Chapter 29: Head and Spine Injuries Flashcards
What do EMTs do to protect the spine?
C-spine, collar, and careful movement
What is a TBI?
Traumatic brain injury, a permanent brain injury
What are the two types of brain injuries and what are the chief concerns with each?
Closed: internal bleeding (causing bruising) leads to increased intracranial pressure
Open: Penetrating trauma consider infection
What are the MOI that make you suspect brain injuries?
MVC, assault, elderly falls, sports, children
Are head injuries serious? What is important to do?
Yes, head injuries are serious. Pay attention to your patient, keep them talking
What are the main signs and symptoms of a head injury?
Confusion (alert, but forgetful/unable to answer questions), irregular breathing, slow heart rate, bruising, CSF, unequal pupils, loss of consciousness, combative, nausea/vomiting, priapism
What is A&O x 3 verses A&O x 4?
Alert and Oriented: Person location time
Alert and Oriented: Person, location, time, and remember what happened
What are the signs and symptoms of skull fracture?
Head deformity, visible cracks, raccoon eyes, battle sign
What are the distinguishing features of a linear skull fracture?
80% of all skull fractures,
no physical signs
Caused by: blunt force, falls, and MVC
What are the distinguishing features of a compressed skull fracture?
Frontal and parietal bones particularly susceptible
Consider: bone fragments can be driven into the brain
Caused by high-energy direct trauma with a blunt object
What are the distinguishing features of a basilar skull fracture?
At the base of the skull
Causes: CSF from ears, raccoon eyes, and Battle’s sign
Caused by: high-energy trauma such as falls
What are the distinguishing features of an open skull fracture?
Likely to accompany multiple system trauma
Brain tissue is exposed to the environment
Caused by: Severe force applied to head
What are the four types of TBIs?
Direct injury: penetrating object
Indirect injury: external forces
Primary: Direct result of impact to head
Secondary: Hours-days later, caused by ischemia, hypoxia, cerebral edema, intracranial pressure, infection
What is coup-countercoup?
Brain hitting back of skull then front of skull (such as when hitting windshield or shaken baby syndrome)
What causes intracranial pressure?
Swelling and blood accumulation because of epidural, subdural, intracerebral, and subarachnoid bleeding
What indicated mild elevation of intracranial pressure?
Increased BP, decreased pulse rate, pupils still reactive, Cheyne-stokes respirations, pt initially attempts to localize and remove painful stimuli this is followed by withdrawal and extension
effects are reversible with prompt treatment
What are Cheyne-Stokes respirations?
Respirations that are fast and then become slow, with intervening periods of apnea
What are signs of moderate elevation of intracranial pressure and what does it indicate?
Widened pulse pressure and brady cardia, pupils are sluggish or nonreactive, central neurogenic hyperventilation, decerebrate posturing,
survival possible but not without permanent neurologic deficit
Indicated that the middle brain stem is involved
What are central neurogenic hyperventilation?
Deep rapid respirations
What are the signs of marked elevation of intracranial pressure and what does it indicate?
Unilateral fixed and dilated pupil, ataxic respirations, flaccid response to painful stimuli, irregular pulse rate, diminished blood pressure
Most pt do not survive this level of intracranial pressure
Indicates that lower portion of brain stem involved/medulla
What is decerebrate posturing?
Arms and legs being held straight out, the toes being pointed downward and internal and wrist rotated outward, and the head and neck being arched backward. The muscles are tightened and held rigidly.
What is epidural hematoma?
Bleeding between the skull and the dura matter
Linear fracture possible
Caused by blow to the head
What is subdural hematoma?
Bleeding blow the dura matter, outside the brain
Caused by falls and deceleration
What is intracerebral hematoma?
Bleeding in the brain tissue
Caused by penetrating injury and deceleration
What is subarachnoid hemorrhage?
Bleeding in the subarachnoid space
blood intermigles with CSF and meninges are irritated
Caused by aneurysm or trauma
What is a concussion?
Closed injury with temporary loss or altering of brains ability to function
No demonstrable physical injury to the brain
Consider: 90% don’t lose consciousness
Pt may be confused or experience amnesia
May have long term effects
What are the signs and symptoms of a concussion? What are these similar to?
Dizziness, visual changes, weakness, nausea and vomiting, ringing in the ears, slurred speech, inability to focus
These signs and symptoms are similar to those of a brain contusion
What is a brain contusion?
It is more serious than a concussion
Physical injury to brain tissue
long-lasting and permanent damage possible
similar signs and symptoms to concussion
What are non-traumatic brain injuries?
Blood clots and hemorrhage
-although their signs and symptoms are similar to other TBI there is no MOI
What are the seven types of spinal injuries?
Compression: weight of body driven against the head
Flexion: head pushed forward and chin meets the chest
Extension: head pushed backwards and the neck is stretched
Rotation: lateral movement of the head
Lateral bending: neck is bent from the side
Distraction: vertebrae and spine are stretched
Penetration: GSW, stabbing
What MOI should peak your index of suspicion for a spinal injury?
MVA, pedestrian vs Car, falls, blunt trauma, penetrating trauma to head, neck, back, chest, MC, rapid deceleration, hanging, diving accidents, recreational vehicle accidents
What should be noted in the primary assessment of a patient with a suspected head or spinal injury?
Patient confusion, amnesia, slurred speech
*watch for vomiting
What is in the secondary assessment of a patient with a suspected head or spinal injury?
Full-body scan, DCAP-BTLS, look for leaking blood/CSF, evaluate pupils, GCS, identify level of impairment (ie L3, T10),
What is Cushings triad?
Indicating increased cranial pressure:
Increased systolic blood pressure, decreased pulse, decreased respirations
(The opposite of shock)
What is E in the GCS?
Eye Opening:
Spontaneous: 4
Response to speech: 3
Response to pain: 2
None: 1
What is V in the GCS?
Best verbal response:
Oriented conversation: 5
Confused conversation 4
Inappropriate words: 3
Incomprehensible sounds: 2
None: 1
What is M in the GCS?
Best Motor Response:
Obeys commands: 6
Localizes pain: 5
Withdraws to pain: 4
Abnormal flexion: 3
Abnormal extension: 2
None: 1
When do EMTs perform spinal immobilization?
Multisystem trauma or AMS, neck pain, weakness, tingling, numbness, intoxication, distracting injury
What is initial injured brain swelling due to?
Cerebral edema
What is the relationship between cervical collars and manual immobilization?
Cervical collars are used in addition to, not instead of, manual immobilization
What is an example of axial loading?
Jump from roof land on feet pain in heels, knees, and lower back
What are common signs of a serious head injury?
Decerebrate posturing, widening pulse pressure, CSF leakage from the ears.
NOT rapid, thready pulse
How can the effectiveness of positive pressure ventilations be determined when treating a head-injured patient?
Immediate reassessment after the intervention
What is the function of the meninges and the CSF?
Shock absorption
What breathing pattern is most indicative of increased intracranial pressure?
Irregular rate, pattern, and volume of breathing with intermittent periods of apnea
What percent of the brain is occupied by brain tissue?
80%
