Head And Neck Flashcards
Rate of injury to head/c-spine higher in women’s or men’s sports?
Women’s sports
Rate of injury to head/c-spine higher in high school or college?
Higher in college
________ ________ are difficult to grade due to subjective report and often result in RTP prior to healing.
Head injuries
The skull and skin combined has a breaking force of _____ to _____ pounds per square inch; skull alone _____.
420 to 490, 40
The most complex and least understood part of the human body?
The brain
Motor function, sensory information, special senses (5 senses), cognition, memory are functions of which part of the brain?
Cerebrum
The largest section of the brain, the ________ is composed of 2 ________ separated by the ________ ________.
Cerebrum, hemisphere, longitudinal fissure
Each hemisphere is divided into what 4 lobes?
Frontal, pariatel, temporal, occipital lobes
Balance and coordination, smooth muscle control; reaction time, injury is rare
Cerebellum
Body temp regulation, emotional control, water balance control, hormone balance and ANS/CNS(hypothalamus), subconscious brain activity
Diencephalon (thalamus, hypothalamus, epithalamus)
HR regulation, respiration regulation, peripheral blood flow regulation
Brain stem
Secreted by cells surrounding the cerebrum’s blood vessels
Cerebrospinal fluid
A leak with skull fracture and torn dura, opening the inter cranial space to the nose and nasal track
Cerebrospinal fluid
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%
_____ 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
Contusion, skull Fx, intracranial hemmorrhage vs. diffuse (headache)
localized head pain
_________ following a blow to the head, probability of skull Fx triples in adults, doubles in kids
Vomiting
Reports of ________ in one or more extremities is sign of serious damage to the brain, SC, or N root
weakness
PCS
Post-concussion syndrome
Persistent SnSx including difficulty concentrating, fatigue, emotional instability
PCS
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
SnSx for Recurrent Concussions
Headache, balance/dizziness, “slowed down”, concentration, sensitivity to light or noise, fatigue, drowsiness, memory
Presence of ________ is more predictive or cognitive deficit as compared to ______.
amnesia, LOC
All unconscious athletes must be managed as if they have ________ ________ until ruled out
c-spine fracture
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
- Frontal
- Nasal
- Zygomatic
- Maxilla
- 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
- Linear (crack)
- Depressed (debt)
- Comminuted (crushed)
When do we refer to a physician following a concussion (3)
- Any loss of consciousness
- Amnesia lasting longer than 15 min
- 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
