Paramedic Vol 4 Chapter 6

Zone 2

Aboce cricoid ring and below angle of jaw

Zone 3

Above angle of jaw, cranial nerves and larger vascular structures

Sympathetic nervous Systems

Adjusts body metabolic rate to waking activity "fight or flight" functions when body comes under threat or extreme stress

Bony fragments or pressure compressing arteries; perfuse anterior spinal cord

Anterior cord syndrome

transmits signals upward to brain

Ascending tracts

Increasing blood pressure to maintain CPP and cerebral perfusion

Autoregulation

Zone 1

Below cricoid ring: Great vessels and trachea

Central processing center; communication junction among cerebrum, spinal cord, cranial nerves, and cerebellum

Brainstem

Combination of increasing blood pressure, slowing pulse, irregular respirations is classic signs of

Brainstem pressure or injury

Penetrating injury that affects one side of cord (Hemitransection)

Brown-Sequard Syndrome

Nerve roots at lower end of spinal cord compressed, interrupting sensation and motor control

Causa equina syndrome

Hyperextension of cervical spine, as might occur with forward fall and facial impact

Central cord syndrome

Blunt trauma to brain tissue; produces capillary bleeding into brains substance

Cerebral contusion

Clear, colorless solution of water, proteins, and slats that surrounds central nervous system and absorbs shock of minor acceleration and deceleration

Cerebralspinal Fluid (CSF)

Performs higher functions; center of consciousness thought, personality, speech, motor control. visual, auditory, tactile (Touch) perception

Cerebrum : Largest Nervous System Element

Cyclic breathing pattern characterized by periods of respirations of increased rate and depth alternating with periods of apnea?

Cheyne-stokes respirations

Hypoglossal Nerve (XII)

Controls muscles of tongue

Parasympathetic Nervous System

Controls rest and regenerative functions

Brainstem (midbrain, pons, medulla)

Conveys motor and sensory information and mediates important autonomic functions

Causes injury away from primary impact point as brain, floating in cerebrospinal fluid inside cranium, sloshes toward impact, then away from it, again impacting interior of skull

Countercoup injuries

Occur directly of impact as brain moves toward and collides with interior of the skull

Coup Injuries

12 distinct pathways: important senses, innervate facial area, control significant body functions

Cranial Nerves

-Skull: bony structure supporting head and face -Cranium: vault for brain; bones fused together at pseudo joints (sutures) -Facial bones: skeletal base for face

Cranium

Circular ring between thyroid cartilage and trachea

Cricoid cartilage

Transmit signals downward through cord

Descending tracts

Bleeding between dura mater and skull's interior surface

Epidural hematoma

Divides cerebrum into right and left hemisphere

Falx cerebri

Occur as specific location in brain; contusions and intracranial hemorrhages

Focal injuries

Le Fort 2

Fracture of both the maxilla and nasal bones

glossopharyngeal nerve

IX

Cushing's triad consists of:

Increased systolic BP, decreased heart rate, and abnormal respirations.

Reduces cereal perfusion; can severely damage brain tissue

Intracranial Pressure (ICP)

Ruptured blood vessel, releases blood into brains substance, blood loss minimal, increases intracranial pressure

Intracranial hemorrhage

Dominant hemisphere, mathematical computation, writing, language, interpretation, speech

Left cerebral hemisphere

Respiratory rate, cardiac center, vasomotor center

Medulla oblongata

Pulse pressure widens, heart rate bradycardia, respirations deep and rapid, pupils sluggish or non reactivity, signs of

Middle brainstem

Facial Nerve (VII)

Movement of facial expression muscles, taste (from anterior 2/3 of tongue)

Control pupil size

Oculomotor nerve

Severe and life threatening, due to gunshots, stabbings, explosions, propelled objects from blast, knife wounds

Penetrating Injuries

Communication interchange between central nervous system components

Pons

Non dominant hemisphere processes nonverbal imagery (Occipital region)

Right Cerebral hemisphere

-Strong and flexible layer of skin, fascia, muscle tissue; extremely vascular -Hair insulates brain from environmental temperature -Only loosely attached to skull

Scalp

-Paralysis of extremities -Pain with and without movement -Tenderness along spine -Impaired breathing -Spinal deformity -Posturing -Priapism -Loss of bowel or bladder control -Nerve impairment to extremities

Signs and Symptoms of Spinal Injury

What does SCALP stand for?

Skin Connective tissue Aponeurosis Loose connective tissue Pericranium

33 bones, main support for axis of body

Spinal column

Bleeding within meninges, specifically beneath dura mater and within subarachnoid space

Subdural hematoma

Fibrous sheet, separates cerebrum from cerebellum

Tentorium cerebella

Establishes and maintains consciousness pathways for optic and olfactory nerves.

Thalamus

-Pinna: visible outer portion -External auditory canal: glands secrete wax (Cerumen) for protection -Middle and inner ear: structures required for hearing

The Ear

-Specialized connective tissues -Dura Matter: Outermost meningeal layer -Pia Mater: Meningeal layer closest to brain and spinal cord -Arachnoid membrane: separating the two layers of mater is stratum of connective tissue

The Meninges

Le Fort 3 Fracture

This fracture involves separation of all the facial bones from their cranial base. It includes fracture of the zygoma, maxilla, and nasal bones.

Numerous C shaped cartilages to keep trachea open

Trachea

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

Traumatic Brain Injury (TBI)

Trochlear Nerve (IV)

eye movement

Trigeminal Nerve (CN V)

large nerve (mostly GSA) with a wide distribution to the face and scalp; it has a smaller SVE component to the muscles of mastication; important nerve and branches from other cranial nerves join to distribute with it; divides into 3 separate branches

Abducens Nerve (VI)

lateral eye movement

Oculomotor Nerve (III)

narrows pupil and focuses lens

olfactory bulb and tract

sense of smell

vagus nerve X function

sensory and motor: 70% of the parasympathetic division of the ANS

Le Fort 1 Fracture

slight instability to maxilla; no displacement

Acoustic Nerve (VIII)

special sense of hearing and balance

Accessory Nerve (XI)

swallowing, head, neck, and shoulder movements

concussion

violent shaking up or jarring of the brain

Optic Nerve (II)

vision

Diffuse injuries

♥Diffuse Axonal Injury (DAI) •Follows acceleration-deceleration injuries where there is a rotational element •Characterized by mild to severe axonal injury •Results in scattered, diffuse loss of function •A continuum of injury from DAI ranges from concussion to persistent vegetative state