Chapter 26: Head and Spinal Injuries

Question 1

Discuss

Layers of meninges from outside in

Answer 1

Dura matter, Arachnoid, pia matter

Question 2

Discuss

What’s a reflex arc?

Answer 2

For reflexes, rather than have sensory nerves go all the way to the brain, sensory nerves connect to motor neurons through connecting nerves.

Question 3

Discuss

Types of skull fx and description

Answer 3

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.

Question 4

Discuss

What’s a TBI?

Answer 4

Traumatic brain injury: A brain injury capable of producing physical, intellectual, emotional, social, or vocational changes

Question 5

Discuss

You come upon a pt with a TBI, what other condition should you be prepared for?

Answer 5

Seizures

Question 6

Discuss

Primary and secondary (examples) TBI

Answer 6

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.

Question 7

Discuss

What’s intracranial pressure and what are S/S?

Answer 7

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.

Question 8

Discuss

What’s Cushing’s triad and what does it signify?

Answer 8

1. Hypertension (widening pulse pressure). 2. Bradycardia. 3. Irregular respirations. Signifies increasing intracranial pressure.

Question 9

Discuss

You have a pt with a potential head injury, and you notice increasing systolic BP, decreasing HR, and irregular respirations. What does that mean?

Answer 9

Increasing intracranial pressure (Cushing’s triad).

Question 10

Discuss

Types of intracranial bleeds (list)

Answer 10

Epidural hematoma, subdural hematoma, subarachnoid hemorrhage, intracerebral hemorrhage

Question 11

Discuss

What’s an epidural hematoma, timescale of onset, and what are S/S?nd what are the symptoms?

Answer 11

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.

Question 12

Discuss

List the layers from out to in of the skull (scalp to brain)

Answer 12

Scalp, periosteum, skull, dura mater, arachnoid, pia mater, cerebrum

Question 13

Discuss

What’s a subdural hematoma, timescale of onset, and S/S?

Answer 13

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.

Question 14

Discuss

What’s a subarachnoid hemorrhage and S/S?

Answer 14

Bleed into subarachnoid space (but outside the brain) where CSF circulates. Causes mengingeal irritation (headache and stiff neck). Can be from trauma or aneurysm.

Question 15

Discuss

What’s an intracerebral hemorrhage and S/S?

Answer 15

Bleeding in the brain itself. From penetrating wound or rapid deceleration (or possibly aneurysm). High mortality rate.

Question 16

Discuss

What’s a concussion?

Answer 16

A mild traumatic brain injury. Closed, with temporary loss or alteration of brain function. Possible retrograde or anterograde amnesia. Pt needs a CT scan.

Question 17

Discuss

What’s retrograde and anterograde amnesia?

Answer 17

Retrograde: Inability to remember events before the incident. Anterograde: Inability to create new memories after the incident.

Question 18

Discuss

What’s a brain contusion and Tx?

Answer 18

Bruising of the brain. May result in microhemorrhages. Likely to heal without medical intervention.

Question 19

Discuss

Types of spine injuries

Answer 19

Distraction (pulled along its length) and subluxulation (verterbrae no longer aligned)

Question 20

Discuss

Location of spinal cord injuries that cause quadriplegia and paraplegia?

Answer 20

Quadraplegia: C5-C6. Paraplegia: L1

Question 21

Discuss

Cheyne-stokes respirations

Answer 21

Fast and then becoming slow with periods of apnea. One of the irregular breathing patterns of Cushing’s triad.

Question 22

Discuss

Central neurogenic hyperventilation

Answer 22

Deep and rapid

Question 23

Discuss

Ataxic respirations

Answer 23

Irregular rate, patter, volume, with intermittend apnea

Question 24

Discuss

Special note for transporting spinal/head injury pt’s

Answer 24

If possible, elevate head 30 degrees to minimize intracranial pressure

Question 25

Discuss

Exceptions for using KED to extricate seated pt

Answer 25

Immediate danger to pt, need immediate access to other pt’s, injuries justify urgent removal

Question 26

Discuss

When to remove a helmet?

Answer 26

If it’s tight fitting leave it on. Consult with med control about removing it

Question 27

Discuss

What are the types of irregular respirations associated with Cushing’s triad?

Answer 27

Cheyne-Stokes respirations, central neurogenic hyperventilaion, ataxic respirations.

Question 28

Discuss

Explain the Cushing reflex

Answer 28

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.