Chapter 33 | Head, Neck, and Spine Trauma

Question 1

Define:

TBI

(abbreviation)

Answer 1

traumatic brain injury

Question 2

Define:

ICP

(abbreviation)

Answer 2

intracranial pressure

Question 3

List:

types of TBIs

4 points

Answer 3

• concussion
• contusion (coup/contrecoup)
• laceration
• hematoma

(TBI is traumatic brain injury)

Question 4

List:

types of cranial hematomas

3 points

Answer 4

• subdural hematoma
• epidural hematoma
• intracerebral hematoma

Question 5

Describe:

primary characteristic of scalp injuries

Answer 5

profuse bleeding

lots of blood vessels

Question 6

Explain:

effects of closed head injuries on ICP

(and what that does)

Answer 6

pressure inside the skull increases the brain is compressed against the skull

pressure reduces perfusion to vital brain structures

Question 7

List:

symptoms of abnormal ICP

(Cushing’s triad)

Answer 7

• widened pulse pressure
• low HR
• irregular RR

(ICP is intracranial pressure)

Question 8

Define:

Cushing’s triad

(and the 3 parts)

Answer 8

three symptoms commonly associated with abnormal intracranial pressure (ICP)

(includes widened pulse pressure, low HR, and irregular RR)

Question 9

Define:

ataxic respirations

Answer 9

pattern of irregular and unpredictable breathing commonly caused by brain injury

irregular pauses and increasing periods of apnea

Question 10

Define:

central neurogenic hyperventilation

Answer 10

pattern of rapid and deep breathing caused by injury to the brain

Question 11

Define:

Cheyne-Stokes breathing

Answer 11

distinct pattern of breathing characterized by quickening and deepening respirations followed by a period of apnea

Question 12

Define:

temporal bones

Answer 12

bones forming part of sides of skull and floor of cranial cavity

Question 13

Define:

concussion

Answer 13

mild closed head injury without detectable damage to the brain

complete recovery is usually expected (but effects may linger)

Question 14

Define:

contusion

(TBI)

Answer 14

bruised brain caused by force of a blow to the head that is great enough to rupture blood vessels

Question 15

Define:

laceration

(TBI)

Answer 15

a cut to the brain

(TBI is traumatic brain injury)

Question 16

Define:

hematoma

(TBI)

Answer 16

a collection of blood within skull or brain

(TBI is traumatic brain injury)

Question 17

Define:

herniation

Answer 17

pushing of a portion of the brain downward toward the foramen magnum

result of increased ICP

Question 18

Fill in the blank:

Herniation typically occurs as a result of [BLANK].

Answer 18

Herniation typically occurs as a result of increased intracranial pressure (ICP).

Question 19

List:

components of GCS (and max scores)

3 points

Answer 19

• eye response (4)
• verbal response (5)
• motor response (6)

Question 20

Define:

air embolism

Answer 20

bubble of air in bloodstream

Question 21

Answer:

How could a patient with a neck wound get an air embolism? What could you to do prevent/treat this?

Answer 21

air could be drawn into the bloodstream through the wound to a major vessel (like carotid artery or jugular vein) due to negative pressure

there is no applicable treatment if it happens, but it could be prevented with occlusive dressing over wound

air embolisms occur when air bubbles enter the circulatory system

Question 22

Define:

pulmonary air embolism

Answer 22

blockage in blood circulation of lung caused by blood clot or air bubble in blood vessel

Question 23

Define:

spinal motion restriction

Answer 23

limiting movement of spine to prevent additional injury

Question 24

List:

indications for leaving helmet in place

4 points

Answer 24

• helmet fits snugly (allows little movement within helmet)
• no impeding airway/breathing problems
• removal would cause further injury
• proper spinal immobilization can be done

Question 25

List:

indications for removing helmet from patient

4 points

Answer 25

• helmet interferes with ability to assess/manage airway and breathing
• helmet allows excessive head movement
• helmet interferes with proper spinal immobilization
• cardiac arrest is present

Question 26

Identify:

process by which the brain is compressed toward and through the foramen magnum

Answer 26

herniation

Question 27

Choose:

The purpose of spinal motion restriction is to prevent movement of individual:

A. muscles.

B. joints.

C. vertebrae.

D. tendons.

Answer 27

C

Question 28

Fill in the blank:

The [BLANK] is the only movable part of the face.

Answer 28

The mandible (jaw) is the only movable part of the face.

hinged at its posterior aspect to allow for functions (talking/chewing)

Question 29

Which of the following statements about an epidural hematoma is true?

A. Patients with epidural hematomas may present similarly to those with subdural hematomas.

B. Unlike subdural hematomas, which occur rapidly, epidural hematomas take hours or days to develop.

C. Epidural hematomas do not carry the threat to life that subdural hematomas do.

D. The bleeding site is between the brain and the dura mater.

Answer 29

A

Patients with epidural hematomas may present similarly to those with subdural​ hematomas, although numerous factors such as size, location, and concurrent injuries play a role in how a patient presents. In a subdural hematoma, presentation of symptoms may be delayed by as long as a day or more.

Question 30

Fill in the blank:

Which of the following findings is least likely in a patient with nontraumatic brain injury?

A. Unequal pupils

B. Battle sign

C. Altered level of consciousness

D. Slurred speech

Answer 30

B

Question 31

Define:

battle sign

Answer 31

bruising over the mastoid process

Question 32

Choose:

Which of the following intracranial physiological events is most likely to occur in a patient with traumatic brain injury but not in a patient with nontraumatic brain injury?

A. Cerebral edema

B. Cerebral contusion

C. Increased intracranial pressure

D. Cerebral hemorrhage

Answer 32

B

how would the brain get bruised?

Question 33

Choose:

In a patient who sustained massive impact trauma to the face during a motor vehicle crash, the presence of facial fractures and a fractured mandible should lead you to suspect:

A. that a compromised airway is not very likely.

B. that the patient is not likely to have a brain injury, because the facial fractures absorbed all of the energy at impact.

C. that the patient was unrestrained.

D. that the energy involved might have caused skull or brain injury.

Answer 33

D

Question 34

Answer:

Your patient responds to painful stimulus with decorticate posturing, his eyes do not open to pain, and he makes incomprehensible sounds when you pinch him.

What score would you score this patient on the Glasgow Coma Scale?

Answer 34

6

• Eye = 1 (no eye opening)
• Verbal = 2 (incomprehensible sounds)
• Motor = 3 (flexion to pain)

Question 35

Describe:

highest possible GCS score

(and describe their mental status)

Answer 35

15

(fully conscious person)

Question 36

Describe:

lowest possible GCS score

(and describe their mental status)

Answer 36

3

(deep coma or death)

Question 37

Answer:

A patient fell while rock climbing. When you apply a deep sternal rub, he extends his arms and legs and shows no other response.

What score would you score this patient on the Glasgow Coma Scale?

Answer 37

4

• Eye - 1
• Verbal - 1
• Motor - 2

Question 38

Answer:

The patient is pulseless and apneic.

What score would you score this patient on the Glasgow Coma Scale?

Answer 38

3

you probably don’t need any more info than that

• Eye - 1
• Verbal - 1
• Motor - 1

Question 39

Answer:

A 73-year-old patient looks spontaneously at you when you speak to her. When you ask her the date, she says “blue.” You note left-sided weakness when she grips your fingers.

What score would you score this patient on the Glasgow Coma Scale?

Answer 39

13

• Eye - 4
• Verbal - 3
• Motor - 6

Question 40

Answer:

A trauma patient moans, bends his arms towards his chest, and points his toes when your partner attempt to start an IV.

What score would you score this patient on the Glasgow Coma Scale?

Answer 40

6

• Eye - 1
• Verbal - 2
• Motor - 3

Question 41

Answer:

You are assessing a 20-year-old male suspected of overdosing. He is staring off into space, writhing, and babbling. When your partner starts an IV, he cries out incomprehensibly but does not pull away.

What score would you score this patient on the Glasgow Coma Scale?

Answer 41

7

• Eye - 4
• Verbal - 2
• Motor - 1

Question 42

Answer:

You are transporting an altered mental status (high suspicion inebriated) patient. When you attempt to insert a nasal airway he opens his eyes, slaps your hand away, curses at you but unsure where he is, and sits up. When you stop, he lays down on the stretcher.

What score would you score this patient on the Glasgow Coma Scale?

Answer 42

11

• Eye - 2
• Verbal - 4
• Motor - 5

Question 43

Answer:

A 75-year-old male rubs his chest and tells you it really hurts. He tells you he wants to go to the hospital, and you help him walk to the stretcher.

What score would you score this patient on the Glasgow Coma Scale?

Answer 43

15

• Eye - 4
• Verbal - 5
• Motor - 6

Question 44

Answer:

A man is found on the ground outside a homeless shelter. When you give him a sternal rub, he opens his eyes, tells you to go away, and pushes your hand away.

What score would you score this patient on the Glasgow Coma Scale?

Answer 44

12

• Eye - 2
• Verbal - 5
• Motor - 5

Question 45

Answer:

A possible overdose patient looks around with an unfocused gaze, mumbles when you ask him questions, and pulls away from a painful stimulus.

What score would you score this patient on the Glasgow Coma Scale?

Answer 45

10

• Eye - 4
• Verbal - 2
• Motor - 4

Question 46

Answer:

An intoxicated patient initially appears unresponsive. When you start an IV, she wakes up and yells at you, then lays back down and closes her eyes.

What score would you score this patient on the Glasgow Coma Scale?

Answer 46

12

• Eye - 2
• Verbal - 5
• Motor - 5

Question 47

Answer:

An adult moves their hand away when you apply pressure to the nail bed. The patient can make words but not form coherent sentences. They open their eyes to pain, but not to speech.

What score would you score this patient on the Glasgow Coma Scale?

Answer 47

9

• Eye - 2
• Verbal - 3
• Motor - 4

Question 48

Answer:

The patient spontaneously looks around. When you speak to the patient, they can tell you who they are, where they are and why, and the date, and obey simple commands.

What score would you score this patient on the Glasgow Coma Scale?

Answer 48

15

• Eye - 4
• Verbal - 5
• Motor - 6

Question 49

Answer:

The patient moves their hand towards the head when you apply pressure above the eyesocket. They are disoriented but able to form sentences. They open their eyes in response to speech.

What score would you score this patient on the Glasgow Coma Scale?

Answer 49

12

• Eye - 3
• Verbal - 4
• Motor - 5

Question 50

Answer:

The patient extends their elbow when you put pressure on the nail bed. They can talk in sentences and are disorientated. They are unable to open their eyes.

What score would you score this patient on the Glasgow Coma Scale?

Answer 50

7

• Eye - 1
• Verbal - 4
• Motor - 2

Question 51

Answer:

The patient opens their eyes when you say their name, and speaks to you in words that make no sense. When you apply pressure on their nail bed, they move their arm away.

What score would you score this patient on the Glasgow Coma Scale?

Answer 51

10

• Eye - 3
• Verbal - 3
• Motor - 4

Question 52

Answer:

The patient opens their eyes when they hear you shouting for help. They groan and make sounds which you cannot recognize as words. They do not respond to pain.

What score would you score this patient on the Glasgow Coma Scale?

Answer 52

6

• Eye - 3
• Verbal - 2
• Motor - 1

Question 53

Answer:

The patient opens their eyes when you speak to them, and can hold a conversation, though seems disorientated. The patient flexes the elbow and wrist when you put pressure on the nail bed.

What score would you score this patient on the Glasgow Coma Scale?

Answer 53

10

• Eye - 3
• Verbal - 4
• Motor - 3

Question 54

Answer:

The patient flexes their elbow and wrist when you put pressure on the nail bed. They do not open their eyes at all. They make grunting noises but no words.

What score would you score this patient on the Glasgow Coma Scale?

Answer 54

6

• Eye - 1
• Verbal - 2
• Motor - 3

Question 55

Answer:

The patient can obey simple commands and opens their eyes when they hear you speak. They can talk to you in sentences and seem a little confused and unsure of where they are.

What score would you score this patient on the Glasgow Coma Scale?

Answer 55

13

• Eye - 3
• Verbal - 4
• Motor - 6

Question 56

Answer:

The patient opens their eyes and extends their left elbow when you put pressure on the left index fingernail bed. They show no response on the right, and they make no sounds.

What score would you score this patient on the Glasgow Coma Scale?

Answer 56

5

• Eye - 2
• Verbal - 1
• Motor - 2

Question 57

Answer:

The patient unable to speak or open eyes. The patient also has no response to pain.

What score would you score this patient on the Glasgow Coma Scale?

Answer 57

3

• Eye - 1
• Verbal - 1
• Motor - 1

Question 58

Choose:

What is your first priority for a patient with massive facial trauma?

A. Preventing permanent scarring

B. Keeping the airway open

C. Protecting the patient’s privacy

D. Bandaging all open injuries

Answer 58

B

Top priorities include securing the airway and controlling bleeding, with cervical spine precautions if indicated.

Question 59

Choose:

If a standard medically approved occlusive dressing is not available, what material might be effective in treating an open neck wound?

A. Elastic wrap (e.g., an Ace bandage)

B. Aluminum foil

C. A piece of heavy plastic that is at least 2 inches larger in diameter than the wound site

D. water- or saline-soaked 4 x 4 gauze pad

Answer 59

C

A sheet of heavy plastic of an appropriate size will most effectively occlude the neck from air entry (secured with medical tape).

Question 60

Choose:

You arrive on scene to an assault victim who is grabbing the side of her neck. You notice hemorrhage on the left side of her neck.

How should you manage this patient’s neck wound once you arrive at her side?

A. Locate an occlusive dressing and place it on the wound in a timely fashion

B. Apply firm, direct pressure bilaterally to the neck

C. Immediately wrap a bandage around the neck

D. Immediately cover the wound with a gloved hand

Answer 60

D

Question 61

Choose:

A diver struck his head on the bottom of the swimming pool and now complains of neck pain and numbness in his lower extremities.

You suspect:

A. compression injury.

B. rotational injury.

C. crush injury.

D. distraction injury.

Answer 61

A

Question 62

Choose:

In neurogenic shock, the pulse rate may be:

A. normal.

B. lower than the blood pressure.

C. undetectable.

D. erratic.

Answer 62

A

Question 63

Choose:

You are the second unit on the scene of a multiple-vehicle crash. You and your partner are caring for a middle-aged woman who is sitting in the passenger seat of a vehicle that seems undamaged. You see no signs of injury in this patient. When you ask her about pain, she replies in a foreign language.

What should you do?

A. Take full spinal precautions, because you cannot determine the extent of the patient’s injuries.

B. Although communication is important, given the fact that there are no MOIs and no signs of injury, you can safely choose not to immobilize the patient.

C. The patient’s language has no bearing on how you treat here. She does not require immobilization.

D. Examine the patient more closely, and look for physical signs of pain when you palpate her back.

Answer 63

A

The language barrier creates an inability to communicate. The patient should be immobilized as a precaution, because the patient cannot relay information about her injuries.

Question 64

Choose:

The police call you for a 50-year-old male patient who has a history of intoxication and belligerence. You find him sitting on the curb with a small abrasion, minimal bleeding to his forehead, and his hands cuffed behind his back. He is exhibiting tremors, and his speech is slurred. He denies any pain, denies any consumption of alcohol, and says that he sustained the abrasion 3 days earlier.

You should:

A. transport him without spinal precautions.

B. ask law enforcement for permission to immobilize the patient.

C. immobilize him, because the history seems unreliable.

D. explain the risks to the patient and let him choose whether or not to be immobilized.

Answer 64

C

The history is inconsistent with your physical findings, and the patient is probably intoxicated. The patient should be immobilized. You should identify the potential for spinal injury while also identifying secondary causes to the patient’s condition.

Question 65

Define:

coup injury

Answer 65

cerebral contusion which occurs at the site of impact

Question 66

Define:

contrecoup injury

Answer 66

cerebral contusion which occurs opposite to the site that was hit

Question 67

Choose:

Which of the following describes shock following spinal injury?

A. Dilation of the blood vessels, resulting in reduction of perfusion to tissues

B. Paralysis of the respiratory muscles occurring with injury to the thoracic spine

C. Paralysis to only one side of the body that does not resolve

D. Inadequate circulation indicated by a rapid pulse and cool, clammy skin

Answer 67

A

Question 68

Choose:

In treating a patient with suspected head or spine injury, manual stabilization of the head and neck can be released:

A. only after the cervical spine has been cleared by an X-ray.

B. when you find a good pulse, motor function, and sensation in the distal extremities.

C. after the patient has been secured to a backboard.

D. after the cervical collar has been applied.

Answer 68

C

Question 69

Choose:

You are treating a 22-year-old male who was stabbed in the neck during a bar fight. What is an important part of the treatment of this injury?

A. Sealing the wound with an occlusive dressing

B. Laying the patient down

C. Checking for subcutaneous emphysema

D. Listening to the lung sounds right away

Answer 69

A

Question 70

Choose:

You are caring for a 19-year-old female patient who was involved in a motor vehicle crash. She sustained blunt-force trauma to her face with contusions, swelling, and minor bleeding throughout her facial region.

Which of the following findings most strongly suggests a fractured mandible?

A. Tenderness to palpation of her zygomatic bone

B. Inability to close her mouth from a wide-open position

C. Bleeding from the nose

D. Lower teeth that are out of alignment in the front

Answer 70

D

Question 71

Choose:

A brain injury is classified as nontraumatic if it is:

A. not serious.

B. not permanent.

C. not attributable to an external cause.

D. not assessable on the Glasgow Coma Scale.

Answer 71

C

Question 72

Choose:

You are treating a 6-year-old car crash victim, and have decided to immobilize him. Which of the following should you refrain from doing?

A. Using a coordinated long axis move onto the backboard

B. Securing the patient on an adult long spine board

C. Securing the patient in his child safety seat

D. Padding the patient’s shoulders

Answer 72

C

Question 73

Choose:

You just arrived at the scene of a motor vehicle crash involving two cars. The passenger of one car is sitting in the front seat, unconscious, with her chin to her chest. She is having snoring respirations, so you carefully position her head in a neutral position to clear her airway. In doing so, you notice that her nose is bleeding, there is a reddened area on her forehead at the hairline, and the windshield is starred, with some hair stuck in the fractured glass.

What type of cervical injury should you suspect?

A. Extension or flexion injury

B. Flexion or rotational injury

C. Axial loading or rotational injury

D. Axial loading or hyperextension injury

Answer 73

A

Question 74

Choose:

You find out that one of your patients from an earlier car wreck suffered bleeding that caused the blood to collect and pool within the patient’s skull. Based on this information, you know that the patient most likely suffered which type of brain injury?

A. Concussion

B. Contusion

C. Laceration

D. Hematoma

Answer 74

D

Question 75

Choose:

A 22-year-old male patient was involved in a physical altercation at a bar. He has no evidence of head trauma, and reportedly did not fall or lose consciousness at any time. His only complaint is pain upon deep inspiration along the front of his left rib cage.

Given the mechanism of injury and his presentation, should this patient be immobilized?

A. Probably so, because he was at a bar and was likely drinking

B. Probably not, because evidence of spinal injury would be obvious

C. Probably so, because he has pain in his chest

D. Probably not, because he does not have the mechanism of injury or the symptoms to suggest the need

Answer 75

D

Question 76

Choose:

Your patient has had his throat slashed during a robbery attempt. You are concerned because it is apparent that the vessels in his neck have been lacerated.

A breach in which of the following vessels would be most likely to lead to an air embolism?

A. Arteries

B. Arterioles

C. Capillaries

D. Veins

Answer 76

D

Question 77

Choose:

Which of the following conditions is least likely to present with a narrow pulse pressure?

A. Head injury

B. Tension Pneumothorax

C. Cardiac Tamponade

D. Shock

Answer 77

A

Tension pneumothorax, cardiac tamponade, and shock are most likely to present with a narrow pulse pressure while a head injury patient is likely to present with a wide pulse pressure. Narrow pulse pressures usually indicate something impeding the normal contraction of the heart.

Symptoms of Cushing’s triad includes widened pulse pressure, low HR, and irregular RR.