Ch. 27 Head and Spinal Injuries

You are transporting a 37-year-old male with a head injury to a local trauma center. When performing your reassessment, which of the following clinical findings would be the earliest indicator of increasing intracranial pressure? A. A decreasing level of consciousness B. An acute decrease in systolic blood pressure C. The presence of decorticate posturing D. A progressive narrowing of the pulse pressure

A. A decreasing level of consciousness

Of the following clinical findings, which one would you MOST likely encounter during the early phase following a fracture of the basilar skull? A. Altered mental status B. Mastoid ecchymosis C. Periorbital ecchymosis D. CSF draining from the nose

A. Altered mental status

A 37-year-old male was struck on the driver side of his vehicle by another car traveling at 45 mph. Your primary assessment reveals that the patient is semiconscious and in respiratory distress. When extricating this patient from his car, you should: A. apply a C-collar and rapidly remove him on a long backboard. B. apply a vest-style extrication device and remove him from the car. C. manually stabilize his head and quickly pull him from the car.

A. apply a C-collar and rapidly remove him on a long backboard

While assessing a patient with blunt head trauma, you note an unstable segment of the skull and a large laceration to the scalp. You should control active bleeding, administer 100% oxygen, and: A. be alert for increased intracranial pressure. B. apply a tight pressure dressing to the scalp. C. administer 1-2 liters of isotonic crystalloid D. immobilize the patient's head prior to the torso.

A. be alert for increased intracranial pressure

A subdural hematoma is an accumulation of blood: A. beneath the dura mater but outside the brain. B. above all of the meningeal layers. C. between the dura mater and the skull.

A. beneath the dura mater but outside the brain

The central nervous system (CNS) is: A. composed of the cerebrum, cerebellum, brainstem, and spinal cord. B. composed of fibers that link nerve cells to the body's vital organs. C. protected and cushioned by two meningeal layers.

A. composed of the cerebrum, cerebellum, brainstem, and spinal cord

A 38-year-old male committed suicide by hanging himself. This mechanism of injury MOST likely resulted in: A. distraction of the upper cervical spine. B. complete spinal cord transection. C. separation of the lower cervical vertebrae. D. brainstem separation from the spinal cord.

A. distraction of the upper cervical spine

Following a traumatic brain injury, a patient presents with Cushing's triad, which consists of: A. hypertension, bradycardia, and irregular respirations. B. hypotension, tachycardia, and rapid respirations. C. hypotension, bradycardia, and shallow respirations. D. hypertension, tachycardia, and abnormal respirations.

A. hypertension, bradycardia, and irregular respirations

The complex network of spinal nerves that controls the lower extremities is called the: A. lumbosacral plexus. B. coccygeal plexus. C. brachial plexus. D. solar plexus.

A. lumbosacral plexus

During your assessment of a 29-year-old female with a severe head injury, you note that her left pupil is dilated and unreactive to light. This suggests pressure on the: A. oculomotor nerve. B. abducens nerve. C. glossopharyngeal nerve. D. hypoglossal nerve.

A. oculomotor nerve

A middle-aged male is found unconscious at the base of the steps to his house. There is no evidence of trauma and there were no witnesses to the event. You should: A. stabilize his head and open his airway with the jaw-thrust maneuver. B. apply a cervical collar and open his airway with the tongue-jaw lift. C. apply manual stabilization of his C-spine and gently tilt his head back. D. assess his airway after performing a head-tilt chin-lift maneuver.

A. stabilize his head and open his airway with the jaw-thrust maneuver

When assessing an unresponsive 20-year-old male with a traumatic brain injury, you note that his left pupil is fully dilated and non-reactive. This indicates injury: A. to the left cerebral hemisphere. B. to the right oculomotor nerve. C. in the region of the cerebellum. D. to the inferior part of the brainstem.

A. to the left cerebral hemisphere

A linear skull fracture: A. usually does not present with deformity of the skull. B. results from extension of a basilar skull fracture. C. typically occurs following diffuse impact to the head. D. causes severe displacement of the cranial bones.

A. usually does not present with deformity of the skull

Which of the following sets of vital signs is MOST indicative of Cushing's triad? A. BP, 170/94 mm Hg; pulse, 120 beats/min; respirations, 24 breaths/min and shallow B. BP, 190/100 mm Hg; pulse, 68 beats/min; respirations, 30 breaths/min and irregular C. BP 90/60 mm Hg; pulse, 110 beats/min; respirations, 28 breaths/min and regular D. BP 100/50 mm Hg; pulse 50 beats/min; respirations, 34 breaths/min and irregular

B. BP, 190/100 mm Hg; pulse, 68 beats/min; respirations, 30 breaths/min and irregular

Which portion of the central nervous system is afforded the BEST protection by the cranium? A. Meninges B. Brainstem C. Cerebrum D. Cerebellum

B. Brainstem

Which of the following statements regarding scalp lacerations is correct? A. Children are less susceptible to hypovolemia from scalp lacerations. B. Scalp lacerations may contribute to hypovolemic shock in adult patients.

B. Scalp lacerations may contribute to hypovolemic shock in adult patients

Which of the following head-injured patients should be hyperventilated at a rate of 20 breaths/min with a bag-mask device and 100% oxygen? A. Semiconscious 34-year-old female with deep, regular breathing, bilaterally dilated and reactive pupils, and bradycardia. B. Unresponsive 21-year-old male with slow, irregular breathing, fixed and dilated pupils, and extensor posturing. C. Semiconscious 25-year-old female with rapid, shallow breathing, dilated and sluggish pupils, and hypertension. D. Unresponsive 30-year-old male with slow, shallow breathing, equal and reactive pupils, and hypotension.

B. Unresponsive 21-year-old male with slow, irregular breathing, fixed and dilated pupils, and extensor posturing

What physiologic response may occur when a head-injured patient is hyperventilated with a bag-mask device and 100% oxygen? A. Vasoconstriction and increased cerebral perfusion B. Vasoconstriction and decreased cerebral perfusion

B. Vasoconstriction and decreased cerebral perfusion

Which of the following signs or symptoms would you MOST likely encounter in a patient who was struck in the back of the head? A. Loss of sensory perception B. Visual disturbances C. Abnormal behavior D. Loss of motor control

B. Visual disturbances

Following a minor head injury, which of the following occurs more commonly in children than adults? A. Convulsions B. Vomiting C. Aspiration

B. Vomiting

The function of the 12 pairs of cranial nerves is to: A. conduct sensory impulses from the skin to the spinal cord. B. allow transmission of sensations directly to and from the brain. C. perform specialized functions in the neck and thoracic cavity.

B. allow transmission of sensations directly to and from the brain

You are transporting a 40-year-old male who experienced blunt trauma to the side of his head. At the scene, he was conscious and alert and refused oxygen; however, you note that his mental status has deteriorated and his respirations have become irregular and shallow. You should: A. start a large-bore IV and deliver a 20 mL/kg fluid bolus. B. assist his ventilations with a bag-mask device. C. insert an advanced airway device immediately. D. apply a nonrebreathing mask set at 15 L/min.

B. assist his ventilations with a bag-mask device

The presence of posturing following severe head trauma is a sign of: A. mastoid injury. B. brainstem injury. C. spinal injury. D. cerebellar injury.

B. brainstem injury

A 19-year-old male was struck by a baseball in the occipital region of the skull. Witnesses report that the patient was briefly unconscious following the incident. He is now conscious and alert, but cannot remember the events immediately following the injury. He is breathing without difficulty and his vital signs are stable. This patient's clinical presentation is MOST consistent with a/an: A. intracerebral hematoma. B. cerebral concussion. C. epidural hematoma. D. cerebral contusion.

B. cerebral concussion

The two MOST common causes of secondary brain injury are: A. blunt trauma and cerebral edema. B. cerebral hypoxia and hypotension. C. infection and intracranial bleeding. D. increased ICP and cerebral edema.

B. cerebral hypoxia and hypotension

The largest portion of the brain, which controls a wide variety of functions, is the: A. cerebellum. B. cerebrum. C. brain stem.

B. cerebrum

Following blunt head trauma, a 44-year-old male presents with clear, watery fluid draining from his nose. You should suspect: A. early herniation of the brainstem. B. damage to all of the meningeal layers. C. rapidly increasing intracranial pressure. D. fracture of the basilar region of the skull.

B. damage to all of the meningeal layers

A patient with closed head trauma would MOST likely deteriorate rapidly following a/an: A. cerebral concussion. B. epidural hematoma. C. cerebral contusion. D. subdural hemorrhage.

B. epidural hematoma

You are caring for an 11-month-old male who fell from a second-story window and landed on his head. While assessing him, it is important to remember that: A. the size of his head will not allow you to perform a jaw-thrust. B. he could develop hypovolemic shock from intracranial bleeding. C. children with head injuries rarely develop hypovolemic shock. D. the fontanelles are still open and should be assessed for bulging.

B. he could develop hypovolemic shock from intracranial bleeding

During a motor-vehicle crash, a 3-year-old female, who was properly restrained in her car seat, is crying and asking for her mommy. There is no obvious injury to the child and she is breathing without difficulty. You should: A. remove her from the car seat and immobilize her on a long backboard. B. immobilize her in the car seat and apply padding as needed. C. leave her in the car seat but avoid immobilization to decrease anxiety.

B. immobilize her in the car seat and apply padding as needed

You are transporting a semiconscious 30-year-old female with an isolated head injury to a local trauma center. When you reassess her, you note that her BP is 78/56 mm Hg and her radial pulses are no longer palpable. You should: A. allow her to remain hypotensive as this will decrease intracranial pressure. B. infuse 20 mL/kg of normal saline as needed to maintain her BP at 90 mm Hg. C. rapidly increase her systolic blood pressure with 1 to 2 liters of normal saline.

B. infuse 20 mL/kg of normal saline as needed to maintain her BP at 90 mm Hg

A 48-year-old male fell approximately 20' from his roof. As you approach him, you note that his eyes are closed and that he is not moving. His respirations are gurgling and you see blood draining from his mouth. You should A. immediately suction his airway. B. take proper standard precautions.

B. take proper standard precautions

Which of the following patients should be assigned a Glasgow Coma Scale (GCS) score of 8? A. 22-year-old female who opens her eyes in response to pain, is unable to recall the year, and pushes your hand away when you palpate her abdomen B. 16-year-old female who opens her eyes when you talk to her, answers your questions inappropriately, and tells you her leg hurts C. 19-year-old male who does not open his eyes, is making mumbling sounds, and pulls his arm away when you are palpating it

C. 19-year-old male who does not open his eyes, is making mumbling sounds, and pulls his arm away when you are palpating it

A 57-year-old male was struck in the head by a falling object. He opens his eyes when you pinch his trapezius muscle, is using inappropriate words, and withdraws from painful stimuli. His Glasgow Coma Scale (GCS) score is: A. 12. B. 10. C. 9. D. 11.

C. 9

Of the following, which is the LEAST common sign or symptom of a head injury? A. An irregular respiratory pattern B. Combative or abnormal behavior C. A cardiac rhythm disturbance D. CSF drainage from a scalp wound

C. A cardiac rhythm disturbance

Mastoid bruising is also referred to as: A. Cullen's sign. B. Gray-Turner's sign. C. Battle's sign. D. raccoon eyes.

C. Battle's sign

Which of the following statements regarding cerebral perfusion pressure (CPP) is correct? A. The minimum CPP that is needed to adequately perfuse the brain is 40 mm Hg. B. The body responds to a decrease in CPP by decreasing mean arterial pressure. C. CPP is the difference between mean arterial pressure and intracranial pressure.

C. CPP is the difference between mean arterial pressure and intracranial pressure

Which of the following situations dictates removal of a football or motorcycle helmet? A. The patient complains of pain to the cervical spine. B. Transport time to the hospital is greater than 30 minutes. C. Respirations of 24 breaths/min and reduced tidal volume D. The patient is conscious but has a bad headache.

C. Respirations of 24 breaths/min and reduced tidal volume

When stabilizing a patient's cervical spine, you should: A. support the lower jaw with your palms. B. position yourself beside the patient. C. align the patient's nose with the navel.

C. align the patient's nose with the navel

A patient with neurogenic shock would be expected to present with: A. hyperthermia and tachycardia. B. pallor and profuse diaphoresis. C. bradycardia and hypothermia. D. unilateral paralysis and tachycardia.

C. bradycardia and hypothermia

A 39-year-old female struck a tree while traveling approximately 40 mph. When you arrive at the scene, the patient is out of her vehicle and walking around. You should: A. have her walk to the ambulance and then immobilize her. B. immobilize her spine only if she complains of neck pain. C. immobilize her in a standing position to a long backboard.

C. immobilize her in a standing position to a long backboard

A young male has experienced a possible neck injury. When you attempt to place his head in a neutral in-line position, he complains of a severe spasm in his neck. You should: A. apply a chemical ice pack to his neck for pain relief. B. carefully continue to move his head into a neutral position. C. immobilize him in the position in which you found him. D. monitor neurological functions as you gently move his head.

C. immobilize him in the position in which you found him

A football player sustained a possible spinal injury when he was tackled. He is conscious and alert, complains of pain to the mid-cervical spine region, and has stable vital signs. You should: A. cut the facemask portion of the helmet off to monitor his airway. B. remove the helmet and immobilize him in the usual fashion. C. immobilize him with his helmet on unless it is not tight-fitting. D. gently move the helmet to ensure that it is tight-fitting.

C. immobilize him with his helmet on unless it is not tight-fitting

When immobilizing a patient onto a long backboard, it is important to: A. follow the commands of the AEMT at the torso. B. secure the head prior to securing the torso. C. secure the torso prior to securing the head.

C. secure the torso prior to securing the head

Manual C-spine stabilization should continue until: A. the patient has been loaded into the ambulance. B. motor and sensory functions have been assessed. C. the patient is fully secured to a long backboard. D. an appropriately-sized C-collar has been applied.

C. the patient is fully secured to a long backboard

If a person places his or her hand on a hot stove: A. the connecting nerves in the spinal cord will detect the painful stimulus and send a sensory message to the brain. B. the sensory nerve will form a reflex arc and send a message to the brain to elicit a motor response. C. the sensory nerve will bypass the brain and send a message directly to the motor nerve. D. the motor nerve will bypass the spinal cord and send a sensory message directly to the brain.

C. the sensory nerve will bypass the brain and send a message directly to the motor nerve

The 31 pairs of spinal nerves serve all of the following functions EXCEPT: A. conducting sensory impulses to the spinal cord. B. controlling movement of the upper and lower extremities. C. transmitting sensations directly to and from the brain. D. conducting motor impulses to the muscles.

C. transmitting sensations directly to and from the brain

A 40-year-old man was struck in the head with a steel pipe. He opens his eyes when you ask him a question, but cannot recall the date or events prior to the injury. When you ask him if he is injured anywhere else, he tells you no. You should assign him a Glasgow Coma Scale (GCS) score of: A. 13 B. 10 C. 11 D. 12

D. 12

What portion of the nervous system controls the functions of many of the body's vital organs, over which the brain has no voluntary control? A. Peripheral B. Somatic C. Adrenergic D. Autonomic

D. Autonomic

A 40-year-old female is semiconscious following blunt head trauma. Your assessment reveals that her respirations are slow and shallow, her pulse is slow, and her blood pressure is elevated. Her pupils are bilaterally dilated and sluggishly reactive. Appropriate management for this patient includes: A. hyperventilation at a rate of 20 breaths/min. B. 20 mL/kg boluses of a crystalloid solution. C. preoxygenation and insertion of a Combitube. D. assisted ventilation at a rate of 10 breaths/min.

D. assisted ventilation at a rate of 10 breaths/min

Following a severe closed head injury, a 23-year-old female develops cardiac dysrhythmias and an irregular pattern of breathing. The area of her brain MOST likely injured is the: A. cerebellum. B. cerebrum. C. cerebral cortex. D. brainstem.

D. brainstem

A young female was involved in a motor-vehicle crash and complains of neck pain. When assessing her, you should NOT: A. assess gross motor function. B. ask her to move her hands or feet. C. ask her to point to the area of pain. D. determine cervical range of motion.

D. determine cervical range of motion

A person would MOST likely experience a compression injury of the lumbar spine when he or she: A. hyperextends the lower back. B. dives head first into a pool. C. laterally bends the lumbar spine. D. falls and lands on his or her feet.

D. falls and lands on his or her feet

The MOST significant complication associated with a severe closed head injury is: A. injury to the lower cervical spine. B. hypertension and bradycardia. C. decreased level of consciousness. D. increased intracranial pressure.

D. increased intracranial pressure

Cerebral edema is aggravated by: A. low CO2 levels in the blood. B. increased pH of the CSF. C. high O2 levels in the blood. D. low O2 levels in the blood.

D. low O2 levels in the blood

Two of the meningeal layers that protect the central nervous system are the arachnoid and pia mater which: A. are avascular and thick. B. are protected by cerebrospinal fluid. C. secrete immune system chemicals. D. produce cerebrospinal fluid.

D. produce cerebrospinal fluid

A 23-year-old male was involved in a motor-vehicle crash and has an obviously depressed skull fracture. His pulse is rapid and weak, his skin is cool and clammy, and his blood pressure is low. You should: A. recognize that his clinical presentation is consistent with brain herniation. B. hyperventilate him at 20 breaths/min with a bag-mask device and 100% oxygen. C. start a large-bore IV, but restrict fluids to avoid an increase in intracranial pressure. D. suspect that he has internal bleeding and administer crystalloid fluid boluses.

D. suspect that he has internal bleeding and administer crystalloid fluid boluses