Ch 28 Head And Spine Injuries Flashcards
Sections of spine and #
Cervical 1-7 Thoracic 1-12 Lumbar 1-5 Sacrum 1-5 Coccyx 1-5
Signs of a skull fracture
Ecchymosis- raccoon eyes and battle signs
CSF out of ear/blood
Linear skull fracture
Account for 80% of skull fractures; also referred to as non-displaced skull fractures. Occur commonly in the temporl-parietal region; Usually no scalp signs, needs CT to notice
Uninjured brain + NO scalp lacs = non-life threatening
Linear skull fracture + scalp lacs = high risk of infection and bleeding inside of the brain
Depressed skull fracture
High engergy trauma with blunt object
Usually in frontal or parietal bones
Loss of consciousness
Basilar skull fractures
Usually occur following diffuse impact to the head and generally result from extension of a linear fracture to the base of the skull and can be hard to diagnose
Crashes or falls
CSF through the ear (bacterial meningitis risk)*
Racoon eyes/battle signs
Open head injuries
Injury to the head often caused by penetrating object in which there may be bleeding and exposed brain tissue
Intracranial pressure
ICP; Increased ICP squeezed the brain agains boney prominences; Accumulation of blood in cranium
Signs of ICP:
Headache, nausea, bradycardia, Cheyne-Stroke respirations, Ataxic (biot) respirations, etc.
In supine patients, head should be elevated 30 degrees to help reduce ICP
Cheyne-stokes
Respirations go from fast to slow
Ataxic (biot) respirations
Irregular rate, pattern, and volume respirations
Epidural hematoma
Collection of blood betweeen skull and dura mater
Usually back and fourth between consciousness and unconsciousness
Pupil on side of the hematoma becomes fixed and dilated
Subdural hematoma
Blood beneath dura matter, on top of brain
Strong deceleration injuries and falls
Intercerebral hematoma
Brain tissue bleeding, also referred to as intraparenchymal hematoma
High mortality rate
Subsrachnoid hemorrhage
Loon for CSF
Trauma/aneurism
Neck rigidity/ headache
Concussion
Temporary loss or alternation of a part or all of the brain’s ability to function without acute physical damage to the brain.
Mild injury where brain swells
Retrograde amnesia
No memory of before the injury
Anterograde amnesia
No memory of right after the injury
Contusion
More severe concussion where brain tissue is damaged more severely and permanently
Cushings reflex
Increased BP
Decreased pulse
Irregular respirations
How many emt’s are required to immobilize a standing patient
Three
Vaccum mattress uses
Reduces pressure point tenderness
Provides comfort
Provides thermal insulation
Axial loading injuries
Injuries in which load is applied along the vertical or longitudinal axis of the spine, which results in load being transmitted along the entire length of the vertebral coloms (e.x. falling from a height and landing on the feet in an upright position)
Battle signs
Bruising behind an ear over the mastoid process that may indicate a skull fracture
Cerebral edema
Swelling of the brain; may not develop until several hours following the initial injury
Aggravated by low oxygen levels - ensure viable airway, ventilations and high-flow O2
Closed head injury
Injury in which the brain has been injured but the skin has not been broken so there is no obvious bleeding
Coup-Contrecoup injury
Dual impacting of the brain into the skull; coup injury occurs at the point of impact, countercoup injury occurs on the opposite site side of the impact as the brain rebounds
Eyes forward position
A head position in which the patient’s eyes are looking straight ahead and the head and torso are aligned
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
Intervertebral disk
The cushion that lies between two vertebrae
Meninges
Three distinct layers of tissue that surround and protect the brain and spinal cord within the skill and spinal canal
Dura mater - tough fiberuos, forms a sac to contain the CNS
Arachnoid & Pia mater - contain blood vessels that nourish the brain and spinal cord
When all layers are penetrated, CSF may leak
Primary (direct) injury
Injury to the brain and its associated structures that is a direct result of impact to the head
Racoon eyes
Bruising under the eyes that may indicate a skull fracture; typically a late sign
Secondary (Indirect) injury
The after effects of the primary injury; includes abnormal processes such as cerebral edema, increased intracranial pressure, cerebral ischemia and hypoxia, and infection; onset is often delayed following the primary injury
Subarachnoid hemmorage
Bleeding into the subarachnoid space where CSF circulates
Traumatic Brain Injury
TBI; a traumatic insult to the brain capable of producing physical, intellectual, emotional, social and vocational changes
Peripheral Nervous System
31 pairs of spinal nerves (sensory impulses, motor impulses)
12 pairs of cranial nerves (transmit information directly to/from the brain, 5 senses)
Most common MOI for head injuries
Motor vehicle crashes, >2/3 of people involved experience head injuries
Followed by assaults, older adult falls, sports-related incidents
Seizures and convulsions
It is not uncommon for patients with head injuries to have a convulsion or seizure as a result of excessive excitability of the brain caused bu the direct injury of the accumulation of fluid within the brain
Hyperventilation
Controversial because it can increase the severity of head injuries and therefore should be avoided except in cases where signs of brainstem herniation have been identified
Glasgow Coma Scale
Eye Opening 4 - Spontaneous 3 - In response to speech 2 - In response to pain 1 - none
Best Verbal Response 5 - Oriented conversation 4 - Confused conversation 3 - Inappropriate words 2 - Incomprehensible sounds 1 - none
Best Motor Response 6 - Obeys commands 5 - Localizes pain 4 - Withdraws to pain 3 - Abnormal flexion 2 - Abnormal extension 1 - none
Injuries to C5-6
Quadripeligia
Injuries to L1
Paraplegia
Cheyne-Stroke respirations
fast and then slow with periods of apnea
Ataxic (biot) respirations
irregular rate and volume with periods of apnea
Cushing Triad
Also referred to as herniation syndrome where intracranial pressure is so great that it forces the brainstem and midbrain through the foramen magnum; can be fatal
Increased blood pressure (hypertension), decreased heart rate (bradycardia) and irregular respirations
Signs of a traumatic brain injury
When to leave a helmet on?
1) there are no impending airway/breathing problems
2) it does not interfere with assessment and treatment of airway/breathing problems
3) you can properly immobilize the spine
When to remove a helmet?
Removing a helmet should always be a two person job!
1) it is a full-face helmet
2) it makes assessing or managing the airway difficult and removal of a face guard to improve airway access is not possible
3) it prevents you from properly immobilizing the spine
4) it allows excessive head movement
Which of the following is NOT a part of the central nervous system? The Brain The spina cord CSF Cranial Nerves
Cranial Nerves
The nervous system is divided into the central nervous system and the
Peripheral nervous system
The brain is divided into the cerebrum, the cerebellum and the _____
Brain stem
Injury to the head and neck may indicate injury to the _____
C-spine
Which of the following is NOT a function of CSF?
Acts as a shock absorber
Bathes the brain and spinal cord
Buffers the brain and spinal cord from injury
Provides continuous oxygen to the brain
Provides continuous oxygen to the brain
The most prominent and most easily palpable spinous process at the base of the neck
C7
Neck rigidity, bloody CSF and headache are associated with what kind of bleeding in the brain?
Subarachnoid hemorrhage
The first step in securing a patient to a backboard is
to provide manual stabilization of the C-spine
The most reliable sign of a head injury
Decreased LOC
Hyperventilation should be used with caution in head injury patients and only be attempted when ____ is available
Capnography
How many EMTs needed to immobilize a standing patient?
3
A vacuum mattress molds to the specific contours of the patient’s body and ____, ____, _____
Reduced pressure point tenderness, provides better comfort and provides thermal insulation
