Trauma ch6
What is the most common outcome of blunt head trauma?
A diffuse injury
What accurately reflects the pathophysiology of anterior cord syndrome?
A flexion dash-extension injury that results in damage to the vertebral artery through either disruption or compression by edema, leading to subsequent ischemia and infarction
What might a victim suffering a concussion and epidural hematoma concurrently present with prior to an increase in intracranial pressure?
A lucid interval
What results from compression of the nerve roots at the lower end of the spinal cord?
Cauda equina syndrome
When the brain, floating in cerebrospinal fluid inside the cranium, "sloshes" toward the impact and then away from it, again impacting the cranial interior, what is the second injury called?
Contrecoup injury
While monitoring the victim of a brain injury during the secondary assessment, you should be especially watchful for:
Cushing's triad.
What do the signs and symptoms of Cushing's triad include?
Increasing systolic blood pressure, slowing pulse, and irregular respirations
What would blunt trauma to the neck that damages the cartilaginous rings of the trachea and/or the vocal cords not cause?
Injury to the T-12/L-1 transition point
Which statement is true regarding pediatric head trauma?
Intracranial hemorrhage in the pediatric patient can contribute significantly to hypovolemia.
What causes the tissue edema resulting from an intracerebral hemorrhage?
Irritation of nervous tissue
What population is most at risk for head or spinal column injury?
Males aged 15 dash-24
What injury would be classified as a diffuse brain injury?
Mild axonal injury
What are the discrete tissues and muscles of the body that are controlled by specific spinal nerve roots?
Myotomes
What accurately reflects the pathophysiology of Brown-Séquard syndrome?
Penetrating injury that hemitransects the cord, resulting in sensory and motor loss to the ipsilateral side of the body
Which meningeal layer is closest to the brain?
Pia mater
You are dispatched for a fall at the local mall. When you arrive you are led by security to a location on the sidewalk where a 43-year-old male patient is lying on his back. He is alert and oriented and tells you that he was running to cross in front of a car when he tripped on the curb, striking his head on the sidewalk. He then rolled onto his back and can no longer move his hands, legs, or trunk, although he can still move his arms. You suspect a low cervical or high thoracic spinal injury. At what point in the assessment would you apply spinal stabilization to this patient?
Primary assessment
You suspect the driver of a car in a motor vehicle collision (MVC) with airbag deployment, despite having no complaint of injury, might still have sustained a spinal injury based on the high-force mechanism of injury. At which point in the assessment would you develop this suspicion?
Scene size-up
Which part of the inner ear is responsible for equilibrium?
Semicircular canals
Which term is defined as a significant mechanical disruption of axons in both cerebral hemispheres with extension into the brainstem?
Severe diffuse axonal injury
What is bleeding called that occurs within the meninges, specifically beneath the dura mater and within the subarachnoid space?
Subdural hematoma
Which of the statements regarding the Glasgow Coma Scale is accurate?
The GCS is not a "perfect" means to accurately represent a patient's level of consciousness.
What is the fibrous connective tissue sheet directly beneath the skin and covering the most superior surface of the head?
The galea aponeurotica
What is not a reason that the atlas/axis joint is the site of the majority of fatal spine injuries?
The spinal cord roots exit the spinal column at this point.
How many layers of connective tissue are there between the cranium and the brain?
Three
You are dispatched to a residence for a 32-year-old female complaining of a severe headache and blurry vision in her left eye. When you question her, she tells you that the headache began the previous day and got worse as the day went on, forcing her to leave work early. When she awoke this morning, she noticed the dizziness and vision change in her eye and decided not to drive herself to the doctor. As you perform your exam, you notice that she winces when you touch the left parietal area of her head. When asked, she remembers that she was struck on the left side of the head by an object she believed was thrown by a lawn mower she walked past three days prior as she was walking the dog. She stated that the object didn't hurt very much so she didn't stop and subsequently forgot about it. You decide to expedite transport for this patient. Which mode of transport is best?
Transport at reduced speed using lights and sirens sparingly
Decorticate posturing as a response to painful stimuli is indicative of:
Upper brainstem disruption.
When an injury occurs directly at the point of impact as the brain moves toward and collides with the interior of the skull, this is called a(n):
coup injury.
The portion of the skull that protects the brain is called the:
cranium.
Bulging fontanelles in the infant patient who has suffered a traumatic event may be indicative of:
increasing intracranial pressure.
A large region of cortical disruption may cause confusion and affect the patient's mental status, such as the patient forgetting the circumstances leading up (before) the incident itself, which is called:
retrograde amnesia.
When developing a spinal clearance policy, age:
should be considered, as the very old may not be able to describe their symptoms accurately.
What results from penetrating injury that affects one side of the cord?
Brown-Sequard syndrome
You are dispatched to the scene of a shallow water diving accident. While en route, what would you consider to be the most likely result of this method of injury?
Axial loading of the cervical spine
What is the white matter of the spinal cord composed of?
Axons
Which injury would you be likely to encounter while treating the driver of a motor vehicle that has been struck from behind?
Fracture of the posterior vertebral elements
Which type of head injury carries a 75 percent or higher mortality rate and is second in lethality after head injuries from auto crashes?
Gunshot wounds
What trauma injury is the most frequent cause of death?
Head injury
The use of which adjunct has reduced the occurrence of head injury in sports?
Helmets
You find significant hypoglycemia is an unresponsive patient with a head injury. You administer:
25 mg of glucose and 100 mg of thiamine.
How does the progression of signs and symptoms of pediatric head injury differ from an adult?
An infant is more prone to direct injury but has a slower progression of increasing ICP.
You suspect increased intracranial pressure in a patient with penetrating chest trauma. Which of the following is appropriate treatment?
Administer fluid resuscitation to maintain a systolic blood pressure of 90 mmHg
You suspect increased intracranial pressure in a patient with penetrating chest trauma. Which of the following is appropriate treatment?
Administer fluid resuscitation to maintain a systolic blood pressure of 90 mmHg.
Which syndrome results from bony fragments or pressure compressing arteries that perfuse the ventral aspect of the spinal cord?
Anterior cord syndrome
When clearing the cervical spine, what would a distracting injury include?
Any injury that produces clinically apparent pain that might distract the patient from the pain of a spine injury
How do superficial scalp wounds provide a risk of infection that can involve the brain?
Emissary veins from the dural sinuses drain into superficial venous circulation.
You are called to the scene of an automobile accident in which the driver was wearing his shoulder belt improperly and struck his face on the steering wheel. As you approach the vehicle, you see the door has been opened and the driver is unconscious, with his head still against the wheel and blood flowing freely from his nose and mouth. His respirations are 18 and shallow and his pulse is 102 radially. To extricate this patient, how should you proceed?
Ensure that any providers assisting you are coordinated and understand what movement is to take place.
