Paramedic Vol 4 Chapter 6
Zone 2
Aboce cricoid ring and below angle of jaw
Zone 3
Above angle of jaw, cranial nerves and larger vascular structures
Sympathetic nervous Systems
Adjusts body metabolic rate to waking activity "fight or flight" functions when body comes under threat or extreme stress
Bony fragments or pressure compressing arteries; perfuse anterior spinal cord
Anterior cord syndrome
transmits signals upward to brain
Ascending tracts
Increasing blood pressure to maintain CPP and cerebral perfusion
Autoregulation
Zone 1
Below cricoid ring: Great vessels and trachea
Central processing center; communication junction among cerebrum, spinal cord, cranial nerves, and cerebellum
Brainstem
Combination of increasing blood pressure, slowing pulse, irregular respirations is classic signs of
Brainstem pressure or injury
Penetrating injury that affects one side of cord (Hemitransection)
Brown-Sequard Syndrome
Nerve roots at lower end of spinal cord compressed, interrupting sensation and motor control
Causa equina syndrome
Hyperextension of cervical spine, as might occur with forward fall and facial impact
Central cord syndrome
Blunt trauma to brain tissue; produces capillary bleeding into brains substance
Cerebral contusion
Clear, colorless solution of water, proteins, and slats that surrounds central nervous system and absorbs shock of minor acceleration and deceleration
Cerebralspinal Fluid (CSF)
Performs higher functions; center of consciousness thought, personality, speech, motor control. visual, auditory, tactile (Touch) perception
Cerebrum : Largest Nervous System Element
Cyclic breathing pattern characterized by periods of respirations of increased rate and depth alternating with periods of apnea?
Cheyne-stokes respirations
Hypoglossal Nerve (XII)
Controls muscles of tongue
Parasympathetic Nervous System
Controls rest and regenerative functions
Brainstem (midbrain, pons, medulla)
Conveys motor and sensory information and mediates important autonomic functions
Causes injury away from primary impact point as brain, floating in cerebrospinal fluid inside cranium, sloshes toward impact, then away from it, again impacting interior of skull
Countercoup injuries
Occur directly of impact as brain moves toward and collides with interior of the skull
Coup Injuries
12 distinct pathways: important senses, innervate facial area, control significant body functions
Cranial Nerves
-Skull: bony structure supporting head and face -Cranium: vault for brain; bones fused together at pseudo joints (sutures) -Facial bones: skeletal base for face
Cranium
Circular ring between thyroid cartilage and trachea
Cricoid cartilage
Transmit signals downward through cord
Descending tracts
Bleeding between dura mater and skull's interior surface
Epidural hematoma
Divides cerebrum into right and left hemisphere
Falx cerebri
Occur as specific location in brain; contusions and intracranial hemorrhages
Focal injuries
Le Fort 2
Fracture of both the maxilla and nasal bones
glossopharyngeal nerve
IX
Cushing's triad consists of:
Increased systolic BP, decreased heart rate, and abnormal respirations.
Reduces cereal perfusion; can severely damage brain tissue
Intracranial Pressure (ICP)
Ruptured blood vessel, releases blood into brains substance, blood loss minimal, increases intracranial pressure
Intracranial hemorrhage
Dominant hemisphere, mathematical computation, writing, language, interpretation, speech
Left cerebral hemisphere
Respiratory rate, cardiac center, vasomotor center
Medulla oblongata
Pulse pressure widens, heart rate bradycardia, respirations deep and rapid, pupils sluggish or non reactivity, signs of
Middle brainstem
Facial Nerve (VII)
Movement of facial expression muscles, taste (from anterior 2/3 of tongue)
Control pupil size
Oculomotor nerve
Severe and life threatening, due to gunshots, stabbings, explosions, propelled objects from blast, knife wounds
Penetrating Injuries
Communication interchange between central nervous system components
Pons
Non dominant hemisphere processes nonverbal imagery (Occipital region)
Right Cerebral hemisphere
-Strong and flexible layer of skin, fascia, muscle tissue; extremely vascular -Hair insulates brain from environmental temperature -Only loosely attached to skull
Scalp
-Paralysis of extremities -Pain with and without movement -Tenderness along spine -Impaired breathing -Spinal deformity -Posturing -Priapism -Loss of bowel or bladder control -Nerve impairment to extremities
Signs and Symptoms of Spinal Injury
What does SCALP stand for?
Skin Connective tissue Aponeurosis Loose connective tissue Pericranium
33 bones, main support for axis of body
Spinal column
Bleeding within meninges, specifically beneath dura mater and within subarachnoid space
Subdural hematoma
Fibrous sheet, separates cerebrum from cerebellum
Tentorium cerebella
Establishes and maintains consciousness pathways for optic and olfactory nerves.
Thalamus
-Pinna: visible outer portion -External auditory canal: glands secrete wax (Cerumen) for protection -Middle and inner ear: structures required for hearing
The Ear
-Specialized connective tissues -Dura Matter: Outermost meningeal layer -Pia Mater: Meningeal layer closest to brain and spinal cord -Arachnoid membrane: separating the two layers of mater is stratum of connective tissue
The Meninges
Le Fort 3 Fracture
This fracture involves separation of all the facial bones from their cranial base. It includes fracture of the zygoma, maxilla, and nasal bones.
Numerous C shaped cartilages to keep trachea open
Trachea
Traumatic insult to brain capable of producing physical, intellectual, emotional, social, and vocational changes
Traumatic Brain Injury (TBI)
Trochlear Nerve (IV)
eye movement
Trigeminal Nerve (CN V)
large nerve (mostly GSA) with a wide distribution to the face and scalp; it has a smaller SVE component to the muscles of mastication; important nerve and branches from other cranial nerves join to distribute with it; divides into 3 separate branches
Abducens Nerve (VI)
lateral eye movement
Oculomotor Nerve (III)
narrows pupil and focuses lens
olfactory bulb and tract
sense of smell
vagus nerve X function
sensory and motor: 70% of the parasympathetic division of the ANS
Le Fort 1 Fracture
slight instability to maxilla; no displacement
Acoustic Nerve (VIII)
special sense of hearing and balance
Accessory Nerve (XI)
swallowing, head, neck, and shoulder movements
concussion
violent shaking up or jarring of the brain
Optic Nerve (II)
vision
Diffuse injuries
♥Diffuse Axonal Injury (DAI) •Follows acceleration-deceleration injuries where there is a rotational element •Characterized by mild to severe axonal injury •Results in scattered, diffuse loss of function •A continuum of injury from DAI ranges from concussion to persistent vegetative state