EMT Chapter 26 - Head and Spine Injuries
Meninges
3 distinct layers of tissue that suspend the brain and the spinal cord within the skull.
Which of the following statements regarding cervical collars is correct?
A cervical collar is used in addition to, not instead of, manual immobilization.
linear skull fractures
Account for 80% of skull fractures; also referred to as nondisplaced skull fractures; commonly occur in the temporal-parietal region of the skull; not associated with deformities to the skull.
Battle's sign
Bruising behind an ear over the mastoid process that may indicate a skull fracture.
raccoon eyes
Bruising under the eyes that may indicate a skull fracture.
2 general types of Head Injuries:
Closed Head Injury, and Open Head Injury
anterograde (posttraumatic) amnesia
Inability to remember events after an injury.
cerebral edema
Swelling of the brain.
A reflex arc occurs when:
a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the motor nerve.
The meninges, along with the cerebrospinal fluid (CSF) that circulates in between each meningeal layer, function by:
acting as a shock absorber for the brain and spinal cord.
The body's functions that occur without conscious effort are regulated by the _________ nervous system.
autonomic
Subarachnoid Hemorrhage
bleeding occurs into the subarachnoid space where the CSF circulates.
A patient with a head injury presents with abnormal flexion of his extremities. What numeric value should you assign to him for motor response?
c
White matter
consists of fiber pathways
When assessing a conscious patient with an MOI that suggests spinal injury, you should:
determine if the strength in all extremities is equal.
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:
immobilize his spine and perform a focused secondary exam.
Where is CSF produced
in a chamber inside the brain, called the Third Ventricle (in the subarachnoid)
Paralegia
legs only. Caused by Injury to L1
Linear skull fractures
nondisplaced skull fractures
TBI has 2 categories:
primary (direct) injury Secondary (indirect) injury
You should be MOST suspicious that a patient has experienced a significant head injury if his or her pulse is:
slow.
The ideal procedure for moving an injured patient from the ground to a backboard is:
the four-person log roll.
Distraction
when the spine is pulled along its length
Helmet should be removed If
1. it makes assessing or managing airway problems difficult and removal of a face guard to improve airway access is not possible 2. it prevents you from properly immobilizing the spine 3. it allows excessive head movement. 4. always remove a helmet from a patient who is in cardiac arrest
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?
3
The Peripheral Nervous System has 2 anatomic parts:
31 pairs of spinal nerves and 12 pairs of cranial nerves
The cervical spine is composed of _____ vertebrae.
7
eyes-forward position
A head position in which the patient's eyes are looking straight ahead and the head and torso are in line.
subluxation
A partial or incomplete dislocation.
concussion
A temporary loss or alteration of part or all of the brain's abilities to function without actual physical damage to the brain.
traumatic brain injury (TBI)
A traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes.
involuntary activities
Actions of the body that are not under a person's conscious control.
voluntary activities
Actions that we consciously perform, in which sensory input or conscious thought determines a specific muscular activity.
subdural hematoma
An accumulation of blood beneath the dura mater but outside the brain.
epidural hematoma
An accumulation of blood between the skull and the dura mater.
primary (direct) injury
An injury to the brain and its associated structures that is a direct result of impact to the head.
subarachnoid hemorrhage
Bleeding into the subarachnoid space, where the cerebrospinal fluid circulates.
intracerebral hematoma
Bleeding within the brain tissue (parenchyma) itself; also referred to as an intraparenchymal hematoma.
Signs of Basilar Skull Fracture include
CSF drainage from the ears, which indicates rupture of the tympanic membrane in the ear and freely flowing CSF through the ear, raccoon eyes or Battle's sign
coup-contrecoup injury
Dual impacting of the brain into the skull; coup injury occurs at the point of impact; contrecoup injury occurs on the opposite side of impact, as the brain rebounds.
Which of the following statements regarding the cranium is correct?
Eighty percent of the cranium is occupied by brain tissue.
For a patient with a Head Injury perform a neurologic examination:
GCS and record the time
Which of the following statements regarding secondary brain injury is correct?
Hypoxia and hypotension are the two most common causes of secondary brain injury.
closed head injury
Injury in which the brain has been injured but the skin has not been broken and there is no obvious bleeding.
open head injury
Injury to the head often caused by a penetrating object in which there may be bleeding and exposed brain tissue.
connecting nerves
Nerves in the spinal cord that connect the motor and sensory nerves.
secondary (indirect) injury
The "after effects" of the primary injury; includes abnormal processes such as cerebral edema, increased intracranial pressure, cerebral ischemia and hypoxia, and infection; onset is often delayed following the primary brain injury.
Which of the following statements regarding a basilar skull fracture is correct?
The absence of raccoon eyes or Battle's sign does not rule it out.
distraction
The action of pulling the spine along its length.
Nervous System consists of two anatomic parts:
The central nervous system (brain and spinal cord) Peripheral Nervous System (conducts sensory and motor impulses from the skin and other organs to the spinal cord)
intervertebral disk
The cushion that lies between two vertebrae.
retrograde amnesia
The inability to remember events leading up to a head injury.
intracranial pressure (ICP)
The pressure within the cranial vault.
four-person log roll
The recommended procedure for moving a patient with a suspected spinal injury from the ground to a long backboard.
Which of the following statements regarding motor nerves is correct
They carry information from the CNS to the muscles.
Which of the following statements regarding motor nerves is correct?
They carry information from the CNS to the muscles.
meninges
Three distinct layers of tissue that surround and protect the brain and the spinal cord within the skull and the spinal canal.
basilar skull fractures
Usually occur following diffuse impact to the head (such as falls, motor vehicle crashes); generally result from extension of a linear fracture to the base of the skull and can be difficult to diagnose with a radiograph (x-ray).
The MOST reliable sign of a head injury is:
a decreased level of consciousness.
Helmet Should be left on in these circumstances
a helmet that fits well prevents the patient's head from moving and should be left on, provided 1. there are no impending airway or breathing problems 2. it does not interfere with assessment and treatment of airway or ventilation problems, and 3. you can properly immobilize the spine. YOU SHOULD ALSO LEAVE THE HELMET ON IF THERE IS ANY CHANCE THAT REMOVING IT WILL FURTHER INJURE THE PATIENT
An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is:
a rapid deterioration of neurologic signs.
Traumatic Brain Injury (TBI)
a traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes
When immobilizing a seated patient with a short backboard or vest-style immobilization device, you should apply a cervical collar:
after assessing distal neurovascular functions.
Any unresponsive trauma patient should be assumed to have:
an accompanying spinal injury.
Subdural Hematoma
an accumulation of blood beneath the dura mater but outside the brain
Equidural Hematoma
an accumulation of blood between the skull and dura mater.
Open Head Injury
an opening from the brain to the outside world exists
A short backboard or vest-style immobilization device is indicated for patients who:
are in a sitting position and are clinically stable.
After your partner assumes manual in-line stabilization of the patient's head, you should:
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:
assisting ventilations at an age-appropriate rate.
When controlling bleeding from a scalp laceration with a suspected underlying skull fracture, you should:
avoid excessive pressure when applying the bandage.
An epidural hematoma is MOST accurately defined as:
bleeding between the skull and dura mater.
Which of the following sets of vital signs depicts Cushing's triad?
blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min
The central nervous system (CNS) is composed of the:
brain and spinal cord.
The _________ is the best-protected part of the CNS and controls the functions of the cardiac and respiratory systems.
brain stem
Battle's Sign
bruising that develops behind one ear over the mastoid process
Coordination of balance and body movement is controlled by the:
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):
cerebral concussion.
The MOST common and serious complication of a significant head injury is:
cerebral edema.
The _________ contain(s) about 75% of the brain's total volume.
cerebrum
The five sections of the spinal column, in descending order, are the:
cervical, thoracic, lumbar, sacral, and coccygeal.
Physical Examinations`
check perfusion , motor function, and sensation in all extremities prior to moving the patient: ***ask patient to squeeze your hands, and to gently push each foot against your hands.
Grey matter
composed of neural cell bodies and synapses, which are connections between nerve cells
CNS
composed of the brain and spinal cord
The frontal and parietal bones of the skull are especially susceptible to:
compressed skull fractures.
Rapid deceleration of the head, such as when it impacts the windshield, causes:
compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain.
Sympathetic nervous system occurs when:
confronted with a threatening situation, it reacts to stress with the fight or flight response. This response dilate pupils, smooth muscle in the lungs dilate, heart rate increases, and BP rises
Which of the following nerves allow sensory and motor impulses to be sent from one nerve directly to another?
connecting
Common signs and symptoms of a serious head injury include all of the following, EXCEPT:
constricted pupils.
Cerebrum
contains about 75% of the brains total volume controls a wide variety of activities including most voluntary motor function and conscious thought
Autonomic Nervous System (involuntary)
controls the functions of many of the body's vital organs, over which the brain has no voluntary control.
Brain Stem
controls virtually all the functions that are necessary for life, including the cardiac and respiratory systems and nerve function transmissions
Cerebellum
coordinates balance and body movements
The tough, fibrous outer meningeal layer is called the:
dura mater.
When immobilizing a patient on a long backboard, you should:
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?
epidural hematoma
What hormone is released in response to the sympathetic nervous system?
epinephrine
The hormone responsible for the actions of the sympathetic nervous system is:
epinephrine.
The MOST important treatment for patients with a head injury, regardless of severity, is
establish an adequate airway.
The MOST important 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:
eye opening, verbal response, and motor response.
It would be MOST appropriate to perform a focused secondary assessment on a patient who:
fainted and fell to the ground from a standing position.
Connecting Nerves
found only in the brain and spinal cord, connect the sensory and motor nerves with short fibers, which allow the cells on either end to exchange simple messages
Spinal Cord carries messages between the brain and body via:
gray and white matter of the spinal cord
Distraction injuries of the spine are MOST commonly the result of:
hangings.
The Parasympathetic nervous system
has the opposite effect on the body, causing blood vessels to dilate, slowing the heart rate, and relaxing the muscle sphincters
When placing a patient onto a long backboard, the EMT at the patient's _________ is in charge of all patient movements.
head
The effectiveness of positive-pressure ventilations when treating a head-injured patient can ONLY be determined by:
immediate reassessment following the intervention.
Crushing's Triad
increased BP, decreased heart rate, and irregular respirations such as Cheyne-Strokes respirations
Primary (Direct) injury
injury to the brain and its associated structures that results instantaneously from impact to the head
Spinal Injuries
inspect DCAP-BTLS, check extremeties: motor, circulation, sensory... ****SPINAL INJURY TO C5-C6 (QUADRIPLEGIA) INJURY L1 (PARALEGIA)
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:
instruct him to assist her ventilations while you perform a rapid assessment.
Bleeding within the brain tissue itself is called a(n)
intracerebral hematoma.
Bleeding within the brain tissue itself is called a(n):
intracerebral hematoma.
Intracerebral Hematoma
involves bleeding within the brain tissue itself
In contrast to a cerebral concussion, a cerebral contusion:
involves physical injury to the brain tissue.
Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless:
it causes a problem managing the ABCs.
A tight-fitting motorcycle helmet should be left in place unless:
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.
When caring for a patient with a possible head injury, it is MOST important to monitor the patient's:
level of consciousness.
Which of the following skull fractures would be the LEAST likely to present with palpable deformity or other outward signs?
linear
Lacerations to the scalp
may be an indicator of deeper, more serious injuries.
Lacerations to the scalp:
may be an indicator of deeper, more serious injuries.
When a patient experiences a severe spinal injury, he or she:
may lose sensation below the level of the injury.
Basilar Skull fractures
occur following diffuse impact to the head, generally result from extension of a linear fracture to the base of the skull
Subluxation
occurs when the vertebrae are no longer aligned
Layers of the Meninges
outer layer-dura mater, inner- arachnoid, and pia mater. Inner layers contain blood vessels that nourish the brain and spinal cord.
Quadriplegia
paralysis of all four limbs Caused by INjury to C5 or C6
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.
When activated, the sympathetic nervous system produces all of the following effects, EXCEPT:
pupillary constriction.
Secondary (indirect) injury
refers to a multitude of processes that increase the severity of a primary brain injury and therefore, negatively impact the outcome.
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:
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:
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?
sensory
31 pairs of spinal nerves conduct:
sensory impulses from the skin and other organs to the spinal cord. They also conduct motor impulses from the spinal cord to the muscles.
Moderate elevation in intracranial pressure with middle brain stem involvement is characterized by:
sluggishly reactive pupils, widened pulse pressure, bradycardia, and posturing.
What part of the nervous system controls the body's voluntary activities?
somatic
The spinal cord is encased in and protected by the:
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:
suction his oropharynx for up to 15 seconds.
Common signs of a skull fracture include all of the following, EXCEPT:
superficial scalp lacerations.
Cerebral Edema
swelling of the brain; aggravated by low oxygen levels in the blood and improved by high ones
Involuntary activities
the actions that are not under a persons conscious control.
Voluntary activities
the actions that we consciously perform, in which sensory input determines the specific muscular activity
Closed Head Injury
the brain has been injured but there is no opening into the brain
Brain divided into 3 main areas:
the cerebrum, the cerebellum, and the brain stem
When the parasympathetic nervous system is activated:
the heart rate decreases and the blood vessels dilate.
Anterograde amnesia
the inability to remember events after the injury
Somatic Nervous System (voluntary)
the part of the nervous system that regulates or controls our voluntary activities, including almost all coordinated muscular activities
Retrograde Amnesia
the patient can remember everything but the events leading up to the injury
When immobilizing a trauma patient's spine, the EMT manually stabilizing the head should not let go until:
the patient has been completely secured to the backboard.
Intracranial Pressure (ICP)
the pressure within the cranial vault. increase squeezes the brain against the bony prominence's within the skull
The Autonomic Nervous System is divided into 2 sections:
the sympathetic nervous system, and the parasympathetic nervous system
12 pairs of cranial nerves:
transmit information directly to or from the brain, they perform special functions in the head and face like: sight, smell, taste, hearing, and facial expressions
If you do not have the appropriate size cervical collar, you should:
use rolled towels to immobilize the patient's head.
Coup-contrecoup injury
when the brain bounces from the frontal lobe to the cerebellum; causes bruising on bottom of brain; may lead to temporal lobe damage resulting in deficits in memory and executive functions