Head and spinal injuries quiz

What is happening with Cushing's triad? An attempt to reduce blood oxygen levels to allow vasoconstriction of cerebral blood vessels. An attempt by the body to reduce blood flow to the brain by decreasing cardiac output. A change in respiratory pattern to blow off more CO2 due to acidosis from brain injury. A physiologic response by the body to increase blood flow to the brain.

A physiologic response by the body to increase blood flow to the brain.

Cerebrospinal fluid drainage from the ears is MOST indicative of: A nasal fracture An epidural hematoma Intracerebral bleeding A skull fracture

A skull fracture

Hypercarbia =

Hyperemia (too much blood) - increase ICP

A 24 year old male calls 911 after being assaulted outside of a bar where he "only had two beers". He tells you he was "just minding his own business" when "two guys" threw him to the ground and kicked him repeatedly in the face. Which of the following is most suspicious for a mandible fracture? Inability to clench teeth together (malocclusion). Mechanism of injury. Lip laceration and missing front teeth. Jaw pain.

Inability to clench teeth together (malocclusion).

You respond to an elderly female who has fallen onto her cat's food dish. The impact was directly onto her face. On exam you note that the patient's right eye is unable to look up or to the side. She tearfully tells you that this is new. What is your major concern? Left sided CVA led to the fall, patient requires a stroke center immediately. Orbital fracture and trapped muscle. The patient's dementia has worsened and she has forgotten about her weird eye. A LeFort fracture has led to maxillary damage with subsequent orbital edema.

Orbital fracture and trapped muscle.

In Brown Sequard/Lateral Hemisection Syndrome the opposite side of the body shows

Pain and temperature loss

Anterior cord Syndrom leads to motor __________ below the level of insult and loss of _____ and/or _______. _________________ remains intact

Paralysis Pain, temperature Proprioception

Suggested SBP in cases of suspected increased ICP

Greater than 100-110

Pt positioning in the case of suspected Increased ICP

Head elevated 30-45 degrees, maintain c-spine immobilization

Your brain is responsible for ____% of the body's total O2 consumption

20%

Normal ICP =

5 -15mmHg

Normal CPP =

60-90mmHg

Your skull holds ___mL of fluid at any given time

~750mL

You respond to reports of an unconscious 16 year old male at a sportball field. Bystanders report than he was standing behind the groundbag thing when the stick someone was swing at a ball flew out of their hands and struck him in the temporal region. On arrival you find him beginning to wake up, although he remains groggy. X - No significant hemorrhage noted A - Intact, vocalizing B - Steady rate, rhythm and quality C - Warm, dry, well perfused HEENT - Ecchymosis to left temple, PERRL @ 4mm, sluggish, no drainage from ears/nose, no crepitus to throat Chest - Atraumatic, L/S clear to auscultation bilaterally Abdomen - Soft, non tender x4 Pelvis - Stable Extremities - Atraumatic, CMS x4 Spine - No midline tenderness, range of motion intact, no step-offs He is sent in BLS for evaluation of concussion. Soon after leaving scene you are toned out for a BLS intercept for unresponsive pediatric patient. Which of the following injury patterns may have been missed? A diffuse axonal injury. A subarachnoid hemorrhage. An epidural hematoma. A subdura hematoma.

An epidural hematoma

Epidural hematoma is a(n) ___________ bleed usually caused by a blow to the temple

Arterial

Secondary causes of brain injury include all of the following, EXCEPT Axonal injury Hypoxia Intracranial hemorrhage Hypotension

Axonal injury

Cushing's Triad

Brady cardia Widening pulse pressure Abnormal respiratory pattern

What spinal cord injury is characterized by motor loss on the same side as the injury, with loss of pain and temperature sensation on the side opposite the injury? Anterior cord syndrome Central cord syndrome Posterior cord syndrome Brown-Séquard syndrome

Brown-Séquard syndrome

MAP - ICP = _____________

Cerebral Perfusion Pressure (CPP)

What happens to cerebral blood flow when a patient is hyperventilated? Decreases Increases Goes sideways No change

Decreases

Dermatomes C3/C4/C5 innervate the _________

Diaphragm "3-4-5 keep you alive"

___________ ___________ injuries account for 50% of all primary brain injuries and 35% of TBI-related deaths

Diffuse Axonal Injury (DAI)

Unconscious -> conscious -> unconscious again =

Epidural hematoma

Central cord syndrome results from a _________ __________ injury

Forced hyperextension

Hypocarbia =

Ischemia - Starve the brain of O2

Fluids to avoid in the setting of suspected increased ICP

LR, D5, Albumin

Brown-Sequard Syndrome is AKA

Lateral Hemisection Syndrome

You are preparing to transport a 14 year old female with a mechanical pencil stuck in her eye. Yes it's ALS because you're going to give her pain medication because she has a pencil in her eye and I'd want pain meds if I had a pencil in my eye. What medication should you administer concurrently? Metoprolol because you know that patients with glaucoma take beta blockers. Diphenhydramine to help her sleep, hoping that she'll close her eyes. Ondansetron to prevent vomiting and an increase in intraocular pressure. An intra-ocular antibiotic.

Ondansetron to prevent vomiting and an increase in intraocular pressure.

Bleeding from a scalp lac with an underlying skull deformity: Should be controlled with firm direct pressure on the skull Is limited due to the scalp's minimal vasculature Commonly causes severe shock in adults May contribute to hypovolemia in adults

May contribute to hypovolemia in adults

Which of the following factors is most important when considering cerebral perfusion? Diastolic blood pressure Systolic blood pressure Capillary refill time Mean arterial pressure

Mean Arterial Pressure

Dermatome T4 is at the ___________ _________

Nipple line

An injury affecting the T4 dermatome would likely affect everything below the ___________. neck. nipples. navicular. navel.

Nipples

Flexion injuries to the spine would MOST likely result from Rapid deceleration forces A direct blow to the frontal lobe Rapid acceleration forces A rear-end motor vehicle crash

Rapid deceleration forces

Patient is a 10 year old boy who was running in the backyard, clotheslined himself on a...clothesline. He is speaking with a hoarse voice and you note him to be coughing intermittently. Oxygenation and ventilation appear to be within normal limits at this time. He is moving air well, you see no signs of subcutaneous emphysema. What is your next best step? Immediate RSI to secure the airway. RSA with plans to insert a supraglottic device. Rapid transport to a hospital with surgical capabilities. Emergent cricothyrotomy.

Rapid transport to a hospital with surgical capabilities

Nausea/vomiting Headache Decreasing level of consciousness Seizure activity Posturing Anisocoria (different pupil sizes)

Signs of increased ICP

Which of the following statements regarding central cord syndrome is correct? Patients with cervical spondylosis or stenosis are at a lower risk for central cord syndrome following an injury. Central cord syndrome typically causes complete paralysis of the lower extremities and decreased proprioception. The patient typically presents with greater loss of function in the upper extremities than in the lower extremities. Central cord syndrome is almost always associated with a vertebral fracture and has an overall poor prognosis.

They patient typically presents with greater loss of function in the upper extremities than in the lower extremities

True or false Anterior cord syndrome usually results from flexion injuries

True

True or false In the setting of suspected increased ICP you should avoid things like vomiting, downward positioning, overstimulation that might create a spike in ICP

True

True or false in the setting of suspected ICP it is ok to use pressors PRN

True

Dermatome T10 is at the _____________

Umbilicus

Central cord syndrome leads to greater loss of sensory and function in __________ than _________ extremities

Upper, lower

Subdural hematoma is a(n) __________ bleed that is common in MVCs in young people, or falls in elderly or alcoholics

Venous

In Brown Sequard/Lateral Hemisection Syndrome the same side of the body shows

Weakness, loss of vibration and proprioception