Chapter 31: Head Trauma

Question 1

cranial skull

Answer 1

helmet-like covering of skull

Question 2

basilar skull

Answer 2

floor of skull, weakest part of skull

Question 3

cerebrospinal fluid

Answer 3

CSF, dense, serous substance that cushions the brain and spinal cord against impact, clear and colorless, produced by brain

Question 4

meninges

Answer 4

layers of tissue that enclose the brain, protects from injury. dura mater, arachnoid, pia mater

Question 5

dura mater

Answer 5

outermost meninges layer, composed of double layer of tough fibrous tissue

Question 6

arachnoid

Answer 6

middle layer of meninges

Question 7

pia mater

Answer 7

bottom layer of meninges, in contact with brain

Question 8

subarachnoid space

Answer 8

lattice of fibrous spongey tissue filled with CSF that separates arachnoid membrane and pia mater

Question 9

epidural bleeding

Answer 9

bleeding that occurs between the dura mater and the skull

Question 10

subdural bleeding

Answer 10

occurs beneath the dura, venous

Question 11

subarachnoid hemorrhage

Answer 11

bleeding between the arachnoid membrane and surface of brain, can be fatal within minutes

Question 12

cerebrum

Answer 12

larges part of brain, compromises three-fourths of brain’s volume, divided into two hemisphere which are each made up of four lobes (frontal occipital parietal temporal), responsible for most conscious and sensory functions, emotions, personality, not attached to inside of skull

Question 13

cerebellum

Answer 13

“little brain,” controls equilibrium, coordinates muscle activity, underneath cerebrum

Question 14

brainstem

Answer 14

funnel shaped inferior part, most primitive, best protected, controls most autonomic functions of body, made of pons, medulla, midbrain.

Question 15

linear skull fracture

Answer 15

most common skull injury, resembles a line, no gross deformity

Question 16

depressed skull fracture

Answer 16

when bony ends are pushed inward toward brain, can be palpated

Question 17

closed skull fracture

Answer 17

skull is fractured, no open wound to scalp

Question 18

open skull fracture

Answer 18

skull fracture with an associated open wound to scalp

Question 19

basilar skull fracture

Answer 19

fracture to the floor or bottom of cranium

Question 20

traumatic brain injury (TBI)

Answer 20

brain injury caused by trauma

Question 21

primary brain injury

Answer 21

the result of trauma to the brain that occurs at the time of insult from a direct impact, acceleration/deceleration, or a penetrating wound, nothing an EMT can do to reverse damage

Question 22

secondary brain injury

Answer 22

from a complex cascade of pathophysiologic processes following the primary brain injury, can last for hours to days, must focus on these to prevent or limit

Question 23

herniation

Answer 23

brain compressed and pushed out of its normal position (downward)

Question 24

cushing reflex

Answer 24

increased systolic BP and decreased HR

Question 25

closed head injury

Answer 25

scalp or skull can be lacerated but the skull remains intact

Question 26

open head injury

Answer 26

involves a break in the skull and a break in the scalp

Question 27

diffuse axonal injury (DAI)

Answer 27

injury from brain from shearing, tearing, stretching nerve fibers

Question 28

concussion

Answer 28

mild DAI, normally causes some disturbance in brain function, from memory confusion to complete loss of responsiveness, usually causes headache, generally presents with altered mental status that progressively improves

Question 29

contusion

Answer 29

bruising and swelling of brain tissue, usually caused by coup/contrecoup or acceleration/deceleration injury

Question 30

coup/contrecoup

Answer 30

damage can be at the point of a blow to the head and/or damage opposite the blow as the brain is propelled against the opposite side of the skull

Question 31

acceleration/deceleration

Answer 31

head comes to sudden stop but brain keeps moving back and forth, causes bruising

Question 32

subdural hematoma

Answer 32

collection of blood between the dura mater and the arachnoid layer of brain, can be acute or occult/chronic, common with severe head injury

Question 33

epidural hematoma

Answer 33

about only 2% of all head injuries that require hospitalization, an extreme emergency, arterial or venous bleeding pools between skull and dura, rapid profuse and severe bleeding

Question 34

laceration

Answer 34

can occur in either an open or closed head injury, a permanent injury, almost always results in bleeding, can cause massive disruption to nervous system

Question 35

purposeful response

Answer 35

patient tries to move away from or remove the pain

Question 36

non-purposeful response

Answer 36

patient responds inappropriately by moving parts of body but not trying to stop pain

Question 37

flexion posturing

Answer 37

flexing arms across chest and extending legs, non-purposeful response, indicates upper-level brainstem injury

Question 38

extension posturing

Answer 38

extend both arms down at sides, extend legs, sometimes arch backs, indicates lower-level brainstem injury

Question 39

consensual reflex

Answer 39

reflex of unstimulated pupil (normal)

Question 40

reaccoon sign

Answer 40

bruising of the soft tissues around one or both eyes, can indicate intracranial injury, delayed sign of skull fracture

Question 41

battle sign

Answer 41

purple discoloration of mastoid area behind ear, delayed/late sign of basilar skull fracture

Question 42

diplopia

Answer 42

double vision

Question 43

retrograde amnesia

Answer 43

patient unable to remember circumstances leading to incident

Question 44

anterograde amnesia

Answer 44

patient unable to remember circumstances after incident

Question 45

emergency medical care for head injuries

Answer 45

1. take spine motion restriction precautions
2. establish and maintain a patent airway
3. establish and maintain adequate breathing
4. if breathing is adequate, maintain adequate oxygenation
5. control bleeding
6. be prepared to provide emergency care for seizures
7. continuously monitor mental status and report/document deterioration
8. transport immediately