CH 12: Spinal & Head Injuries Flashcards
General functions of the different lobes of the brain.
Frontal: Executive functions (intentions and how to accomplish them) cognition, memory/recall, abstract ideas, reasoning.
Temporal: Primary auditory cortex, memory storage, speech comprehension (Wernicke’s area)
Parietal: Tactile sensations, proprioception, kinesthesia, understanding of objects + their relationship to you
Occipital: Primary high-order visual cortex, deals with vision and seen things relationship to you, EXCEPT the ability to see.
How many PAIRS of nerve roots exit each vertebra?
1 pair on each side
What landmark does the spine enter the skull?
Foramen magnum
When the spinal cord is severely damaged or severed altogether, where does loss of function occur?
Function is impaired or lost entirely BELOW the site of injury.
What vertebrae control the phrenic nerve and why is that important for FR’s?
C3,C4 & C5 control the phrenic nerve which controls the diaphragm which controls the ability to breathe.
How can you tell the difference between a sprain/strain & a spinal cord injury?
Muscle sprains and ligament strains are usually localized and tender on palpation.
Spinal cord damage would yield crepitus of vertebrae and referred pain/numbness in places in the body inferior to site of damage.
What are 3 bony landmarks useful for locating specific vertebrae?
Scapular spine: T2/T3
Inf. angle of scapula: T7/T8
Iliac crest: L1/L2
What are the most common dangerous MOI’s? (8)
1) Fall from height >1m
2) Axial load to head
3) Anyone involved in a Motor vehicle accident
4) Unresponsive w/ unknown cause
5) Severe blunt force to head
6) Penetrating trauma to head, neck, or torso
7) Cracked helmet
8) Lighting strike/electrocution
What are the 5 types of motion involved in head/spine injuries?
- Hyper-extension
- Hyper-flexion
- Hyper-rotation
- Axial load
- Whiplash motion
When stabilizing the head during manual SMR, what is the motion that is most important to limit?
Extension of the neck
Describe axial load, and the movements commonly associated with it.
A force that is directed through the top of the head and through the spine.
Because it is rare to just land directly on top of one’s head, axial load is usually in combination with hyper extension and/or hyper flexion
What blood vessel weaves through the vertebral facet joints to provide 20% of blood flow to the brain?
The vertebral artery. As little as 20% rotation/extension can decrease blood flow through this vessel.
What are the terms used to describe bruising around the eyes and ears?
Periorbital ecchymosis: bruising under/around eyes (racoon eye’s)
Periauricular ecchymosis: Bruising under/around ears (Battle’s sign)
What are the terms used to describe CSF leaking from facial orifices?
Rhinorrhea: CSF leakage out of nose
Otorrhea: CSF leakage out of ear.
What is the halo effect?
When blood is mixed with leaking CSF. Looks like a fried egg.
What does periorbital ecchymosis usually a sign of? (More specific than just head trauma)
Facial bone fractures. The articulations of the facial bones compared the larger skull bones are much weaker and susceptible to fractures.
Why was the Canadian C-spine rule created?
The CCR was developed to simplify and standardize the assessment of patients with suspected spinal injuries.
What are the 5 steps to rule out a spinal injury using the CCR?
1) Do you have numbness/tingling in fingers? (Grip test)
2) Do you have pain in your neck?
3) Was your neck pain immediate or delayed? (Immediate = bad)
If ALL previous questions were answered “no” then proceed to step 4:
4) Palpate C-spine. Bones not soft tissue.
5) Ask patient to slowly rotate head 45 degrees left & right.
If all steps are passed, SMR can be ruled out and can be brought to their feet and removed from field to proceed with Secondary assessment.
Under what conditions can you implement the CCR checklist?
1) Patient must be ALERT (GCS = 15)
2) Vital signs are STABLE
3) >16 years old
4) No previous spinal surgeries
What are the 5 types of manual SMR and when are they best used?
1) Head grip: can be used in most SMR situations
2) Trap squeeze: same as head grip
3) Modified trap squeeze: best used for flipping patient
4) Sternal forehead grip: same as 2+3
5) Sternal/spinal grip: best used for patient in seated position or when transitioning during prone-to-supine flip.
What is In-Line stabilization and how is it best performed?
Used to bring a patient into “neutral alignment” which means having their chin in line with their neck and their spine is straight.
1) Direct patient to remain still
2) Ensure arms/elbows are completely stable
3) Place in head grip position and:
3a) ROTATE so chin is in line with sternum
3b) TILT or LATERALLY FLEX the head so nose is in line with sternum
3c) FLEX or EXTEND the head IF NECESSARY
What are the contra-indications for In-line stabilization?
1) The patients head is extremely angulated to one side
2) The patient complains of pain, pressure, or muscle spasm in the neck when moved
3) You feel resistance or crepitus when attempting re-alignment
Can cervical collars be used on their own? What will happen if a collar isn’t sized correctly? How many responders are required to apply?
No, a cervical collar is only to be used in conjunction with manual SMR, and requires 2 responders.
Too small: not enough support
Too tall: hyper extends the neck, possible causing more damage.
When would it be appropriate to board a patient?
1) If the environment is no longer safe to remain in.
2) CPR must be performed and the ground is not stable enough to resist the compressions
In what order would you apply straps to a boarded patient?
1 - Torso
2 - Pelvis & proximal legs
3 - Distal legs
4 - Head
The adult brain is divided into what 4 major brain regions? (Different than lobes)
1) Brain stem
- Vital link to brain and rest of body + autonomic functions
2) Cerebellum
- Responsible for subconscious motor control (balance)
3) Diencephalon
- Contains thalamus, hypothalamus and epithalamus
- responsible for information filtering and homeostasis
4) Cerebrum
- Seat of intelligence
- Supported on diencephalon
How should skull fractures be treated?
Always treated with SMR techniques, to minimize chance of brain trauma.
What are 4 signs that a patient may be suffering from an orbital fracture?
1) Double or tunnel vision
2) Numbness above eyebrow or over cheek
3) Massive nasal discharge
4) Eyes may not be able to follow moving objects
How should a patient with a skull impalement be treated and should the object be removed?
Heavily dress the would area in sterile gauze, with a route for blood to drain.
Avoid direct pressure on head and NEVER remove object, unless it prevents BREATHING.
Cerebral bleeding management: Epidural Hematoma (7)
- Arterial
- Forms between skull and dura mater
- Results from a low-velocity blow to head
- S/S appear rapidly
- LOR will be unresponsive briefly, become alert and then decline rapidly, becoming sluggish
- Motor function will be impaired on side of body opposite to injury
- High pressure, low SA
Cerebral bleeding management: Subdural Hematoma (7)
- Venous
- Bleeding in subdural space
- Results from violent blow to head
- S/S appear much slower, up to days later
- Bleeding is slower, so pain will gradually increase over time
- Speaking and vision will be disturbed w/ possible personality changes
- Lower pressure, over larger SA
Cerebral bleeding management: Subarachnoid Hematoma (5)
- Arterial
- Found between arachnoid membrane and pia mater
- Space is occupied by CSF circulation which builds pressure rapidly
- Can occur spontaneously from ruptured aneurysm or head injury
- Rapid onset headache
Cerebral bleeding management: Intracerebral Hematoma (4)
- Arterial or venous
- Blunt force or penetrating trauma that damages brain vessels physically
- Usually more than one contusion and can enlarge over time
- Specific S/S depend on location and size of hematoma
What is Cushing’s Triad?
It is a physiological nervous system response to acute elevations of intracranial pressure.
Characterized by 3 specific symptoms:
1) Increase in BP (typically systolic)
2) Bradycardia - onset is over 5-10 mins
3) Irregular or continuous changes in respirations
What is a Sport Related Concussion?
A traumatic brain injury caused by a direct blow to the head, neck, or body that results in an impulsive force being transmitted to the brain that occurs in sports and exercise-related activities.
What are the 5 defining characteristics of a sports related concussion?
1) Initiates a neurotransmitter and metabolic cascade, with possible axonal injury
2) S/S may appear immediately or over minutes to hours
3) All abnormalities are invisible to neuroimaging
4) Results in a range of clinical s/s that may not include loss of responsiveness
5) Does not have specific diagnostic criteria
What is the average time it takes for a concussion to resolve?
7-10 days
What are the names of concussion-specific MOI?
Coup: Initial, direct cause of damage
Typically followed by:
Contrecoup: Secondary, recoil damage of the brain hitting the opposite side of the coup
What are the 6 clinical domains of a concussion?
1) Symptoms (somatic, cognitive or emotional)
2) Physical signs (LOR amnesia, neurological deficit)
3) Balance impairment (unsteady gait)
4) Behaviour changes (irritability, sadness, aggression)
5) Cognitive impairment (slowed reaction times)
6) Sleep disturbances (Drowsiness and trouble falling/staying asleep)
What parts of Primary and Secondary Assessment are modified to detect concussions?
Primary: Refer to list of Red Flags and see if any are present during assessment
Secondary: Add a SCAT (Sport Concussion Assessment Tool) to assessment
When a player shows ANY signs, or complains of any symptoms of a concussion, what 5 things must be done?
1) Do not allow RTP same day
2) Do not leave player alone
3) Should be assessed and continuously monitored for changes
4) Should be seen be an MD
5) Must follow a closely monitored and gradual return to play process
Why is it important to monitor concussed players for hours/days post injury? (Specifically GCS)
Intracranial bleeding can be very delayed for hours or even days post injury. GCS should be assessed at
- Time of injury
- 2-3 hours post
- 24 hours post
- 48 hours post
- 72 hours post
(Best case scenario)
What is Post-Concussion Syndrome? When does a normal concussion on average resolve itself?
A blanket term used for the many symptoms that commonly occur after a concussion. Any combination of physical, cognitive, behavioural or emotional symptoms will usually persist beyond 3 months.
A normal concussion will normally resolve within 7-10 days.
What is Second Impact Syndrome, and why is it relevant for AT’s to be aware of it?
Can occur when a second head trauma is inflicted before the first one has resolved. The second blow could occur within minutes days or weeks from primary injury and could be fatal.
AT’s must recognize S/S because an athlete could have been cleared to RTP prematurely.
Very few confirmed cases of this exist, so exact pathophysiology of this is unknown.
What is CTE?
Chronic Traumatic Encephalopathy causes nerve cell death, resulting in brain tissue degeneration. Can occur in athletes who have been exposed to multiple concussions/repetitive head impacts. Not well understood but doesn’t seem to be related to singular head injuries.
At this time, only diagnosable upon death.
