CH 35 Flashcards by Alexis Bobbitt

If a trauma patient cannot be assessed properly in their vehicle, you should:
maintain manual stabilization of the head, apply a cervical collar, and move the patient from the vehicle onto a long backboard.
apply a vest-type extrication device and then rapidly remove them from the vehicle using at least three people.
apply a rigid cervical collar, perform a rapid assessment only, and then remove the patient with the two-person lift technique.
grasp the patient behind the shoulders, cradle their head in your arms to protect the spine, and rapidly extricate them from the car.

maintain manual stabilization of the head, apply a cervical collar, and move the patient from the vehicle onto a long backboard.

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A 39-year-old man crashed his vehicle into a wooded area and was not found for approximately 8 hours. When you arrive at the scene and assess him, you note that he is conscious but anxious. He is unable to feel or move below his mid-thoracic area and complains of a severe headache. His blood pressure is 210/130 mm Hg, heart rate is 44 beats/min, and respirations are 22 breaths/min. This patient’s clinical presentation is most consistent with:
symptomatic bradycardia.
autonomic dysreflexia.
neurogenic shock.
intracranial pressure.

autonomic dysreflexia.

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Medications administered in the prehospital setting for a patient with a head injury would most likely be used to:
prevent cardiac dysrhythmias or increase heart rate.
reduce body temperature and promote diuresis.
facilitate intubation or terminate seizures.
reduce cerebral edema and prevent shivering.

facilitate intubation or terminate seizures.

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Decerebrate posturing is characterized by:
inward flexion of the wrists and flexed knees.
pulling in of the arms toward the core of the body.
flexion of the arms and extension of the legs.
extension of the arms and extension of the legs.

extension of the arms and extension of the legs.

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Horner syndrome is identified when a patient with a spinal injury:
is unable to identify the left arm from the right arm.
has a drooping upper eyelid and small pupil.
can move their arms, but not the legs.
cannot close their fingers against resistance.

has a drooping upper eyelid and small pupil.

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Disruption of the lower parasympathetic nerves in the sacrum results in:
loss of bowel/bladder tone.
pupillary abnormalities.
numbness or tingling in the extremities.
irreversible seizures.

loss of bowel/bladder tone.

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Which of the following factors would likely result in secondary spinal cord injury?
Hyperglycemia
Hyperkalemia
Hypocalcemia
Hypoglycemia

Hypoglycemia

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A patient with a possible spinal injury is acutely agitated. What type of medication, if any, should they receive after hypoxia has been ruled out?
Short-acting, reversible sedative
Corticosteroid
Dissociative anesthetic
Neuromuscular blocker

Short-acting, reversible sedative

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Spinal cord injuries that cause neurogenic shock generally produce:
cool, clammy skin distal to the site of the spinal cord injury.
signs and symptoms that are identical to those of hypovolemic shock.
flaccid paralysis and complete loss of sensation distal to the injury.
reflex tachycardia due to sympathetic nervous system stimulation.

flaccid paralysis and complete loss of sensation distal to the injury.

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General treatment for a man with a significant head injury and signs of Cushing triad includes:
elevating the head 15 to 30 degrees.
administering a corticosteroid.
ventilating at a rate of 30 breaths/min.
a 20-mL/kg bolus of normal saline.

elevating the head 15 to 30 degrees.

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Which of the following is a sign of a moderate elevation in intracranial pressure?
Unilaterally blown pupil
Widened pulse pressure
Biot (ataxic) respirations
Irregular pulse rate

Widened pulse pressure

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Which of the following statements regarding the brainstem is correct?
The brainstem is responsible for muscle coordination.
The brainstem connects the spinal cord to the brain.
All but 4 of the 12 cranial nerves exit the brainstem.
The brainstem provides protection to the cerebellum.

The brainstem connects the spinal cord to the brain.

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The dura mater:
is the inner meningeal layer and is composed of a thin, translucent, highly vascular membrane that adheres firmly directly to the surface of the brain.
anatomically separates the cerebellum and the brainstem and contains vasculature that resembles a spider web.
is the middle meningeal layer and is composed of a delicate transparent membrane that is damaged easily by trauma.
folds in to form the tentorium, a structure that separates the cerebral hemispheres from the cerebellum and brainstem.

folds in to form the tentorium, a structure that separates the cerebral hemispheres from the cerebellum and brainstem.

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A skier wiped out while skiing down a large hill. He is conscious and alert and complains of being very cold; he also complains of neck stiffness and numbness and tingling in all of his extremities. A quick assessment reveals that his airway is patent and his breathing is adequate. You should:
perform a detailed neurologic exam and carefully palpate his neck.
administer oxygen and perform a detailed secondary assessment.
immobilize his spine and quickly move him to a warmer environment.
apply a cervical collar and start an IV line with warm normal saline.

immobilize his spine and quickly move him to a warmer environment.

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The brain connects to the spinal cord through a large opening at the base of the skull called the:
cribriform plate.
foramen magnum.
occipital condyle.
palatine bone.

foramen magnum.

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Wrist extension is controlled at the level of:
C5.
C4.
T1.
C6.

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What type of skull fracture is most common following high-energy direct trauma to a small surface area of the head with a blunt object?
Open fracture
Depressed fracture
Nondisplaced fracture
Basilar fracture

Depressed fracture

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Which of the following is a sign of neurogenic shock?
Tachycardia
Diaphoresis
Hypertension
Bradycardia

Bradycardia

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Vagal tone remains intact following a spine injury because:
the vagus nerve originates outside the medulla and regulates the heart via the carotid arteries.
parasympathetic nerve fibers are largely under the control of the involuntary nervous system.
the nerve fibers of the parasympathetic nervous system do not originate from the brainstem or spinal cord.
the thoracolumbar system provides parasympathetic stimulation to the periphery via alpha and beta receptors.

the vagus nerve originates outside the medulla and regulates the heart via the carotid arteries.

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Following a traumatic brain injury, initial swelling of the brain occurs due to:
a slow heart rate.
acute hypertension.
cerebral vasodilation.
severe ischemia.

cerebral vasodilation.

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What spinal cord injury is characterized by motor loss on the same side as the injury, but below the lesion?
Posterior cord syndrome
Anterior cord syndrome
Central cord syndrome
Brown-Séquard syndrome

Brown-Séquard syndrome

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Spinal shock is a condition that:
generally affects the sensory nerves but spares the motor nerves.
results in permanent neurologic deficits in the majority of patients.
is usually temporary and results from swelling of the spinal cord.
typically manifests within 24 to 36 hours following a spinal injury.

is usually temporary and results from swelling of the spinal cord.

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You have just completed spinal immobilization of a hemodynamically stable patient with a possible spinal injury. Prior to moving the patient to the ambulance, it is most important to:
apply a cardiac monitor and obtain a full set of vital signs.
reassess pulse, motor, and sensory functions in all extremities.
start an IV of normal saline in case the patient deteriorates.
perform a detailed secondary assessment to detect other injuries.

reassess pulse, motor, and sensory functions in all extremities.

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What type of intracranial hemorrhage would most likely be caused by a penetrating head injury?
Epidural hematoma
Subarachnoid hemorrhage
Intracerebral hematoma
Subdural hematoma

Intracerebral hematoma

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Upon arriving at the scene of a motor vehicle crash, you find the driver of the car still seated in her two-door vehicle. The passenger side of the vehicle has sustained severe damage and is inaccessible. The driver is conscious and alert and complains only of lower back pain. The backseat passenger, a young child who was unrestrained, is bleeding from the head and appears to be unconscious. You should: carefully assess the driver for occult injuries before removing her from the vehicle. rapidly extricate the driver so you can gain quick access to the child in the backseat. ask the driver to step out of the vehicle so you can access the backseat passenger. apply a vest-type extrication device to the driver and quickly remove her from the car.

rapidly extricate the driver so you can gain quick access to the child in the backseat.

When moving an injured patient from the ground onto a long backboard, it is preferred that you: use the four-person log roll technique. log roll the patient away from you. slide the patient onto the backboard. use a scoop stretcher to move the patient.

use the four-person log roll technique.

Which of the following statements regarding the hangman's fracture is correct? Severe hyperflexion of the neck commonly results in a hangman's fracture. It is a fracture of C2 that is secondary to significant distraction of the neck. Most hangman's fractures occur during a fall from greater than 10 feet. Hangman's fractures occur when the patient's skull rapidly accelerates.

It is a fracture of C2 that is secondary to significant distraction of the neck.

Common clinical findings associated with a subdural hematoma include: bilateral hemiparesis. bilateral hemiparalysis. rapidly rising blood pressure. a slow progression of symptoms.

a slow progression of symptoms.

Spinal cord injury without radiographic abnormalities can occur in children because: their spinal cord is more compressed than an adult's. unlike adults, their vertebrae are more curved. they have excessive mobility of C1 and C2. their vertebrae lie flatter on top of each other.

their vertebrae lie flatter on top of each other.

A leading cause of death in spinal cord injury patients who are discharged from the hospital includes: muscular atrophy. myocardial infarction. pneumonia. ischemic stroke.

pneumonia.

What portion of the brainstem is responsible for maintenance of consciousness? Limbic system Reticular activating system Diencephalon Basal ganglia

Reticular activating system

In contrast to secondary spinal cord injury, primary spinal cord injury occurs: from penetrating mechanisms. within 24 hours of the injury. at the moment of impact. from progressive swelling.

at the moment of impact.

Following a spinal injury, a patient presents with abdominal breathing and use of the accessory muscles in the neck. This suggests injury at or above: T1–T4. C3–C4. C1–C2. T2–T5.

C3–C4.

A motorcycle or football helmet should be removed if: the patient is breathing shallowly and access to the airway is difficult. you are going to transport the patient to a medical treatment facility. the patient complains of severe neck pain and the helmet fits snugly. you are properly trained in the technique, even if you are by yourself.

the patient is breathing shallowly and access to the airway is difficult.

Which of the following is a type of secondary brain injury? Intracerebral hemorrhage Cerebral edema Axonal injury Skull fracture

Cerebral edema

When assigning a Glasgow Coma Scale (GCS) score to a patient who has limb paralysis due to a spinal cord injury, you should: exclude the motor response portion of the GCS. use another method for assessing neurologic function. score the patient as having no motor response. ask the patient to blink or move a facial muscle.

ask the patient to blink or move a facial muscle.

Following a traumatic injury, a 19-year-old woman presents with confusion, tachycardia, and hypotension. Her skin is cool, clammy, and pale. Further assessment reveals abdominal rigidity and deformity with severe pain over her thoracic vertebrae. In addition to administering high-flow oxygen and immobilizing her spine, you should: start at least one large-bore IV line and give crystalloid boluses as needed to maintain adequate perfusion. perform a focused history and physical exam, start an IV of normal saline, and administer a corticosteroid. start at least one large-bore IV of normal saline and administer a narcotic analgesic to treat her severe pain. conclude that she is in neurogenic shock, start an IV line of normal saline, and initiate a dopamine infusion.

start at least one large-bore IV line and give crystalloid boluses as needed to maintain adequate perfusion.

Early signs and symptoms of increased intracranial pressure include: headache and vomiting. hypertension and bradycardia. widening of the pulse pressure. arm flexion and leg extension.

headache and vomiting.

You are assessing a patient who sustained blunt trauma to the center of her back. She is conscious, but is unable to feel or move her lower extremities. Her blood pressure is 80/50 mm Hg, pulse is 40 beats/min and weak, and respirations are 24 breaths/min and shallow. If IV fluids do not adequately improve perfusion, you should: give 0.5 mg of atropine and consider a dopamine infusion. administer a sedative and paralytic and then intubate her trachea. administer 1 mg of epinephrine 1:10,000 via rapid IV push. administer a corticosteroid to reduce spinal cord inflammation.

give 0.5 mg of atropine and consider a dopamine infusion.

Hyperacute pain to touch is called: paresthesia. hyperesthesia. anesthesia. akathisia.

hyperesthesia.

A spinal cord concussion is: caused by a short-duration shock or pressure wave within the cord. a condition that results in a permanent loss of neurologic function. the result of direct trauma and is associated with spinal cord edema. characterized by temporary dysfunction that lasts for up to 1 week.

caused by a short-duration shock or pressure wave within the cord.

When immobilizing a patient to a long backboard, you should first: ensure that the patient's head is stabilized manually. assess distal pulse, sensory, and motor functions. apply the appropriately sized cervical collar to the patient. log roll the patient as a unit and assess their back.

ensure that the patient's head is stabilized manually.

The phrenic nerves arise from which plexus? Lumbar Cervical Sacral Brachial

Cervical

A complete spinal cord injury to the upper cervical spine: is not compatible with life and results in immediate death due to cardiopulmonary failure. will result in permanent loss of all cord-mediated functions below the level of the injury. results in quadriplegia but the patient usually retains their ability to breathe spontaneously. results in neurologic dysfunction that is considered to be permanent if it lasts longer than 24 hours.

will result in permanent loss of all cord-mediated functions below the level of the injury.

In which of the following situations would it be most appropriate to apply a vest-type extrication device to a patient who is seated in their crashed motor vehicle? Conscious with bilateral femur fractures Unconscious with obvious spinal deformity Confused with lower back pain and tachycardia Conscious with neck pain and stable vital signs

Conscious with neck pain and stable vital signs

Open fractures of the cranial vault: cause death due to increased intracranial pressure. are uncommonly associated with multisystem trauma. typically cause lethal atrial cardiac dysrhythmias. are associated with a high risk of bacterial meningitis.

are associated with a high risk of bacterial meningitis.

Which of the following statements regarding a closed head injury is correct? Diffuse brain injury occurs with all closed head injuries. Closed head injuries are less common than open head injuries. Intracranial pressure is usually minimal in a closed head injury. In a closed head injury, the dura mater remains intact.

In a closed head injury, the dura mater remains intact.

When performing your neurologic assessment of a patient, you should first: ask the patient if they can feel or move their legs. determine the patient's level of consciousness. assess the pupils for size, equality, and reactivity. obtain an initial Glasgow Coma Scale score.

determine the patient's level of consciousness.

Displacement of bony fragments into the front portion of the spinal cord results in: Brown-Séquard syndrome. anterior cord syndrome. central cord syndrome. complete spinal cord injury.

anterior cord syndrome.

Which of the following statements regarding central cord syndrome is correct? Patients with cervical spondylosis or stenosis are at a lower risk for central cord syndrome following an injury. Central cord syndrome is almost always associated with a vertebral fracture and has an overall poor prognosis. Central cord syndrome typically causes complete paralysis of the lower extremities and decreased proprioception. The patient typically presents with greater loss of function in the upper extremities than in the lower extremities.

The patient typically presents with greater loss of function in the upper extremities than in the lower extremities.

Autoregulation is defined as: an increase in mean arterial pressure to maintain cerebral blood flow. the forcing of cerebrospinal fluid into the spinal cord as intracranial pressure increases. reflex bradycardia that occurs secondary to systemic hypertension. a decrease in cerebral perfusion pressure that reduces intracranial pressure.

an increase in mean arterial pressure to maintain cerebral blood flow.

The most significant complication associated with prolonged immobilization of a patient on a long backboard is: compression of the vena cava. patient discomfort and frustration. pressure lesion development. increased intracranial pressure.

pressure lesion development.

Proprioception is defined as: a person's ability to sense light touch. a person's awareness of pain and the ability to localize it. the loss of thermoregulatory function distal to an injury. the ability to perceive the position and movement of one's body.

the ability to perceive the position and movement of one's body.

A patient with diaphragmatic breathing without intercostal muscle use has most likely experienced a spinal injury above the level of: T2. C5. C7. C2.

T2.

A 45-year-old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions should include: manually stabilizing his head and opening his airway with the jaw-thrust maneuver. performing a tongue-jaw lift and looking in his mouth for any obvious obstructions. applying a cervical collar and assisting his ventilations with a bag-mask device. rolling the patient onto his side as a unit and suctioning his mouth for 15 seconds.

manually stabilizing his head and opening his airway with the jaw-thrust maneuver.

Which of the following types of skull fracture would be the least likely to present with gross physical signs? Linear fracture Depressed fracture Open fracture Basilar fracture

Linear fracture

The crescent-shaped fold that divides the cerebrum into left and right hemispheres is called the: mesencephalon falx cerebelli. diencephalon tentorium.

falx cerebelli.

A diffuse axonal injury: is generally associated with better neurologic outcomes than a cerebral concussion because permanent brain damage does not occur. involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body. results in severe stretching or tearing of the portion of the nerve cell that receives sensory messages from the rest of the body. is a specific, grossly observable brain injury that can easily be diagnosed with a computer tomography scan of the head.

involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body.

Which of the following conditions that can cause an airway obstruction is unique to patients with an injury to the upper cervical spine? Blood or secretions in the mouth Improperly inserted oropharyngeal airway Retropharyngeal hematoma Oropharyngeal occlusion by the tongue

Retropharyngeal hematoma

Regardless of the method of spinal immobilization used, you must: always secure the head before the torso. keep the head, neck, and trunk in alignment. secure the patient in the position found. stabilize the head using slight manual traction.

keep the head, neck, and trunk in alignment.

When applying a vest-type extrication device to a seated patient, their head should be secured to the device: before you apply a cervical collar. after you move them to a long backboard. only after the torso is fastened securely. before you secure their torso.

only after the torso is fastened securely.

A 19-year-old woman fell from a second story window and landed on her head. She is unconscious with a blood pressure of 168/104 mm Hg, heart rate of 56 beats/min, and irregular respirations of 8 breaths/min. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the most appropriate treatment for this patient involves: preoxygenating her with a bag-mask device and 100% oxygen for 2 to 3 minutes, performing nasotracheal intubation, transporting at once, starting at least one large-bore IV line en route, and obtaining her Glasgow Coma Scale score. intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments. hyperventilating her with a bag-mask device at a rate of 20 breaths/min, starting two large-bore IV lines, applying a cardiac monitor, administering 5 mg of Valium to prevent seizures, and transporting to a trauma center. applying oxygen via nonrebreathing mask, covering her with blankets, starting an IV of normal saline set to keep the vein open, applying a cardiac monitor, initiating transport, and monitoring her pupils while en route to the hospital.

intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments.

Injury to the temporal lobe on the left side would most likely cause: abnormal speech. sleep abnormalities. lack of coordination. visual disturbances.

abnormal speech.

The innermost meningeal layer that rests directly on the brain and spinal cord is the: arachnoid. dura mater. pia mater. cortex.

pia mater.

What spinal nerve tract carries information regarding pain and temperature? Spinocerebellar Reticulospinal Corticospinal Lateral spinothalamic

Lateral spinothalamic

Pupils that are slow (sluggish) to react to light: indicate compression of an optic nerve. suggest minor intracranial pressure. are a sign of cerebral hypoxia. indicate impending brain herniation.

are a sign of cerebral hypoxia.

A positive Babinski reflex is observed when the: toes curve or move downward when the sole of the foot is touched. patient's reflexes are hyperactive in response to an external stimulus. patient responds to pain by flexing the arms and extending the legs. toes move upward in response to stimulation of the sole of the foot.

toes move upward in response to stimulation of the sole of the foot.

A subluxation is defined as: a partially severed spinal cord. a partial or incomplete dislocation. severe distraction injury of the neck. a completely severed spinal cord.

a partial or incomplete dislocation.

If the mechanism of injury indicates that your patient may have sustained a spinal cord injury: contact medical control to determine if spinal immobilization is needed. fully immobilize the spine only if gross neurologic deficits are present. assume that a spine injury exists, regardless of the neurologic findings. apply a cervical collar and transport the patient in a position of comfort.

assume that a spine injury exists, regardless of the neurologic findings.

Modification of your physical examination of a patient with a suspected spinal cord injury following a two-car motor vehicle crash is based on: the number of occupants in the vehicle. injuries to patients in the other vehicle. the patient's weight or body mass index. the mechanism of injury.

the mechanism of injury.

Hypotension that is associated with neurogenic shock is the result of: profound peripheral vasoconstriction. increased peripheral vascular tone. concomitant internal hemorrhage. loss of alpha receptor stimulation.

loss of alpha receptor stimulation.

As the body ages, the intervertebral discs: calcify and become more rigid. are not able to protect the spinal cord. enlarge and result in increased height. lose water content and become thinner.

lose water content and become thinner.

The parietal lobe of the brain: controls the body's ability to perceive body limb movement. controls functions such as long-term memory, taste, and smell. is important for voluntary motor action and personality traits. is where the optic nerve originates and processes vision.

controls the body's ability to perceive body limb movement.

Prior to immobilizing an anxious patient with a suspected spinal injury on a backboard, it is important to: make note of any neurologic deficits or gross injuries up to that point. ask the patient to pull against your hands with their feet. apply a cervical collar to free up the medic who is holding the patient's head. administer the appropriate dose of a sedative to facilitate patient compliance.

make note of any neurologic deficits or gross injuries up to that point.

A compression or burst fracture of the cervical spine would most likely occur following: a direct blow to the occipital region of the skull. a significant fall in which the patient lands head first. rapid acceleration following a motor vehicle crash. axial loading after a patient falls and lands feet first.

a significant fall in which the patient lands head first.