brain stem

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

C) intracerebral hematoma

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

C) rapid deterioration of neurologic signs

The five sections of the spinal column, in descending order, are the:

Cervical, Thoracic, Lumbar, Sacral, Coccygeal

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

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

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) apply 100% oxygen via a nonrebreathing mask and obtain baseline vital signs B) immediately place her on a long backboard and prepare for rapid transport C) perform a focused secondary assessment of the patient's head and neck D) instruct him to assist her ventilations while you perform a rapid assessment

D) instruct him to assist her ventilations while you perform a rapid assessment

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) the patient adamantly denies neck pain C) sensory and motor functions remain intact D) it causes a problem managing the airway

D) it causes a problem managing 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: A) pack his nostrils to stop the drainage of blood B) assist his ventilations with a bag valve mask C) immobilize his spine and transport immediately D) suction his oropharynx for up to 15 seconds

D) suction his oropharynx for up to 15 seconds

Inability to remember events after an injury

anterograde amnesia

Injuries in which load is applied along the vertical or longitudinal axis of the spine, which results in load being transmitted along the entire length of the vertebral column; for example, falling from a height and landing on the feet in an upright position

axial loading injuries

Fractures that usually occur following diffuse impact to the head (eg, falls, MVC's); generally result from extension of a linear fracture to the base of the skull and can be difficult to diagnose with a radiograph

basilar skull fractures

Bruising behind an ear over the mastoid process that may indicate a skull fracture

battle signs

Injury in which the brain has been injured but the skin has not been broken and there is no obvious bleeding

closed head injury

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

concussion

A brain injury that occurs when force is applied to the head and energy transmission through brain tissue causes injury on the opposite side of original impact

coup-contrecoup brain injury

An accumulation of blood between the skull and the dura matter

epidural hematoma

Tough, elastic structures between adjoining vertebrae that act as shock absorbers

intervertebral disks

Bleeding within the brain tissue (parenchyma) itself; also referred to as an intraparenchymal hematoma

intracerebral hematoma

The pressure within the cranial vault

intracranial pressure

Actions of the body that are not under a person's conscious control

involuntary activities

Fractures that commonly occur in the temporoparietal region of the skull and that are not associated with deformities to the skull; account for 80% of skull fractures; also referred to as nondisplaced skull fractures

linear skull fractures

Three distinct layers of tissue that surround and protect the brain and the spinal cord within the skull and the spinal canal

meninges

Injury to the head often caused by a penetrating object in which there may be bleeding and exposed brain tissue

open head injury

An injury to the brain and its associated structures that is a direct result of impact to the head

primary injury

Bruising under the eyes that may indicate a skull fracture

raccoon eyes

The inability to remember events leading up to a head injury

retrograde amnesia

The aftereffects of the primary injury; includes intracranial pressure, cerebral ischemia and hypoxia, and infection; onset is often delayed following the primary brain injury

secondary injury

An insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes

traumatic brain injury

Actions that we consciously perform, in which sensory input or conscious thought determines a specific muscular activity

voluntary activities