EMT Chapter 28: Head and Spine Injuries

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.

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

B. hangings.

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.

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.

Lacerations to the scalp:

may be an indicator of deeper, more serious injuries.

The _________ nervous system consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves.

peripheral

When immobilizing a child on a long backboard, you should:

place padding under the child's shoulders as needed.

A patient who cannot remember the events that preceded his or her head injury is experiencing:

retrograde amnesia.

Battle sign is an indication of which of the following?

skull fructure

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.

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.

The cervical spine is composed of _____ vertebrae.

7

Which of the following statements regarding cervical collars is correct?

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

What part of the nervous system controls the body's voluntary activities? Select one: A. Somatic B. Autonomic C. Sensory D. Central

A. Somatic

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.

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.

The body's functions that occur without conscious effort are regulated by the _________ nervous system.

autonomic

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

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

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.

In a(n) ________, CSF flows freely from the patient's ear; this type of injury can be difficult to diagnose with a radiograph.

Basilar skull fracture

When controlling bleeding from a scalp laceration with a suspected underlying skull fracture, you should:

avoid excessive pressure when applying the bandage.

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.

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.

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.

Which of the following acts as a shock absorber for the CNS?

Cerebrospinal fluid The brain and spinal cord essentially float in this fluid, buffered from injury.

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?

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

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 MOST important immediate treatment for patients with a head injury, regardless of severity, is to:

establish an adequate airway.

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.

Which of the following statements regarding the cranium is correct?

Eighty percent of the cranium is occupied by brain tissue.

You are reassessing a patient and you find that her left pupil is dilated and fixed. What does this indicate?

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

When securing a patient to a backboard, what area of the body should you secure last?

Head

Cushing triad in a patient is a sign of which of the following?

Intracranial pressure Cushing triad is a sign of intracranial pressure.

Which of the following skull fractures would be the LEAST likely to present with palpable deformity or other outward signs?

Linear

Accounting for approximately 80% of all skull fractures, which of the following often present with no physical signs?

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?

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?

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.

Coordination of balance and body movement is controlled by the:

cerebellum

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.

When assessing a conscious patient with an MOI that suggests spinal injury, you should:

determine if the strength in all extremities is equal.

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?

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

When placing a patient onto a long backboard, the EMT at the patient's _________ is in charge of all patient movements.

head