Chapter 31 Head Trauma: Review

A 21-year-old male has a gunshot wound to the head. As you assess him, which finding would you recognize asa nonpurposeful response to pain?

Flexing his arms across his chest when you pinch his shoulder

The EMT is properly assessing for sensory function in the hands when he tells or asks the patient:

"Can you tell me which finger I am touching?"

A male patient in his thirties fell 10 feet off a loading dock, landing on his head and back. He has deformity and depression to the back of his head and is unresponsive with snoring respirations. Vital signs are pulse, 132 beats/min; respirations, agonal; blood pressure, 136/64 mmHg, and SpO2, 89%. The patient responds to painful stimuli with purposeful motion. Which instruction would you provide other caregivers at the scene?

"I need someone to start positive pressure ventilation at 12 breaths per minute."

A patient complaining of a headache states that he fell and struck the back of his head. Which statement by the patient should be of most concern to the EMT?

"I take a blood thinner for my heart."

At an industrial complex, a young male was struck in the head by a large piece of steel thrown from a grinding machine. Assessment reveals a soft, painful depression underlying a tear in his scalp, which is covered with dried blood. Clear fluid is draining from his right ear. The patient is conscious but confused and exhibits the following vital signs: pulse, 84 beats/min; respirations, 16 breaths/min and adequate; blood pressure, 142/76 mmHg; and SpO2, 90%. Emergency Medical Responders are on scene and are maintaining manual spine motion restriction precautions. Which instruction indicates the next step needed in this patient's care?

"Will someone administer supplemental oxygen to the patient?"

Which patient has an isolated brain injury that should be considered the most serious?

A 21-year-old male wearing a deformed motorcycle helmet who does not respond to verbal or painful stimuli after crashing

A trauma surgeon informs you that the patient whom you transported to the emergency department earlier was diagnosed with an epidural hematoma. The patient was taken into surgery and the hematoma was removed, and now the patient is in critical condition. Based on this information, the EMT should recognize that in this patient:

A pocket of arterial blood collected between the skull and dura mater

A 40-year-old male fell 20 feet from a ledge while hiking. The park ranger is now maintaining manual spine motion restriction for the patient. The patient is combative and confused, but his airway is open and his breathing is adequate. The patient has a radial pulse of 112 beats/min, blood pressure of 96/76 mmHg, and SpO2 of 91% on room air. What should the EMT do first?

Begin administering supplemental oxygen

When assessing a patient with a head injury, which finding is most indicative of increasing pressure within the skull?

Blood pressure of 192/106 mmHg

A middle-ages male died immediately after a self-inflicted gunshot wound to the head. Which portion of the central nervous system was most likely damaged to cause such a rapid death?

Brainstem

You have been called to a residence of a patient with diabetes who exhibits an altered mental status. A family member states she could not reach the patient by telephone, so she came over and found the patient awake but confused. The patient can remember his name and address, but cannot remember the day or year. He refuses to go to the hospital, but consents to an assessment. Of these physical exam findings discerned on assessment, which one is most concerning?

Bruise to the left temple

A 68-year-old female patient complains of a headache and generalized weakness. Her husband informs you that she was with a friend yesterday and was involved in a motor vehicle collision. She did strike her face on the dashboard, but refused treatment on scene. Her past medical history includes a stroke with right arm weakness and high blood pressure, for which she takes medications. When assessing this patient, which finding should concern the EMT most?

Bruising behind her left ear

Which finding, when considered individually, is most consistent with a basilar skull fracture?

Bruising behind the ear

A patient exhibits retrograde amnesia when she:

Cannont remember falling and hitting her head

You are assessing a patient who has sustained blunt trauma to the head. Which sign would be most indicative of the loss of cerebrospinal fluid?

Clear fluid coming from the nose

You suspect that an unhelmeted male patient who was thrown from a motorcycle may have a basilar skull fracture. As you perform the secondary assessment, which finding would reinforce this suspicion?

Clear fluid coming from the right ear and left nostril

A young adult male is in police custody after he crashed his car into a utility pole. There is minor front-end damage to the vehicle, and the air bags deployed. The patient was not wearing a seat belt and has an abrasion to his forehead. He is awake and oriented to person, time, and place. His speech is slurred and he has an odor resembling that of beer on his breath. The arresting officer states that he just wants you to check the patient before he transports him to jail. Given this scenario, which action seems most appropriate for the EMT to take?

Contact medical direction with assessment findings

The cerebellum is described as the area of the brain that:

Controls reflexes and assists in maintaining body posture

A young adult female was struck by a vehicle while she was riding her bicycle. She was not wearing a helmet. She is now unresponsive and has a deformity with a deep depression to the temporal area of the head. You do not see any bleeding, and the patient's scalp is intact. What is the greatest threat associated with this injury?

Damage to the brain

The parameters of the Glasgow Coma Scale are:

Eyes, motor, and verbal response

Which finding indicates that a patient who received a blow to the head is suffering from something other that a simple concussion?

His pupils are noticeable unequal when assessed

A young male patient was running through a park shortly before dawn and struck his head on a low-hanging branch of a tree. Emergency Medical Responders have already provided spine motion restriction precautions and are providing supplemental oxygen since the patient was initially unresponsive. During transport, which finding obtained during your reassessment would best indicate that the patient has experienced a concussion?

Improving memory

You are transporting a patient with a past medical history of a meningeal tumor. You would recognize his kind of tumor as being located:

In tissue surrounding the brain

As a brain herniation occurs, the body responds by:

Increasing systolic blood pressure in an attempt to maintain perfusion to the brain

A 57-year-old man tripped and fell on the sidewalk, hitting his head on the concrete. According to witnesses, the patient was unresponsive for several minutes following the fall. Which bit of information would be most critical to relay to the physician in the emergency department?

Known history of alcoholism

Which statement is true regarding linear skull fractures?

Linear skull fractures cannont typically be identified with palpation

A patient was ejected from a car when it overturned at a high rate of speed. The patient is unresponsive. The primary assessment is complete and you are providing positive pressure ventilation with supplemental oxygen. The patient has a significant deformity to the right side of his head, and both pupils are equal but slow to react to light. The patient also has deformity to the forearms. Vital signs are pulse, 144 beats/min; respirations, 24 breaths/min and inadequate; blood pressure, 90/50 mmHg; and SpO2, 97%. Based on this presentation, the EMT should:

Look for evidence of bleeding in an area of the body other than the brain

A young female pedestrian was hit by a car and thrown 15 feet, striking her head against a metal guardrail. You start your secondary assessment and note a deep depression to the right parietal area of her head, with intact skin overlying the area. You should:

Note the injury and continue assessing the patient

A patient who fell out of a tree has an open skull injury. What you be an appropriate way to describe and document this injury on the PCR?

Obvious deformity and instability to the right side of the skull with a laceration to the overlying scalp

An unhelmeted rider, who was thrown from his motorcycle when he wrecked, has a large scalp avulsion with obvious skull depression to the top of his head with venous bleeding. These findings suggest which type of injury?

Open head injury

A young adult male has a gunshot wound to the left side of his head. He is unresponsive with snoring respirations. He is breathing 6 times per minute with a pulse rate of 52 beats/min and a blood pressure of 192/104 mmHg. His radial pulse is strong and his skin is cool, but not diaphoretic. In addition to spine motion restriction precautions, the first intervention for this patient would be:

Performing a jaw-thrust maneuver

A 14-year-old male fell 10 feet from a retaining wall and hit his head on a metal post. He is responsive to verbal stimuli with incomprehensible speech. The secondary assessment indicates blood and fluid coming from inside the patient's left ear. Given these assessment findings, the EMT should:

Place a piece of sterile gauze over the ear to catch the fluid

Your assessment of a patient who was involved in a motor vehicle collision reveals a deformity to the left side of the head underneath the hair. On further inspection, you note that the skin overlying the deformity is still intact. Based on these assessment findings, what should be the EMT's greatest concern?

Possible brain injury

A woman fell from a second-story window onto the concrete sidewalk below. She is unresponsive and has a large depression to the back and top of her skull. Additional findings include abdominal bruising and an angulated left ankle. Your partner reports that the patient's vital signs are pulse, 68 beats/min; respirations, 14 breaths/min and irregular; blood pressure, 198/112 mmHg; and SpO2, 91% on room air. Based on these assessment findings, what should the EMT suspect is occurring?

Severe head injury with increasing pressure within the skull

You have been called by family members for their mother, who is "not acting right." At the scene, the family informs you that they are concerned because their 68-year-old mother has been complaining of a headache for two days and is now very confused. When asking about a bruise on the right side of her forehead, the family states she fell in church a week ago and hit her head. Since all other aspects of the assessment are unremarkable, you suspect a head injury. Which type of injury would you suspect given the findings and history?

Subdural hematoma

A 41-year-old male patient was struck in the head with a metal pipe during a fight with an angry neighbor. The scene is safe, and as you approach the patient, you note that he is combative and has blood on the left side of his head and face, and on his shirt. His breathing appears to be labored and he is incontinent of urine. Which care should you perform immediately?

Take manual cervical spine motion restriction

What best describes the purpose of determining a Glasgow Coma Scale score in a patient with a head injury?

The GCS score helps determine whether a patient's mental status is improving or deteriorating

When using the Glasgow Coma Scale (GCS) the EMT understands that:

The higher the score, the better the patient's neurologic status

A woman strikes her forehead against the dashboard of her car as it strikes a tree. Immediately following the impact, her brain shifts back and forth within her skull. Based on the anatomy and physiology of the skull, which statement is true?

The ridges of the basilar skull can damage as it moves back and forth