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Sinclair Paramedic 2150 > 2- Trauma- Head, Neck, Spine Injuries > Flashcards

2- Trauma- Head, Neck, Spine Injuries Flashcards

1
Q

What happens to intracranial blood vessels as CO2 changes

A

High CO2- Vessel dilation

Low CO2- Vessel constriction

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2
Q

Define intracranial pressure

A

Pressure of the brain and contents in skull

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3
Q

Define cerebral perfusion pressure

A

Pressure required to perfume the brain

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4
Q

Define mean arterial pressure

A

Pressure maintained in vascular system

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5
Q

Cushings Triad signs, what does it indicate, what to do for it

A
  • Increased systolic pressure
  • BradyC
  • Irregular resp pattern

Indicates Increased intracranial pressure

-20-30 RR for 5 min

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6
Q

Explain cerebral herniation syndrome

A

Brain is forced downward, pressure is applied to the brain stem, LOC decreases, rapid progression to coma

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7
Q

Cerebral herniation syndrome associated symptoms (5)

A
  • Ipsilateral pupil dilation
  • Out/downward deviation
  • Contralateral paralysis or decerebrate posturing
  • Respiratory arrest
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8
Q

What do bilaterally dilated and unreactive pupils suggest

A

Possible brain stem injury

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9
Q

What do bilaterally dilated and reactive pupils suggest

A

Possible ICP

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10
Q

Other causes of pupil changes

A
  • Hypothermia
  • Drugs
  • Anoxia
  • Ocular trauma
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11
Q

What treatment is indicated for herniation syndrome and how much for adult, children and infants and the goal

A
  • Hyperventilation
  • 20 RR, adult

25 RR, children

30 RR, infants

-Maintain 30-35 ETCO2

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12
Q

Concerns of facial injuries (4)

A
  • High vasculature, can bleed briskly
  • Possible airway compromise
  • Aspiration
  • Possible shock
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13
Q

Management of facial injuries (3)

A
  • Direct pressure
  • Airway support/suction
  • Intubate if needed
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14
Q

Management for scalp wounds, stable vs nonstable

A

Stable- Direct pressure with dressings

Nonstable- Dressings, avoid direct pressure

*Always check for instability

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15
Q

3 types of skull fractures

A
  1. Linear
  2. Depressed
  3. Compound
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16
Q

Indications to suspect a skull fracture (2)

A
  • Large contusion

- Darkened swelling

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17
Q

Management for skull fractures

A

-Dressing, avoid excess pressure

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18
Q

What is meningeal layer is damaged from a depressed skull fracture and the cause

A
  • Dura Mater

- Small objects at high speed

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19
Q

Key info of open skull fractures (3)

A
  1. High mortality rate
  2. Multi systems trauma likely
  3. Meningitis likely
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20
Q

What is a DAI brain injury

A

Diffuse atonal injury

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21
Q

Explain a diffuse injury (3)

A
  1. Generalized edema
  2. No structural lesion
  3. Most common injury from severe blunt head trauma
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22
Q

Associated symptoms of diffuse axial injury (2)

A
  • Unconscious

- No focal defects

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23
Q

Explain the diffuse axonal injury - Concussion (2) and symptoms (2)

A
  • No structural injury to the brain
  • Variable period of unconsciousness or confusion, followed by normal consciousness
  • Short term retrograde amnesia
  • Dizzy, headache, nausea, ringing in ears
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24
Q

Explain the diffuse axonal injury - Cerebral contusion (2) and symptoms (2)

A
  • Bruising of the brain, swelling may be rapid and severe
  • Prolonged unconsciousness, profound confusion or amnesia
  • Focal neurological signs
  • May have personality changes
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25
Q

Explain the diffuse axonal injury - Axonic brain injury (2) and what possibly helps with it

A
  • Small cerebral artery spasm due to anoxia
  • No-reflow phenomenon, can’t be restored after 4 to 6 min, after that irreversible damage occurs

-Hypothermia seems protective

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26
Q

Name the 3 meninges and the layer it resides (outer, middle, inner)

A

Dura Mater- Leather like, outer layer

Arachnoid Mater- Middle layer

Pia Mater- Very thin, inner layer, on the brain

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27
Q

Where does an epidural hemorrhage occur

A

Between the skull and the dura mater

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28
Q

What causes an epidural bleed

A

A linear or depressed skull fracture and the middle meningeal artery tears

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29
Q

Signs of an epidural bleed (2)

A
  • Rapid onset

- Lucid interval

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30
Q

What is the lucid interval process in terms of head injuries (4)

A
  1. Go unconscious from head injury
  2. Regain consciousness
  3. Rapid bleed develops
  4. Unconsciousness again
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31
Q

Where does a subdural bleed occur and what is it

A

Occurs between dura mater and arachnoid mater and from a venous rupture

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32
Q

What causes a subdural bleed and what people is it common in

A
  • Contusion from blunt trauma

- Common in people with repeated falls

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33
Q

2 key points about subdural bleeds

A
  1. They have the highest mortality rate for head bleeds

2. It’s slow developing, can take days to months

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34
Q

Where does an intracerebral hemorrhage occur

A

Directly into the brain tissue

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35
Q

Where does a subarachnoid hemorrhage occur

A

Between the arachnoid mater and pia mater

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36
Q

Where does a basilar skull fracture occur and what is it

A

A fracture at the base of the skull that lacerated an artery

37
Q

What are the 2 sings of a basilar skull fracture and the locations

A
  • Battle sign- Bruising behind ears, can travel down the neck
  • Raccoon eyes- Blood pools in the upper eye lid area
38
Q

Explain decorticate vs decerebrate

A

Decorticate- Arms and legs curl in towards midline

Decerebrate- Arms and legs extend out

39
Q

Name all the points of the Eye part of the GCS

A

4- Opens eyes spontaneously
3- Opens eyes to voice
2- Opens eyes to painful stimuli
1- No response

40
Q

Name all the points of the Verbal response part of the GCS

A 
5- Oriented
4- Confused
3- Inappropriate words
2- Incomprehensible sounds
1- Silent
41
Q

Name all the points of the Motor response part of the GCS

A 
6- Obeys commands
5- Localizes pain
4- Withdraws from pain
3- Abnormal flexion (decorticate)
2- Abnormal extension (decerebrate)
1- No movement
42
Q

Vital signs differences between shock and increased ICP head injury

A

Shock ICP
LOC Decreased Decreased
RR Increased Decreased (Varies)
HR Increased Decreased
BP Decreased Increased
Pulse- Narrows Widens
Pressure

43
Q

Signs of a head injury (4)

A
  • Loss of consciousness!!!
  • Retrograde amnesia (Before event)
  • Anterograde amnesia (After event)
  • Presence of CSF (Halo Test)
44
Q

Treatment for head injuries

A
  • ABC’s, O2, Monitor, IV, C-spine

- BP of 110-120 systolic

45
Q

What is most important to look for with any trauma patient

A

A medical reason that may be the cause for the trauma

46
Q

Most important thing for all eye injuries is to

A

Cover both eyes

47
Q

Treatment for small foreign objects in the eye

A

Flush with saline from the opposite side of the face

48
Q

Treatment for an impaled object in the eye

A
  • Moist sterile dressing on wound
  • Immobilize in place
  • Cover both eyes
49
Q

Treatment for a protruding eyeball

A
  • Cover with moist dressing

- Cover both eyes

50
Q

Treatment for chemical burns of the eye (2)

A
  • Force open eye, flush with saline for 20 minutes

- Bandage both eyes

51
Q

Treatment for thermal eye burns

A
  • Cover both eyes with moist sterile dressing

- Transport to burn center

52
Q

Treatment for light burns to the eye

A
  • Cover with sterile pad and eye shield

- Transport supine

53
Q

Never do what to an eye with a laceration

A

-Exert pressure or manipulate it

54
Q

An exposed eye ball with a laceration treatment

A
  • Moist, sterile dressing

- Cover with metal eye shield

55
Q

Laceration around an eye treatment

A

-Direct pressure, not on the eye ball

56
Q

What primarily causes retinal detachment and signs of it

A
  • Blunt trauma

- Pt sees flashing lights and/or specks and injection

57
Q

What do you do with contacts in eye injuries

A

Leave in place unless there is a chemical burn to the eye

58
Q

Explain the 3 different Le Fort fractures

A

LF 1. Across face between nose and maxilla

LF 2. From cheek, arches above nose through eye socket

LF 3. Across top of eye socket

59
Q

What should always be checked with a nose bleed and how to treat

A
  • BP

- Lean forward, pinch nose

60
Q

2 most common causes of nose bleeds

A
  1. Trauma

2. Hypertension

61
Q

How to treat an ear injury

A
  • Dressing between ear and scalp
  • If avulsed, wrap in moist/sterile gauze
  • Foreign body in ear, dont attempt removal
62
Q

What is at risk in a blunt neck injury

A

Larynx and trachea

63
Q

Blunt neck injury can result in what sign

A

Subcutaneous emphysema

64
Q

What is the primary damage of a spinal cord injury

A
  • At the time of force
  • Cut, torn, crushed, cut off blood supply
  • Usually irreversible
65
Q

What is secondary damage of a spinal cord injury

A
  • After time of force

- HypoT, Hypoxia, Blood vessel injury, Swelling, Compression from hemorrhage

66
Q

How many dermatology are in the body

67
Q

What is an axial loading spinal injury

A

-Vertical compression of spine

68
Q

What is a sign of a hyperflexion spinal injury and explain it

A

Lipstick sign

-Chin hyperflexes to the chest so hard that it leaves a mark

69
Q

What is a cause of a hyperextension spinal cord injury

A

Rear ended in MVC, head moves backward as the body goes forward

70
Q

What is a hyperrotation spinal cord injury

A

Over twisting/turning of the spine

71
Q

What is a distraction spinal cord injury and another name for it

A
  • Pulling of head from the spine

- Hangman’s fracture

72
Q

Around where does the spinal cord end

73
Q

What is central cord syndrome

A
  • From hyperext or hyperflex
  • Paralysis of arms
  • Electrical/tingling sensation to the ass and genitals
74
Q

What is anterior cord syndrome

A
  • Flexion injury
  • Decreased sensation below site of injury
  • Sense of touch intact
  • Paralysis is present
75
Q

What is brown sequard syndrome

A
  • Penetrating injury where 1/2 the spinal cord is torn
  • Same sided weakness, loss of pain
  • Opposite side loss of temperature senseation
76
Q

What is complete cord transaction

A
  • Complete paralysis and sensation
  • Bradycardia
  • Painful priapism
77
Q

Best way to assess pain in an unconscious patient and why

A
  • Periorbital pressure

- Even a paralyzed person can feel it

78
Q

What are 4 complications of spinal mobile restriction

A
  1. Airway compromise and aspiration
  2. Head and low back pain
  3. Life threatening hypoxia
  4. Pressure sores
79
Q

What are 7 mechanisms of injury for back boarding

A
  1. MVC above 40 mph
  2. Fall from 3x pts height
  3. Axial load injury
  4. Diving accident
  5. Penetrating wound near spine
  6. Sport injury to head/neck
  7. Unconscious trauma patient
80
Q

What 5 things make a patient a reliable source

A
  1. Calm
  2. Cooperative
  3. Sober
  4. Alert
  5. No distracting injuries
81
Q

What 5 things indicate a patient should be back boarded

A
  1. Mechanism of injury
  2. Spinal pain or tenderness
  3. Abnormal PMS
  4. Unreliable patient
  5. EMS provider has any doubt
82
Q

4 parts to spinal mobile restriction

A
  1. Manual stabilization of c-spine
  2. C-collar
  3. Back board
  4. PMS before and after immobilization
83
Q

How to log roll a patient with an unstable pelvis

A

YOU DONT!!!

84
Q

What patients require side SMR transport

A
  • Unconscious not intubated

- Pregnant (If you can tell they are)

85
Q

Can you immobilize a Peds patient in a car seat

86
Q

What must be considered with SMR of the elderly

A
  • Curvature of the spine (kyphosis)

- Can immobilize directly on the cot

87
Q

When should you remove a motorcycle helmet

A
  • Poor fitting
  • Significant neck flexion
  • Unable to manage the airway
88
Q

When should you remove an anthemic helmet

A
  • Face mask cannot be removed quickly
  • Airway cannot be controlled
  • Helmet does not securely hold the head
  • Helmet prevents stabilization
89
Q

What is best to cover an open sucking neck wound

A
  • Vaseline gauze

- OR electrode/defib pad

Sinclair Paramedic 2150 (16 decks)

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