Chapter 28 - Head and Spine Injuries

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: a-14. b-15. c-12. d-13.

a-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? a-3 b-4 c-2 d-5

a-3

An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is: a-a rapid deterioration of neurologic signs. b-a progressively lowering blood pressure. c-acute unilateral paralysis following the injury. d-an acute increase in the patient's pulse rate.

a-a rapid deterioration of neurologic signs.

A short backboard or vest-style immobilization device is indicated for patients who: a-are in a sitting position and are clinically stable. b-are found supine and have stable vital signs. c-require prompt extrication from an automobile. d-are sitting in their car and are clinically unstable.

a-are in a sitting position and are clinically stable.

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: a-assisting ventilations at an age-appropriate rate. b-hyperventilating her at 30 breaths/min. c-administering oxygen via a nonrebreathing mask. d-ventilation assistance to maintain an oxygen saturation of 90%.

a-assisting ventilations at an age-appropriate rate.

When controlling bleeding from a scalp laceration with a suspected underlying skull fracture, you should: a-avoid excessive pressure when applying the bandage. b-apply firm compression for no longer than 5 minutes. c-apply manual pressure and avoid applying a bandage. d-elevate the patient's head and apply an ice pack.

a-avoid excessive pressure when applying the bandage.

The effectiveness of positive-pressure ventilations when treating a head-injured patient can ONLY be determined by: a-immediate reassessment following the intervention. b-a neurosurgeon or emergency department physician. c-noting a decrease in the heart rate during ventilations. d-reassessing the patient's blood pressure after at least 10 minutes.

a-immediate reassessment following the intervention.

Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless: a-it causes a problem managing the ABCs. b-sensory and motor functions remain intact. c-the patient adamantly denies neck pain. d-lateral immobilization has been applied.

a-it causes a problem managing the ABCs.

When caring for a patient with a possible head injury, it is MOST important to monitor the patient's: a-level of consciousness. b-blood pressure. c-pulse regularity. d-pupil size.

a-level of consciousness.

Which of the following nerves carry information from the body to the brain via the spinal cord? a-sensory b-motor c-somatic d-central

a-sensory

You should be MOST suspicious that a patient has experienced a significant head injury if his or her pulse is: a-slow. b-weak. c-irregular. d-rapid.

a-slow.

When immobilizing a trauma patient's spine, the EMT manually stabilizing the head should not let go until: a-the patient has been completely secured to the backboard. b-an appropriately sized cervical collar has been applied. c-the head has been stabilized with lateral immobilization. d-the patient has been secured to the ambulance stretcher.

a-the patient has been completely secured to the backboard.

The meninges, along with the cerebrospinal fluid (CSF) that circulates in between each meningeal layer, function by: a-regenerating brain cells after they have been damaged. b-acting as a shock absorber for the brain and spinal cord. c-producing leukocytes that protect the brain from infection. d-delivering oxygen directly to the CNS.

b-acting as a shock absorber for the brain and spinal cord.

When immobilizing a seated patient with a short backboard or vest-style immobilization device, you should apply a cervical collar: a-after the torso has been adequately secured. b-after assessing distal neurovascular functions. c-before manually stabilizing the patient's head. d-after moving the patient to a long backboard.

b-after assessing distal neurovascular functions.

Any unresponsive trauma patient should be assumed to have: a-internal bleeding in the abdomen. b-an accompanying spinal injury. c-a history of diabetes mellitus. d-a severe intracranial hemorrhage.

b-an accompanying spinal injury.

After your partner assumes manual in-line stabilization of the patient's head, you should: a-apply an appropriately sized rigid cervical collar. b-assess distal neurovascular status in the extremities. c-thoroughly palpate the patient's head for deformities. d-use four people to log roll the patient onto a backboard.

b-assess distal neurovascular status in the extremities.

An epidural hematoma is MOST accurately defined as: a-bleeding between the dura mater and brain. b-bleeding between the skull and dura mater. c-an injury caused by a damaged cerebral artery. d-venous lacerations that occur within the brain.

b-bleeding between the skull and dura mater.

The _________ is the best-protected part of the CNS and controls the functions of the cardiac and respiratory systems. a-cerebral cortex b-brain stem c-spinal cord d-cerebellum

b-brain stem

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: a-immediately place her on a long backboard and prepare for rapid transport. b-instruct him to assist her ventilations while you perform a rapid assessment. c-perform a focused secondary assessment of the patient's head and neck. d-apply 100% oxygen via a nonrebreathing mask and obtain baseline vital signs.

b-instruct him to assist her ventilations while you perform a rapid assessment.

Which of the following skull fractures would be the LEAST likely to present with palpable deformity or other outward signs? a-compressed b-linear c-open d-basilar

b-linear

A patient who cannot remember the events that preceded his or her head injury is experiencing: a-posttraumatic amnesia. b-retrograde amnesia. c-anterograde amnesia. d-perigrade amnesia.

b-retrograde amnesia.

Which of the following sets of vital signs depicts Cushing's triad? a-blood pressure, 80/40 mm Hg; pulse, 30 beats/min; respirations, 32 breaths/min b-blood pressure, 90/50 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min c-blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min d-blood pressure, 200/100 mm Hg; pulse, 140 beats/min; respirations, 28 breaths/min

c-blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min

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): a-cerebral contusion. b-intracerebral hematoma. c-cerebral concussion. d-intracranial hemorrhage.

c-cerebral concussion.

Which of the following nerves allow sensory and motor impulses to be sent from one nerve directly to another? a-autonomic b-somatic c-connecting d-peripheral

c-connecting

When assessing a conscious patient with an MOI that suggests spinal injury, you should: a-rule out a spinal injury if the patient denies neck pain. b-defer spinal immobilization if the patient is ambulatory. c-determine if the strength in all extremities is equal. d-ask the patient to move his or her head to assess for pain.

c-determine if the strength in all extremities is equal.

When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his right ear. This indicates: a-fractures to the internal structures of the ear following direct trauma. b-significant pressure and bleeding in between the skull and dura mater. c-rupture of the tympanic membrane following diffuse impact to the head. d-a linear skull fracture and a significant increase in intracranial pressure.

c-rupture of the tympanic membrane following diffuse impact to the head.

When placing a patient onto a long backboard, the EMT at the patient's _________ is in charge of all patient movements. a-lower extremities b-chest c-waist d-head

d-head

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: a-perform a rapid head-to-toe exam and immobilize his spine. b-allow him to refuse transport if his vital signs remain stable. c-obtain a Glasgow Coma Score value and give him oxygen. d-immobilize his spine and perform a focused secondary exam.

d-immobilize his spine and perform a focused secondary exam.

Moderate elevation in intracranial pressure with middle brain stem involvement is characterized by: a-ataxic respirations, unequal pupils, no response to pain, and an irregular pulse. b-fixed and dilated pupils, decreased blood pressure, and irregular respirations. c-increased blood pressure, bradycardia, reactive pupils, and rapid respirations. d-sluggishly reactive pupils, widened pulse pressure, bradycardia, and posturing.

d-sluggishly reactive pupils, widened pulse pressure, bradycardia, and posturing.

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: a-assist his ventilations with a bag-mask device. b-pack his nostrils to stop the drainage of blood. c-immobilize his spine and transport immediately. d-suction his oropharynx for up to 15 seconds.

d-suction his oropharynx for up to 15 seconds.