Chapter 31: Head Trauma Flashcards
cranial skull
helmet-like covering of skull
basilar skull
floor of skull, weakest part of skull
cerebrospinal fluid
CSF, dense, serous substance that cushions the brain and spinal cord against impact, clear and colorless, produced by brain
meninges
layers of tissue that enclose the brain, protects from injury. dura mater, arachnoid, pia mater
dura mater
outermost meninges layer, composed of double layer of tough fibrous tissue
arachnoid
middle layer of meninges
pia mater
bottom layer of meninges, in contact with brain
subarachnoid space
lattice of fibrous spongey tissue filled with CSF that separates arachnoid membrane and pia mater
epidural bleeding
bleeding that occurs between the dura mater and the skull
subdural bleeding
occurs beneath the dura, venous
subarachnoid hemorrhage
bleeding between the arachnoid membrane and surface of brain, can be fatal within minutes
cerebrum
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
cerebellum
“little brain,” controls equilibrium, coordinates muscle activity, underneath cerebrum
brainstem
funnel shaped inferior part, most primitive, best protected, controls most autonomic functions of body, made of pons, medulla, midbrain.
linear skull fracture
most common skull injury, resembles a line, no gross deformity
depressed skull fracture
when bony ends are pushed inward toward brain, can be palpated
closed skull fracture
skull is fractured, no open wound to scalp
open skull fracture
skull fracture with an associated open wound to scalp
basilar skull fracture
fracture to the floor or bottom of cranium
traumatic brain injury (TBI)
brain injury caused by trauma
primary brain injury
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
secondary brain injury
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
herniation
brain compressed and pushed out of its normal position (downward)
cushing reflex
increased systolic BP and decreased HR
closed head injury
scalp or skull can be lacerated but the skull remains intact
open head injury
involves a break in the skull and a break in the scalp
diffuse axonal injury (DAI)
injury from brain from shearing, tearing, stretching nerve fibers
concussion
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
contusion
bruising and swelling of brain tissue, usually caused by coup/contrecoup or acceleration/deceleration injury
coup/contrecoup
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
acceleration/deceleration
head comes to sudden stop but brain keeps moving back and forth, causes bruising
subdural hematoma
collection of blood between the dura mater and the arachnoid layer of brain, can be acute or occult/chronic, common with severe head injury
epidural hematoma
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
laceration
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
purposeful response
patient tries to move away from or remove the pain
non-purposeful response
patient responds inappropriately by moving parts of body but not trying to stop pain
flexion posturing
flexing arms across chest and extending legs, non-purposeful response, indicates upper-level brainstem injury
extension posturing
extend both arms down at sides, extend legs, sometimes arch backs, indicates lower-level brainstem injury
consensual reflex
reflex of unstimulated pupil (normal)
reaccoon sign
bruising of the soft tissues around one or both eyes, can indicate intracranial injury, delayed sign of skull fracture
battle sign
purple discoloration of mastoid area behind ear, delayed/late sign of basilar skull fracture
diplopia
double vision
retrograde amnesia
patient unable to remember circumstances leading to incident
anterograde amnesia
patient unable to remember circumstances after incident
emergency medical care for head injuries
- take spine motion restriction precautions
- establish and maintain a patent airway
- establish and maintain adequate breathing
- if breathing is adequate, maintain adequate oxygenation
- control bleeding
- be prepared to provide emergency care for seizures
- continuously monitor mental status and report/document deterioration
- transport immediately
