Chapter 28 Head and Spine Injuries

73.In supine patients with a head injury, the head should be elevated _____ to help reduce intracranial pressure.

30 degrees

53.Which of the following statements regarding cervical collars is MOST correct?

A cervical collar is used in addition to, not instead of, manual immobilization.

89.Which of the following acts as a shock absorber for the CNS?

Cerebrospinal fluid (CSF)

39.The MOST reliable sign of a head injury is

a decreased level of consciousness.

18.Common signs and symptoms of a serious head injury include all of the following, EXCEPT

a rapid, thready pulse.

54.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.

41.After your partner assumes manual in-line stabilization of the patient's head, you should

assess distal neurovascular status in the extremities.

48.The body's functions that occur without conscious effort are regulated by the _________ nervous system.

autonomic

9.The central nervous system (CNS) is composed of the

brain and spinal cord.

16.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 airway.

40.Moderate elevation in intracranial pressure with middle brain stem involvement is characterized by

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

65.When the parasympathetic nervous system is activated

the heart rate decreases and the blood vessels dilate

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.

109.During your initial 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 ventilations as you perform a rapid trauma assessment.

78.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

8.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

120.Which of the following interventions may be used to help reduce intracranial pressure?

30-degree elevation of the head

62.The cervical spine is composed of _____ vertebrae.

7

95.You are reassessing a patient and you find that her left pupil is dilated and fixed. What does this indicate?

A fixed, dilated pupil indicates increased ICP.

85.When assessing a patient with a suspected head or spine injury, which of the following should you do?

Administer high flow oxygen and assess the patient in the position found.

100.Which of the following sets of vital signs MOST accurately depicts Cushing's triad?

BP, 190/110; pulse, 55; respirations, 30

87.Which of the following are signs of Cushing triad?

Bradycardia, hypertension, irregular respirations

97.You are treating a patient who went face-first through a windshield. She has extensive head injuries and is displaying hypertension, bradycardia, and Cheyne-Stokes respirations. Which of the following should you suspect?

Cushing triad

56.Which of the following statements regarding the cranium is MOST correct?

Eighty percent of the cranium is occupied by brain tissue.

92.While performing a secondary assessment of a patient who was hit with a tire iron on the side of the head, you find a depressed area above the patient's left ear. This indicates that the patient could have which of the following?

Epidural hematoma

93.When securing a patient to a backboard, what area of the body should you secure last?

Head

12.Which of the following statements regarding secondary brain injury is correct?

Hypoxia and hypotension are the two most common causes of secondary brain injury.

86.Signs of Cushing triad include

Increased blood pressure (hypertension), Decreased heart rate (bradycardia), Irregular respirations such as Cheyenne-Stokes respiration and Biot respiration

19.Which of the following breathing patterns is MOST indicative of increased intracranial pressure?

Irregular rate, pattern, and volume of breathing with intermittent periods of apnea

94.The time between an initial period of unconsciousness and a subsequent loss of consciousness is referred to as what?

Lucid interval

75.Which of the following is NOT a symptom of a concussion?

Muscle tremors

105.Which of the following statements regarding helmet removal is MOST correct?

Padding should be placed under the occiput as the helmet is removed.

10.What part of the nervous system controls the body's voluntary activities?

Somatic

72.Neck rigidity, bloody cerebrospinal fluid, and headache are associated with what kind of bleeding in the brain?

Subarachnoid hemorrhage

43.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.

83.The brain is divided into three major areas

The cerebrum; The cerebellum;The brainstem

88.four-person log roll

The recommended procedure for moving a patient with a suspected spinal injury from the ground to a long backboard or other spinal immobilization device.

66.Which of the following statements regarding motor nerves is correct?

They carry information from the CNS to the muscles.

17.An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is

a rapid deterioration of neurologic signs.

99.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.

59.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.

68.Any unresponsive trauma patient should be assumed to have

an accompanying spinal injury.

21.A short backboard or vest-style immobilization device is indicated for patients who

are in a sitting position and are clinically stable.

42.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.

64.When controlling bleeding from a scalp laceration with a suspected underlying skull fracture, you should

avoid excessive pressure when applying the bandage.

5.A man jumped from the roof of his house and landed on his feet. He complains of pain to his heels, knees, and lower back. This mechanism of injury is an example of

axial loading.

81.You are assessing a man who has a head injury and note that cerebrospinal fluid is leaking from his ear. You should recognize that this patient is at risk for

bacterial meningitis.

84.In a(n) ________, CSF flows freely from the patient's ear; this type of injury can be difficult to diagnose with a radiograph.

basilar skull fracture

45.An epidural hematoma is MOST accurately defined as

bleeding between the skull and dura mater.

24.Which of the following sets of vital signs depicts Cushing's triad?

blood pressure, 80/40 mm Hg pulse, pulse 30 beats/min respirations, 32 breaths/min

31.The _________ is the best-protected part of the CNS and controls the functions of the cardiac and respiratory systems.

brain stem

113.A football player experienced a possible spinal injury when he was tackled. He is conscious and alert, but tells you that he is having trouble breathing. His respirations are 28 breaths/min and labored. He is still wearing his helmet. You should

carefully remove the helmet, immobilize his spine, and administer oxygen.

44.Coordination of balance and body movement is controlled by the

cerebellum.

108.You arrive at the scene shortly after a 50-year-old male fell and struck his head on an end table. The patient is conscious and alert, complains of a mild headache, and can recall the events before and after the fall. This patient's presentation is MOST consistent with a/an

cerebral concussion.

38.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.

67.The MOST common and serious complication of a significant head injury is

cerebral edema.

52.The _________ contain(s) about 75% of the brain's total volume.

cerebrum

98.The major mass of the brain is called the

cerebrum.

74.Injury to the head and neck may indicate injury to the

cervical spine.

6.The five sections of the spinal column, in descending order, are the

cervical, thoracic, lumbar, sacral, and coccygeal.

63.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.

114.What nerves allow sensory and motor impulses to be sent from one nerve directly to another?

connecting

27.Which of the following nerves allow sensory and motor impulses to be sent from one nerve directly to another?

connecting

35.When assessing a conscious patient with an MOI that suggests spinal injury, you should

determine if the strength in all extremities is equal.

33.The tough, fibrous outer meningeal layer is called the

dura mater.

47.When immobilizing a patient on a long backboard, you should

ensure that you secure the torso before securing the head.

60.Which of the following head injuries would cause the patient's condition to deteriorate MOST rapidly?

epidural hematoma

50.The hormone responsible for the actions of the sympathetic nervous system is

epinephrine.

79.The MOST important immediate treatment for patients with a head injury, regardless of severity, is to

establish an adequate airway.

7.The Glasgow Coma Scale (GCS) is used to assess

eye opening, verbal response, and motor response.

102.It would be MOST appropriate to perform a focused physical exam on a patient who

fainted and fell to the ground from a standing position.

51.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.

4.Hyperextension injuries of the spine are MOST commonly the result of

hangings.

49.Distraction injuries of the spine are MOST commonly the result of

hangings.

61.When placing a patient onto a long backboard, the EMT at the patient's _________ is in charge of all patient movements.

head

116.Airbags, in conjunction with properly worn seatbelts, are of MOST benefit when a person is involved in a

head-on crash

30.The effectiveness of positive-pressure ventilations when treating a head-injured patient can ONLY be determined by

immediate reassessment following the intervention.

57.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.

110.You respond to a motor-vehicle crash involving a small car versus a tree. When you arrive, you find the patient, a 39-year-old male, still seated in his vehicle. He is conscious and alert and is complaining of neck pain. He does not have any immediately life-threatening injuries. You should

immobilize his spine with a short backboard and remove him from the car.

71.You respond to a 38-year-old man who fell while rock climbing. He is unconscious with an open airway. The respiration and pulse rates are within normal limits. His distal pulses are intact. You check his pupils and find that they are unequal. You know this could be a sign of

increased intracranial pressure.

32.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.

58.Bleeding within the brain parenchyma (tissue) is MOST appropriately called a/an

intracerebral hematoma.

76.Cushing triad in a patient is a sign of which of the following?

intracranial pressure.

3.In contrast to a cerebral concussion, a cerebral contusion

involves physical injury to the brain tissue.

26.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.

20.A tight-fitting motorcycle helmet should be left in place unless

it interferes with your assessment of the airway.

82.When opening the airway of a patient with a suspected spinal injury, you should use the

jaw-thrust maneuver.

119.You are dispatched to a residence for a young female who was kicked in the abdomen by her boyfriend. While en route to the scene, you should ask the dispatcher if

law enforcement is at the scene

80.A high school football player was injured during a tackle and complains of neck and upper back pain. He is conscious and alert and is breathing without difficulty. The EMT should

leave his helmet and shoulder pads in place.

77.When caring for a patient with a possible head injury, it is MOST important to monitor the patient's

level of consciousness.

23.Which of the following skull fractures would be the LEAST likely to present with palpable deformity or other outward signs?

linear

90.Accounting for approximately 80% of all skull fractures, which of the following often present with no physical signs?

linear skull fractures

103.The MOST important treatment for patients with a head injury, regardless of severity, is to

maintain airway patency.

106.After removing a motorcycle helmet, you should

maintain manual stabilization of the head and apply a cervical collar.

107.A 30-year-old male experienced closed head trauma when he crashed his motorcycle; he was not wearing a helmet. As you approach the patient, you can hear snoring respirations and can see blood draining from his mouth. You should

manually stabilize his head and perform a jaw-thrust maneuver.

101.Assessing an unconscious trauma patient's airway begins by

manually stabilizing his or her head.

34.Lacerations to the scalp

may be an indicator of deeper, more serious injuries.

46.When a patient experiences a severe spinal injury, he or she

may lose sensation below the level of the injury.

115.The mesentary is/are

membranous folds that attach the intestines to the walls of the body

36.The _________ nervous system consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves.

peripheral

70.The nervous system is divided into the central nervous system and the

peripheral nervous system.

117.When a hollow organ is punctured during a penetrating injury to the abdomen

peritonitis may not develop for several hours

37.When immobilizing a child on a long backboard, you should

place padding under the child's shoulders as needed.

118.Because the depth of an open abdominal wound is often difficult to determine

prompt transport to the hospital is essential.

15.When activated, the sympathetic nervous system produces all of the following effects, EXCEPT

pupillary constriction.

22.A patient who cannot remember the events that preceded his or her head injury is experiencing

retrograde amnesia.

11.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.

28.Which of the following nerves carry information from the body to the brain via the spinal cord?

sensory

91.You are treating a patient who might have a skull fracture. What should you do if a dressing you have applied to a head wound becomes soaked?

simply apply a clean dressing over the soaked dressing

96.Battle sign is an indication of which of the following?

skull fracture

111.A young male was assaulted and is found unconscious. Your assessment reveals bruising around his eyes and blood-tinged fluid draining from his nose. You should be MOST suspicious for a/an

skull fracture.

2.You should be MOST suspicious that a patient has experienced a significant head injury if his or her pulse is

slow.

29.The spinal cord is encased in and protected by the

spinal canal.

112.You are assessing a 27-year-old female who was ejected from her car when it struck a utility pole at a high rate of speed. She is unconscious and has slow, irregular breathing. Her blood pressure is 180/90 mm Hg and her pulse rate is 50 beats/min and bounding. The MOST appropriate treatment for this patient includes

spinal immobilization, assisted ventilation with oxygen, and rapid transport.

14.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.

25.Common signs of a skull fracture include all of the following, EXCEPT

superficial scalp lacerations.

13.The ideal procedure for moving an injured patient from the ground to a backboard is

the four-person log roll.

55.If you do not have the appropriate size cervical collar, you should

use rolled towels to immobilize the patient's head.

69.Helmets must be removed in all of the following cases, EXCEPT

when there are no impending airway or breathing problems.