8) Head, Neck, SC Flashcards
National Head Injury Foundation defines (TBI) as:
“a traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes.” It is classified as a direct or indirect injury to the tissue of the cerebrum, cerebellum, or brainstem.
Head injury is especially what PTs & why:
= very young PTs b/c: head size relative rest of body, neck flexibility, inability to self-protect
Shortened Nrv. pathway involved in a reflex action is:
Speed of reflex ultimately allows for
= reflex arc
= quick responses, reducing the seriousness of injury. Other reflexes help stabilize the body if it stands in one position for a length of time.
Reflex arc:
Acquires impulse speed via:
= sensory ascending Nrv. pathway involved in reflex action
= Short pathway
2 specific types of direct brain injury:
Direct brain injuries 2 categories:
= are coup and contrecoup injury (Figures 57-29)
= focal or diffuse (can onlt be assigned 1)
Coup injuries) occur @:
Most commonly collides/hurts:
Least commonly collides/hurts:
Possible injury:
= point of impact as brain moves toward/collides w/in skull
= frontal region b/c its interior surface is rough & irregular
= occipital areas b/c smooth, and coup injuries occur less
= brain slides along rough contours @ base of the skull
Contrecoup) def/:
S/S:
Most common injury:
= brain “sloshes” toward impact & then away from it, again impacting the skull’s interior
= blow to forehead might cause injury to the occipital region (visual center) & produce visual disturbances (“seeing stars”).
= frontal (from impact to occipital) b/c frontal bones have irregular inner surface.
ipsilateral:
Contralateral:
= same side
= opposite side
Le Fort I:
Le Fort II:
Le Fort II:
= horizontal line maxilla
= /\ break above nasal hole ending of posterior zygomatic
= W of nose/eyes
Sig/ head injury PT should receive/maintain oxy/ if < than:
If spinal injury is suspected, head & neck should be pos/ed:
Hypos for brief time can worsen outcome of head injuries:
= 96%
= gently moved into a Neutral position
= hypotension & hypoxia
Angionecrosis Edema:
Trimsmis:
Mentim:
= angioedemna
= Locked jaw
= tip of chin
“Anvil” of ear:
= Stapes
Any expanding lesion within the cranium results in
a increase in intracranial pressure
Baroreceptors) Fn:
A&P:
= receptors that monitor blood pressure
= Great vessels recept/ Gives feedback to brain > Sympathetic NS Activation, AArch & carotid arteries> feedback to medulla >SNS
Basilar Skull Fracture is fracture of:
Usually involves a fracture of the cribriform plate
Blood-Brain Barrier) built so:
Prevents & Protects:
= CNS capillary walls thicker, more complete, not as permeable as elsewhere in body.
= Doesn’t permit interstitial flow of proteins & materials as freely as normal capillaries, Protects w/ need lipid loving to get through, anything that can get through can cause damage
Brain perfusion] Cerebral Perfusion Pressure (CPP) form:
MAP’s relation w/ perfusion:
Head injury PTs will have increase BP b/c:
= MAP – ICP (Norm/ ICP between 5-15 mmHg average 10mL)
= MAP needs to stay > ICP to maintain brain perfusion
= increase MAP helps to keep the MAP>ICP. (bodys attempt to compensate)
Body makes how much CSF in 24Hrs
What structure is maker:
~500-600mL
Bone usually fractured in basilar skull fracture:
= Cribriform plate
Brain Herniation) def/:
Initial stages:
Late Stage:
S/S:
Para/Sympathetic Nervous System affect:
= Trauma causes swelling inside skull
= blood & CSF are compressed out.
= Increasing ICP forces brain out foramen magnum (can cause cushings)
= 1 pupil sluggish or dilated, or unequal (anisocoria), Decorticate or Decerebrate posturing, Abnorm/ Resp/s, Severe altered/LOC, Weakness/Paralysis, Projectile vomiting
= Cuts off PSNS response thus + SNS (SNS thoracic lumbar) (PSNS cranial sacral)
Brain Injury) 1 S/S:
2 Treatment of Brain Herniation:
3 Vent/ing Brain Herniation:
4 Do not let PT become:
5 Note with ETCO2 & ICP:
1= AMS, Alterations in personality, Amnesia, Cushing’s triad
2= Maintain ETCO2 between 30-40, Vent/ at upper end of norm/, Admin IV fluids for SBP 90-100,
3= Adults: No more 20 per/min, Children: No more 30per/min Infants: No more 35 per/min
4= hypoxic or hypovolemic
5= Norm ETCO2 35-45 but controlled hypervent/ 30-40
(if overoxygenate can actually decrease amount going to brain)
Brain perfusion) circulation lacks:
circulatory main structures:
= Lymphatic system replaced by the CSF flow system.
= internal carotid & basilar arteries interconnect via circle of Willis @ base of the brain.
Pons:
Medulla Oblongata:
= Communication interchange between CNS components
= Respiratory center, cardiac center, vasomotor center.
Flow ends/drains:
= Venous drainage occurs initially through bridging veins that drain cerebral surface & “bridge” w/ dural sinuses (large, thin-walled veins) & ultimately drain into internal jugular veins & lastly superior vena cava.
Mid brain) 1 Hypothalamus:
2 Thalamus:
= “homeostasis” Endocrine Fn, N/V reflex, hunger, thirst, kidney Fn, body temps, emotions
= Establishes & maintains consciousness; pathways for optic & olfactory nerves
Cauda Equina Syndrome) def:
Usually caused by:
S/S:
= Nerve roots @ lower end of SC are compressed
= herniated disc, tumor or infection
= Loss of bowel & bladder control – Saddle anesthesia
Central Cord Syndrome) Usually results from:
Considered what type of injury:
S/S:
More commonly seen in patients:
= hyperextension of the cervical spine
= incomplete cord injury
= motor loss/weakness to upper EXTRMs & bladder Fn loss
= >50 years of age &/or w/ arthritis
Cerebellum Fn:
location:
Brainstem + Cerebellum:
= Coordinates: Fine Motor, Posture, Equilibrium, M. tone, CN8
= Located in the posterior fossa
= Hindbrain (Contains 2 hemispheres)
Both brain & SC bathed in what acting as cushion & vol:
= CSF~150mL; watery, clear fluid that acts as cushion
Cerebrum) lobes
= occipital, temporal, parietal, frontal
Cerebrum) 1 Frontal Lobe
2 Broca’s Area
3 Central Sulcus/Fissure
4 Parietal Lobe
5 Postcentral Gyrus
6 Precentral Gyrus
7 Occipital Lobe
8 Temporal Lobe “Hearing & Language”
9 Cerebellum “Balance & Coordination” fine motors
10 Pons
11 Medulla Oblongata
12 Corpus callousum
1= “Personality”
2= Broca’s Area
3= Central Sulcus/Fissure
4= “Sensory” Wernicke’s Area “speech comprehension”
5= Primary sensory cortex
6= Primary motor cortex
7= “Vision”
8= “Hearing & Language”
9= “Balance & Coordination” fine motors
10= Pons
11= Medulla Oblongata
12= Corpus callousum
chemoreceptors=
in the carotid bodies and in the arch of the aorta. These chemoreceptors are stimulated by decreased PaO2, increased PaCO2, and decreased pH
Choroid plexus) located & Fn:
CSF flow starts at 1:
CSF through surrounding 2:
CSF returned to3:
CSF dumped off 4:
=in brain ventricles gen/s CSF in largest 2-4 ventricles
= lateral ventricles to 3rd & 4th ventricle
= through subarachnoid space surrounding brain & SC
= venous circulation through arachnoid granulations
= dural sinuses of brain & through spinal arachnoid space to arachnoid villi found @ end of SC (spinal cistern)
CN 10:
= vagus “wondering” parasympathetic F.s: HR, digestion, & RR & also provides sensory info from throat & voice box.
CN 11:
= Accessory = traps Muscles motor
CN 12:
= Hypoglossal = motor tongue control out “12 & 21 baskin robin flavors”
CN 1:
= Olfactory → smell “1 nose”
CN 2:
= Optic → vision (sensing light) “2 eyes”
CN 3,7,9,10
Pupil correlates w/ L. of injury EX right pupil blown is right brain trauma
CN 3:
= Oculomotor: pupil m-vt (controls pupils sizes) “3 words cocaine constricts pupils”
CN 4:
= Trochlear: eye motor function (look up & down) “it go up, down, up, down”
CN 5:
= trigeminal “suicide “= chewing muscles (chewing mastication), Sensory→Ophthalmic (forehead), maxillary (cheek)& mandibular (chin) “5 fingers to the face/chew”
CN 6:
= abducens= Lateral Eye m-vt “6 letters (TO SIDE)”
CN 7:
= facial: controls facial expressions, taste @ front 2/3s of tongue, & some F.s of salivary & lacrimal glands “L I C K M A D”
CN 8:
= vestibulocochlear= sense hearing, balance, equilibrium
CN 9:
= glossopharyngeal= controls taste @ back of tongue, helps w/ swallowing by saliva production. “9 lime”
CNS) The Brain: Makes up ~ what% of cranial vault
Cranium’s 3 major structures
= 80%
= Cerebrum, Cerebellum, Brainstem
Coup Injuries:
Contrecoup Injuries:
= Occur directly at the point of impact as the brain moves towards and collides with the interior of the skull
= Occurs at the opposite side of the direct impact * Brain sloshes backward and collides with the interior of the skull
Cranial nerve location mnemonic:
Nerve locations:
= “Sexy EMTs Play Erotic Jokes, Exciting Their Erotic Lover’s Asshole Stimulating Them.”
= Sniffer- smells (Olfactory)
= Eyes - Eyesight (Optic)
= Pupils - Pupils & eye movement (Oculomotor)
= Eyes = eyes movement (Trochlear)
= Jaw -mastication (Trigeminal: sense face & motor jaw)
= Eyes - Eye movement (Abducens)
= Taster - Taste & facial expression (Facial)
= Ears - Ears hearing & balance (Vestibulocochlear)
= Licker- tongue taste & swallow (Glossopharyngeal)
= ABDMN- Autonomic control thorax & ABDMN (Vagus)
= Shoulders -shrug & neck m-nt (Spinal Accessory)
= Tongue - Tongue movement (Hypoglossal)
Cranial nerves carrying parasympathetic nerve fibers?
CN: 3,7,9,10
Cranial nerves name mnemonic:
Cranial nerve names:
= “Oh, Oh, Oh, To Touch And Feel A Girl’s Vagina, Such Heaven!
1. Olfactory
2. Optic
3. Oculomotor
4. Trochlear
5. Trigeminal
6. Abducens
7. Facial
8. Vestibulocochlear (or Auditory)
9. Glossopharyngeal
10. Vagus
11. Spinal Accessory
12. Hypoglossal
Cushing’s triad, a classic sign of brainstem injury includes
Bradycardia, Hypertension, irregular rhythm of vent/s
decorded position=
flexing forearms outwards
decortit position=
flexing forearms inwards
Mandible injuries S/S:
= Misalignment of the teeth, Numbness of the chin, inability to open the mouth
Diffuse Axonal Injury) Caused by:
3 Classification categories:
Nerves can repair selfs b/c schwan cells but never back to 100 b/c scar tissues (make new neurons daily)
= direct blow to the head * Severe acceleration/deceleration
= Mild diffuse axonal injury (mild concussion) – Moderate diffuse axonal injury (classic concussion) – Severe diffuse axonal injury (brainstem injury)
DRG dorsal respiratory group=
keeps in check w/ VRG
Ears) Pinna:
External auditory canal Glands:
Middle & inner ear:
Semicircular canals:
= Visible outer portion of the ear
= secrete wax (cerumen) for protection
= Structures required for hearing
= balance/ equilibrium
Endotracheal intubation indications:
= breathing fail/arrest, cardiac arrest, airway closing/needs to be protected
Epidural Hematoma) what & where:
Nearly always the result of:
Commonly hand & hand w/:
= Accumulation of blood between the skull and dura mater
= blow to the head that produces a linear fracture
= hand & hand w/ basilar skull fracture
Eye Injuries) Lacerations:
If laceration of globe itself:
If part of eyeball exposed:
Eye Extrusion:
= Bleeding maybe heavy, but usually controlled w/ gentle P.
= apply no pressure to the eye.
= moist sterile dressing prevents drying. Cover injured eye
w/ protective metal shield/cup or sterile dressing & other eye
= DONT reposition simply cover wet & other
Eyes) supply:
Outside of eye gets oxygen from atmosphere not venous system
~70% of eye sits inside skull
Face) Facial Bones:
Skin, SubC tissue & small muscles Blood supply:
Facial Nerves:
= Zygoma, maxilla, mandible, nasal bones
= External carotid artery, facial, temporal, & maxillary arteries
= Trigeminal (CN-V) (controls mastification) – Facial (CN-VII) * Bell’s palsy
Foreman magnum Fn & relation w/ brain
hole for SC & Brain stem sit right above hole
CLs) Temporal Lobe) know:
Functions:
= sensory processor
= Hearing & auditory processing, memory storage (hippocampus is located here), language comprehension (Wernicke’s area, typically left hemisphere), emotional responses & smell processing.
CLs) Frontal Lobe) know by:
Fn:
= Personality
= Motor control (primary motor cortex), problem-solving, decision-making, & planning (executive functions), personality & emotions, speech production (Broca’s area, typically left hemisphere).
Gray matter:
White matter:
= (cell bodies) sensory processing
= mostly comprising communication pathways (axons) motor
“Hammer” of ear:
= Malleus “both have M”
Categories of Motor Pathways:
Categories of somatosensory Pathways:
=
= posterior funiculus-medial lemniscal pathway, Anterolateral pathway, Spinocerebellar pathway
SC) 1 white matter surround & covered w/
2 White matter forms what bundles/columns:
3 White matter composed of:
4 Ascending SC tracts Fn:
1= surround Gray matter & covered w/ myelinated Nrv-fibers
2= Anterior, Lateral, & Posterior white columns
3= (Axons) Nrv-cell pathways
4= Transmit sense/info signals up to brain
SC) 1 white matter surround & covered w/
2 White matter forms what bundles/columns:
3 White matter composed of:
4 Descending SC tracts:
1= surround Gray matter & covered w/ myelinated Nrv-fibers
2= Anterior, Lateral, & Posterior white columns
3= (Axons) Nrv-cell pathways
4= message/effector to end of tract “Brain to Motor)
Hering-Breuer reflex=
prevents over expansion of lungs from inhalation>
During inspiration, lungs become distended, activating stretch receptors.
Epidural Hematoma)
= Hx head trauma, Rapid onset of symptoms, LOC, Lucid interval (min-hours), +ICP w/ N/V/AMS, Lapse in unconsciousness, paralysis on contralateral side of head injury, Dilated, fixed pupil on ipsilateral side., Death
PTs usually have better outcome b/c acute symptoms
H/A, blurry vision, N/V
Venous fast bleed
white matter, then form three bundles or columns of myelinated (covered with a protein sheath) nerve fibers on each side of the cord around the gray matter: the anterior white column, the lateral white column, and the posterior white column. This white matter composed of nerve cell pathways called axons contains bundles of axons that transmit signals upward to the brain in what are called ascending tracts and bundles that transmit signals downward through the cord in what are called descending tracts. These tracts are paired with one ascending and one descending on each side. Injury can affect either or both.
white matter, then form three bundles or columns of myelinated (covered with a protein sheath) nerve fibers on each side of the cord around the gray matter: the anterior white column, the lateral white column, and the posterior white column. This white matter composed of nerve cell pathways called axons contains bundles of axons that transmit signals upward to the brain in what are called ascending tracts and bundles that transmit signals downward through the cord in what are called descending tracts. These tracts are paired with one ascending and one descending on each side. Injury can affect either or both.
Rear-impact auto collision can cause what type of neck injury
Injuries that produce tissue damage on the opposite side of the point of impact are called:
= Hyperextension
= Contrecoup injuries
Hypoadrenalism
- hard response to stress
Indirect Brain Injury) def/:
Cause:
= Diminishing circulation to brain tissue (ICP)
= Increasing ICP exacerbated by hypoxia, hypercarbia, systemic hypotension(must maintain BP & O2)
Diceph/) Insular Lobe) know by: Critical processor
Fns:
Location:
= Critical processor
= Taste perception, emotional responses & self-awareness, visceral functions (EX: heartbeat, breathing).
= Deep within the lateral sulcus, beneath the frontal & temporal lobes. (hidden beneath temporal & frontal lobes)
intervertebral disc) def:
Nucleus pulposus:
Annulus fibrosus:
= separates each vertebrae but C1/2 & fused vertebrae of sacrum & coccyx
= inner sphere, gelatinous and absorbs compressive stress
= outer collar, contain the nucleus pulposus.
Intracerebral Hemorrhage) located @ & from:
Note w/ symptomology:
S/S:
= w/in brain tissue w/ Penetrating & blunt injuries
= may vary, mimics CVA, Depends on regions & severity
= AMS commonly, Thunderclap H/A, Vomiting, 1 dilated pupil, rapid deterioration
Intracranial Perfusion) Brain perfusion may be disrupted by:
Any reduction in cerebral blood flow triggers:
If pressure continues to expand:
Brain’s response to high CO2 & increasing ICP causes:
= increasing ICP, hypotension,
= BP rise (autoregulation) for adequate cerebral perfusion
= ICP becomes so high, ICP can impead on Fn or SC
= hyperventilation and hypertension
Jaw wire shut: cut if absolute need airway access} cut wires going bottom to top
Wire jaw PTs will go back into surgery if wires cut bc mandible if mandible broken, theyll not be able to open mouth
Maxilla fractures require immense force
Kiesselbach area(little area)=
where 4 different arteries connect together→ super vascular
Le Fort Facial Fractures) Le Fort 1:
Le Fort 2:
Le Fort 3:
= Slight instability to maxilla; no displacement
= Fracture of both maxilla & nasal bones
= Fracture involving entire face below brow ridge (zygoma, nasal bone, maxilla)
Le Fort II and III fractures usually result in
cerebrospinal fluid leakage
Linear skull fracture:
less severe most common
Linear skull fractures are
small cracks in the cranium and represent about 80 percent of all skull fractures
Maxillary fractures MOI & S/S:
types of facial fracture:
= blunt-force, high energy impacts & Massive angioedema, facial crepitus, Misalignment of teeth
Meninges) Protective membranes that cover the entire CNS:
Layers of the meninges:
= Protective membranes the cover the entire CNS
= Dura, Arachnoid Mater, & Pia Mater
Most head injury PTs who’re in a coma & likely to need endotracheal intubation have a GCS score of:
8 or less
Most of the cranial cavity is occupied by the:
Cerebrum
Neck) Zones) Zone I:
Zone 2:
Zone 3:
= Below cricoid ring (Highest mortality w/ injury)
= Great vessels & trachea @ cricoid ring & below angle of jaw( Injuries more common)
= Above angle of jaw, CNs & larger vascular structures
Neurogenic Shock) def:
Problems:
Occurs @ causing:
= SC/Brain Injury disrupts ability to control body autonomic Fns = “pipe” problem, Unable to maintain BP, Severe reduction CO
= above T-vertebrae, loss of all SNS innervation, causing widespread BP plummet
Occipital Lobe) know by: all ojos
Functions: Visual processing & interpretation, recognizing shapes, colors, & motion
= all ojos
= Visual processing & interpretation, recognizing shapes, colors, & motion
Ocular Muscles do what & Innervated by 3CNs:
Remember by:
= control eye m-nt by Oculomotor (CN-III), trochlear (CN-IV),& abducens (CN-VI)
= OCULAR MUSCLES is 13 letters = CN 3+4+6
Vertebral ligaments:
ligamentum flavum:
interspinous ligament:
supraspinous ligament:
nuchal ligament:
= Primarily located posteriorly & connect vertebrae together
= strongest supporting ligament of vertebral column, helps maintain curvatures of spine & straighten spine after flexing
= Thin ligament connects spinous processes of 2 adjoining vertebrae together
= runs posteriorly along the spinous processes from the seventh cervical vertebra to the sacrum
= protects & supports the neck. It runs from the seventh cervical vertebra to the skull’s occipital bone
Parietal Lobe) Know:
Function:
= Sensory perception (touch, temperature, pain)
= Sensory perception (touch, temp, pain), spatial orientation & awareness of body position, understanding language (Wernicke’s area, typically left hemisphere).
Spinal Canal) Vertebral Foramen:
Articular facets:
Back, chest, pelvic muscles provide:
kids can hyperflex more vs adults b/c:
= Contains and protects spinal cord
= form joint between vertebra (above & below) Held in place by various lig/s
= supports. (post&anterioer longitudinal ligament) (Intervertebral disc & body of vertebral)
= kids have larger wedges compared to adults
Spinal Cord Syndromes) Anterior Cord Syndrome:
Results from:
S/S:
Commonly seen w/:
= bony frag/s or pressure compressing arteries of anterior SC
= severe extension-flexion injury
= Loss of motor, sensory, light, & temp/ Fn below injury site
= Old & pedis rear end MVC w/ improper head restraint
Spinal Nerve Plexuses) def/:
Locations:
Key myotomes for neurologic evaluation:
Dermatomes
= sensory components of spinal nerves innervate specific & discrete surface areas called dermatomes
= distributed from the occiput of the head to the heel of the foot and buttocks.
= arm extension (C-5), elbow extension (C-7), small finger abduction (T-1), knee extension (L-3), & ankle (plantar) flexion (S-1).
“Stirup” of ear:
= Incus
Subdural Hematoma) what & where:
Occurs after or w/:
Deadly b/c:
Meningies involveved & most common vessel:
= Accumulation of blood beneath dura mater but outside brain = falls or injuries involving strong deceleration forces
= Venous bleed slower S/S onset slower High mortality
= Dura & arachnoid involved} Most common vessel is the superior sagittal sinus
The cranium’s several bones fused together at called
pseudojoints called sutures.
maxillary bone projects:
Zygoma:
Soft tissue of eyelids/lashes
= inferiorly & medially, eye socket/orbit, part of cheek
= cheek bone, completes protection of orbit laterally & inferiorly
= give additional protection to the very sensitive and critical ocular surface.
The sensory components of the spinal nerves that innervate specific and discrete surface areas are called:
Dermatomes
The spinal cord ends in the area of:
By adulthood, sections of spinal column that’ve fused are:
= L1/L2
= Coccyx & Sacrum
Vertebral arch is formed:
pedicles:
Laminaes:
transverse processes & superior & inferior articular processes project from: (Figure 57-12). The superior and inferior articular processes (otherwise known as facet joints) comprise the joints between one vertebra and the vertebrae immediately above and below it.
= 2 pedicles & laminaes
= protrude posteriorly connecting vertebral body to laminae
= posterior to pedicles & connect midline spinous process to pedicles on either side.
= the junction of the pedicles and the laminae
lobe that controls Fns as N/V reflex, hunger, thirst, & temp:
Hypothalamus
CNS blood supply) 1 Brain receives ~ of body’s blood flow/min:
2 Circle of Willis:
3 comprised of:
1= ~15- 20%
2= system “circle of feeders” coming off 4 arteries that provide supplements (blood oxy glucose) to brain
3= Carotid system (anterior) & Vertebrobasilar system (posterior)
Clear, watery fluid filling the posterior chamber of the eye
Fluid that fills anterior chamber separated by lens
- Vitreous humor
- Aqueous humor
