Chapter 28- Head And Spine Injuries Flashcards
Central nervous system includes:
The brain and the spinal cord.
The brain
The organ that controls the body; it is also the center of consciousness.
The brain is divided into three major areas:
cerebrum
Cerebellum
Brainstem
The cerebrum contains
75% of the brain’s total volume
Controls a wide variety of activities, including most voluntary motor function and conscious thought.
Divided into two hemispheres with four lobes
The brainstem
Controls virtually all the functions that are necessary for life, including the cardiac and respiratory systems and nerve function transmissions
Best protected part of the CNS
The spinal cord
Mostly made up of fibers that extend from the brain’s nerve cells.
Carries messages between the brain and the body via gray and white matter of the spinal cord.
Gray matter
Composed of neural cell bodies and synapses which are connections between nerve cells.
White matter
Consists of fiber pathways.
Meninges
Three distinct layers of tissue that suspend the brain and the spina cord within the skull and spinal canal.
Dura mater
A tough, fibrous layer that closely resembles leather.
Inner two layers of the meninges
Arachnoid and pia mater
Cerebral spinal fluid is produced..
In a chamber inside the brain, called the third ventricle.
There is approximately how much CSF in the brain at any one time.
125-150 mL
If a patient with a head injury has what looks like a runny nose or reports a salty taste at the back of the throat, you should assume that the fluid is….
Cerebrospinal fluid
_____ pairs of spinal nerves conduct sensory impulses from the skin and other organs to the spinal cord
31
Cranial nerves are the _____ pairs of nerves that emerge from the brainstem and transmit information directly to or from the brain
12
If a sensory nerve in this arc detects an irritating stimulus, such as heat, it will…
Bypass the brain and send a message directly to a motor nerve, causing a response such as pulling away from heat.
Voluntary activities
Actions that we consciously perform, in which sensory input determines the specific muscular activity.
Involuntary activities
Actions that are not under our conscious control, such as breathing.
The skull is composed of two groups of bones:
The cranium, which protects the brain
And the facial bones.
The cranium is occupied by _____% brain tissue, ______% blood supply, and _____% CSF
80, 10, 10
Intervertebral disk
The cushion that lies between two vertebrae.
How may vertebrae in the cervical spine?
7
How many vertebrae in thoracic spine?
12
How many vertebrae in lumbar spine?
5
How many vertebrae in sacrum?
5
How many vertebrae in coccyx?
4
The two general types of head injuries:
Closed head injuries
Open head injury
Closed head injury
Those in which the brain has been injured but there is no opening into the brain
Open head injury
One in which an opening from the brain to the outside world exists.
Ecchymosis
Bruising
Raccoon eyes
Bruising under the eyes that may indicate a skull fracture
Battle sign
Bruising behind an ear over the mastoid process that may indicate a skull fracture.
Linear skull fractures
Account for 80% of skull fractures; also referred to as a non displaced skull fractures; commonly occurs in the temporal-parietal region of the skull; not associated with deformities to the skull
Depressed skull fractures
Result from high-energy direct trauma to the head with a blunt object
Basilar skull fractures
Also associated with high energy trauma, but they usually occur following diffuse impact to the head.
Open skull fractures
Is what the name implies; brain tissue may be exposed to the environment which significantly increases the risk of a bacterial infection.
Traumatic brain injury (TBI)
A traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes.
Traumatic brain injuries are classified into two broad categories:
Primary (direct) injury
Secondary (indirect) injury
Primary brain injury
Injury to the brain and its associated structures that result instantaneously from impact to the head.
Secondary brain injury
Refers to a multitude of processes that increase the severity of a primary brain injury and, therefore, negatively impact the outcome.
Coup-contrecoup injury
When the head falls back against the headrest and/or seat, and the brain slams into the rear of the skull.
Cerebral edema
Swelling of the brain
Intracranial pressure (ICP)
Pressure within the cranial vault.
Cheyne stokes respiration’s
Respiration’s that are fast and then become slow, with intervening periods of apnea
Ataxic (Biot) respiration’s
Characterized by irregular rate, pattern, and volume of breathing with intermittent periods of apnea
Signs and symptoms of ICP
Decreased pulse rate headache nausea vomiting decreased alertness bradycardia sluggish or non reactive pupils decerebrate posturing increased or widened blood pressure
The triad of _______ ________ ________ signifies increased ICP
Increased systolic BP
Decreased pulse rate
Irregular respirations
Epidural hematoma
An accumulation of blood between the skull and dura mater
Subdural hematoma
An accumulation of blood beneath the dura matter but outside the brain.
Intracerebral hematoma
Bleeding within the brain tissue itself
Subarachnoid hemorrhage
Bleeding occurs into the subarachnoid space, where the CSF circulates
Concussion
A temporary loss or alteration of part or all of the brain’s abilities to function without actual physical damage to the brain.
Retrograde amnesia
When the patient can remember everything but the events leading up to the injury
Anterograde (posttraumatic) amnesia
Inability to remember events after the injury
Contusion (of the head)
Bruise to the brain. Far more serious than a concussion
Hyper-extension
When the spine is pulled along its length
Can cause fractures in the spine as well as ligament and muscle injuries.
Axial loading injuries
Injuries where load is applied along the vertical or longitudinal axis of the spine;
Ex: falling from a height and landing on the feet in an upright position.
PMS
Pulse
Motor
Sensation
Cushing triad
Increased blood pressure (hypertension)
Decreased heart rate (bradycardia)
Irregular respirations (cheyne-stokes and bigots)
ICP indicators
Eyes forward position
A head position in which the patient’s eyes are looking straight ahead and the head and torso are in line.
Do not move the head any farther if the patient reports any of the following symptoms:
- muscle spasms in the neck
- substantial increased pain
- numbest, tingling, or weakness in the arms or legs
- compromised airway or ventilations
