Head And Neck Flashcards by Jordan Harding

Rate of injury to head/c-spine higher in women’s or men’s sports?

Women’s sports

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Rate of injury to head/c-spine higher in high school or college?

Higher in college

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________ ________ are difficult to grade due to subjective report and often result in RTP prior to healing.

Head injuries

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The skull and skin combined has a breaking force of _____ to _____ pounds per square inch; skull alone _____.

420 to 490, 40

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The most complex and least understood part of the human body?

The brain

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Motor function, sensory information, special senses (5 senses), cognition, memory are functions of which part of the brain?

Cerebrum

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The largest section of the brain, the ________ is composed of 2 ________ separated by the ________ ________.

Cerebrum, hemisphere, longitudinal fissure

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Each hemisphere is divided into what 4 lobes?

Frontal, pariatel, temporal, occipital lobes

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Balance and coordination, smooth muscle control; reaction time, injury is rare

Cerebellum

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Body temp regulation, emotional control, water balance control, hormone balance and ANS/CNS(hypothalamus), subconscious brain activity

Diencephalon (thalamus, hypothalamus, epithalamus)

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HR regulation, respiration regulation, peripheral blood flow regulation

Brain stem

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Secreted by cells surrounding the cerebrum’s blood vessels

Cerebrospinal fluid

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A leak with skull fracture and torn dura, opening the inter cranial space to the nose and nasal track

Cerebrospinal fluid

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At rest the brain demands ____% of the body’s O2 uptake; for each degree increased in core body temp (C), the brain demands an additional ____%.

20%, 7%

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_____ and _____ of concussions; with repeated injury, increase risk for concussion event, increase in SnSx, increase in days to recovery, increase risk of second impact syndrome.

Number, recency

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Contusion, skull Fx, intracranial hemmorrhage vs. diffuse (headache)

localized head pain

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_________ following a blow to the head, probability of skull Fx triples in adults, doubles in kids

Vomiting

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Reports of ________ in one or more extremities is sign of serious damage to the brain, SC, or N root

weakness

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PCS

Post-concussion syndrome

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Persistent SnSx including difficulty concentrating, fatigue, emotional instability

PCS

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Signs of Brain/C-spine trauma

Unconsciousness, Not breathing, no pulse, prone on field (motionless), Nystagmus, Vacant stare, Amnesia, confusion, disorientation, irritability, inability to focus, delayed verbal/motor response, dizziness, headache, blurred vision, tinnitus, slurred speech, nausea, vomiting, unusually fatigued, photophobia, emotional

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SnSx for Recurrent Concussions

Headache, balance/dizziness, “slowed down”, concentration, sensitivity to light or noise, fatigue, drowsiness, memory

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Presence of ________ is more predictive or cognitive deficit as compared to ______.

amnesia, LOC

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All unconscious athletes must be managed as if they have ________ ________ until ruled out

c-spine fracture

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Ideal on-field evaluation is done by two responders: 1) __________ _____ _______, 2) ________ ________ & _________ ________.

1) stabilizes the head, 2) performs primary & secondary assessments

______ _________ can be difficult; however once you have ________ and _______, no need to move from found position until fracture of c-spine is managed.

body positioning, | breathing and pulse

3 pathologic body positions

1) decerebrate, 2) decorticate, and 3) flexion contracture (C5-6 lesion)

First priority of Primary Assessment

Establish LOC

Primary Assessment

Establish LOC; when approaching scene, look for movement; attempt to communicate with athlete while stabilizing the head

If unresponsive, use _______ __________.

``` AVPU pain stimuli (pinch fingernail, pinch patient, knuckles to sternum) ```

T/F | Ammonia inhalants are discouraged due to potential unwanted c-spine movement

True

Remove face mask with continued stabilization of helmet and use the ________ ____ ________ to open airway.

modified jaw lift

Includes examination of the body for severe bleeding or damage

secondary assessment

stationary skull hit by object; one side of the brain is injured

coup

skull is moving at high velocity and suddenly stops; damage opposite impact

countercoup

Repeated non traumatic blows cause a higher degree of degenerative changes; cumulative neurologic deficits; makes getting an accurate history important at physical time

Subconcussive Forces

A violent jarring or shaking that results in a disturbance of brain function

Concussion

Battle Sign

Bruising over mastoid process indicative of basilar skull fracture hours post-injury

Nystagmus

Involuntary Circular movement

Anisocoria

Unilaterally dilated pupil, can be from intracranial hemorrhage placing pressure on Cranial Nerve III, reactive to light bilateral

Determines the presence of cerebrospinal fluid in any fluid escaping from the ears or nose

Halo Test

Raccoon Eyes

Indicative of skull or nasal fracture

Palpations should include

Spinous & Transverse Processes; skull & facial structures; throat to rule out trauma to the larynx, trachea, & hyoid bone; muscle spasm that was identified on inspection

Anterograde Amnesia

List of events post-injury; repeated 5 min later

Retrograde Amnesia

Happenings prior to the injury are prompted for recall

Balance & Coordination can be assessed through _____ ________ or the __________ Test.

tandem walking, Romberg

Bones of the face

1. Frontal 2. Nasal 3. Zygomatic 4. Maxilla 5. Mandible

Tandem walking

Pt walks heel-to-toe along straight line for ~10 yards; pt returns to starting position by walking backward

Romberg Test

Pt shuts eyes and abducts arms to 90 degrees with elbows extended; pt tilts head backward and lifts one foot off ground while attempting to maintain balance; pt is asked to touch the index finger to the nose with eyes remaining closed.

The temporary cessation of breathing

Apnea

Monitor and record pulse rate immediately and every _____ min (for_____min)

5, 20

T/F | BP should decrease across your evaluation of the injury; if it remains high, SN of brain hemorrhage

True

Cranial Nerve I (name and Function)

Olfactory - Smell

Cranial Nerve II

Optic - Vision (test peripheral vision)

Cranial Nerve III

Oculomotor - Pupil reaction to light, elevation of upper eyelid

Cranial Nerve IV

Trochlear - Depress and adduct eye

Cranial Nerve V

Trigeminal - Face sensation and muscles of mastication (clench teeth)

Cranial Nerve VI

Abducens - Lateral eye movement (test ability to abduct eye past midline)

Cranial Nerve VII

Facial - Muscles of expression (smile) and taste

Cranial Nerve VIII

Vestibulocochlear - Equilibrium, hearing

Cranial Nerve IX

Glossopharyngeal - Pharyngeal muscles (swallow, voice) and taste

Cranial Nerve X

Vagus - Muscles of pharynx and larynx (swallow, voice, gag reflex)

Cranial Nerve XI

Accessory - Trapezius and sternocleidomastoid muscles (shrug shoulders)

Cranial Nerve XII

Hypoglossal - Tongue movement

Spearing

cervical flexion associated with axial loading of the c-spine: highly dangerous

Although illegal, spearing still occurs in over ____% of all football plays; cervical dislocations primary occur at the level of _____; lordotic curve is 0 at ____ degrees of c-spine flexion

19, C4-6, 30 degrees

Second-impact syndrome

A second blow to the head following a recent concussion; risk for sudden death or serious brain injury as high

Subdural Hematoma

Caused by venous bleeding between the Dura mater and the brain

This injury accounts for a majority of head-injury deaths in sport; symptoms may take longer to develop (30 days after trauma) due to slower venous bleeds, making detection harder

Subdural Hematoma

Epidural Hematoma

Caused by arterial bleeding between the Dura mater and the skull; usually rapid onset of symptoms

The outermost meningeal covering of the brain

Dura mater

A fold in the dura mater in the longitudinal fissure between the two cerebral hemispheres

Falx cerebri

If arterial blood flow to the brain is obstructed/damaged, the design of the ________ ____ __________ permits at least a partial supply of blood to the affected area

Circe of Willis

Cerebral Spinal Fluid (CSF) originates from the | __________ ___________

Choroid Plexuses

Should be used in conduction with on field testing

Standardized Assessment of Concussion Instrument (SAC)

Measures the magnitude of brain injuries;scores of 11 - 15 have good prognosis

Glasgow Coma Scale

Serial 7s test

Neurological function test that assesses analytical skills; athlete is asked to count backwards from 100 x 7

Pulse pressure of ___ mmHg is normal: greater than him ___ mmHG is indicated of increased intracranial bleeding

40, 50

Importance of vomiting with head injury is a likely indicator of school fracture: __ times likely and children, and ___ times likely in adults.

2x children | 3x adults

Three types of school fractures

1. Linear (crack) 2. Depressed (debt) 3. Comminuted (crushed)

When do we refer to a physician following a concussion (3)

1. Any loss of consciousness 2. Amnesia lasting longer than 15 min 3. Worsening of symptoms

Post-concussion syndrome (PCS) symptoms that persist for more than ____ months after injury represent disruption of the brain, especially the ______ _____, ________ lobe, and _______ lobe.

3, brain stem, frontal , temporal

BESS (balance error scoring system)

Firm surface bout: double leg stance, single leg stance, tandem leg stance; soft surface about: double leg stance single leg stance tandem leg stance

Jefferson's fracture

A fracture of a circular bone in two places similar to breaking a doughnut in half

Cervical stenosis

Narrowing of the spinal canal with hyperflexion or hyperextension of the neck, transient quadriplegia can result when the ratio of the diameter of the spinal canal and I am in of the vertebral body is .80 or less, higher risk

True/false: the football helmet has been implicated in increasing the number of injuries to the cervical spine

True

Individuals who have suffered trauma to the are recognizable by their uncovering; segmental, robotlike movement

Cerebellum

Formed by the medulla oblongata and the pones

Brain stem

Sympathetic nervous system

The part of the central nervous system that supplies the involuntary muscles