Chapter 26: Head and Spinal Injuries Flashcards
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Layers of meninges from outside in
Dura matter, Arachnoid, pia matter
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What’s a reflex arc?
For reflexes, rather than have sensory nerves go all the way to the brain, sensory nerves connect to motor neurons through connecting nerves.
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Types of skull fx and description
Linear: nondisplaced. Compressed: high energy direct blunt trauma; bony fragments may be driven into brain. Often present with neurological signs. Basilar: High energy diffuse impact, generally from extension of linear fx to base of skull; produces CSF drainage from ears, raccoon eyes or Battle’s sign (but often not for 24 hrs); Open: high mortality rate.
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What’s a TBI?
Traumatic brain injury: A brain injury capable of producing physical, intellectual, emotional, social, or vocational changes
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You come upon a pt with a TBI, what other condition should you be prepared for?
Seizures
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Primary and secondary (examples) TBI
Primary: injury that results from instantaneous impact to the head. Secondary: refers to process that increases severity of primary brain injury; hypoxia and hypotension most common, but also including cerebral edema, intracranial hemorrhage, increased ICP, cerebral ischemia, infection.
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What’s intracranial pressure and what are S/S?
Pressure in the skull that compresses the brain and pushes it out the foramen mangum. S/S: Cushing’s triad: increased systolic BP, decreased HR, irregular respirations.
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What’s Cushing’s triad and what does it signify?
- Hypertension (widening pulse pressure). 2. Bradycardia. 3. Irregular respirations. Signifies increasing intracranial pressure.
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You have a pt with a potential head injury, and you notice increasing systolic BP, decreasing HR, and irregular respirations. What does that mean?
Increasing intracranial pressure (Cushing’s triad).
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Types of intracranial bleeds (list)
Epidural hematoma, subdural hematoma, subarachnoid hemorrhage, intracerebral hemorrhage
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What’s an epidural hematoma, timescale of onset, and what are S/S?nd what are the symptoms?
Blood between skull and dura mater. Almost always from a linear fx of the temporal bone (thin bone), cutting the middle meningeal artery. Rapidly progressing symptoms (arterial bleed). Hours to days. Loss of consiousness, then lucid interval, then loss of of consciousness.
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List the layers from out to in of the skull (scalp to brain)
Scalp, periosteum, skull, dura mater, arachnoid, pia mater, cerebrum
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What’s a subdural hematoma, timescale of onset, and S/S?
Bleed beneath dura mater but outside brain. Usually with strong deceleration. Bleed source is from veins that bridge cerebral cortex and dura, so slower bleed (veinous) and slower onset of symptoms (days to weeks). Fluctuating level of consciousness and slurred speech. Most lethal of all head injuries.
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What’s a subarachnoid hemorrhage and S/S?
Bleed into subarachnoid space (but outside the brain) where CSF circulates. Causes mengingeal irritation (headache and stiff neck). Can be from trauma or aneurysm.
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What’s an intracerebral hemorrhage and S/S?
Bleeding in the brain itself. From penetrating wound or rapid deceleration (or possibly aneurysm). High mortality rate.
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What’s a concussion?
A mild traumatic brain injury. Closed, with temporary loss or alteration of brain function. Possible retrograde or anterograde amnesia. Pt needs a CT scan.
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What’s retrograde and anterograde amnesia?
Retrograde: Inability to remember events before the incident. Anterograde: Inability to create new memories after the incident.
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What’s a brain contusion and Tx?
Bruising of the brain. May result in microhemorrhages. Likely to heal without medical intervention.
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Types of spine injuries
Distraction (pulled along its length) and subluxulation (verterbrae no longer aligned)
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Location of spinal cord injuries that cause quadriplegia and paraplegia?
Quadraplegia: C5-C6. Paraplegia: L1
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Cheyne-stokes respirations
Fast and then becoming slow with periods of apnea. One of the irregular breathing patterns of Cushing’s triad.
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Central neurogenic hyperventilation
Deep and rapid
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Ataxic respirations
Irregular rate, patter, volume, with intermittend apnea
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Special note for transporting spinal/head injury pt’s
If possible, elevate head 30 degrees to minimize intracranial pressure
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Exceptions for using KED to extricate seated pt
Immediate danger to pt, need immediate access to other pt’s, injuries justify urgent removal
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When to remove a helmet?
If it’s tight fitting leave it on. Consult with med control about removing it
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What are the types of irregular respirations associated with Cushing’s triad?
Cheyne-Stokes respirations, central neurogenic hyperventilaion, ataxic respirations.
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Explain the Cushing reflex
Increasing ICP starts constricting arterioles and reducing blood supply to the brain. Body compensates by increasing MABP (mean arterial blood pressure) to restore perfusion. Meanwhile, the vagus nerve (parasympathetic nervous system) senses the increasing pressure and induces bradycardia (in fact at first, the sympathetic nervous system caused tachycardia). Finally, the increasing ICP puts pressure on the brainstem, which interferes with breathing, causing irregular respirations.
