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Head and Spine Injuries Flashcards

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1
Q

Central nervous system

A

Composed of brain and spinal cord

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2
Q

Peripheral nervous system

A

conducts sensory and motor impulses to and from the skin, muscles, and other organs to spinal cord

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3
Q

What is the cranium occupied with?

A

80% brain tissue
10% blood supply
10% CSF

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4
Q

The most prominent and most easily palpable spinous process is?

A

C-7

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5
Q

Major regions of the brain

A

Cerebrum
Diencephalon
Brainstem
Cerebellum

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6
Q

How much glucose and oxygen does the brain use?

A

Glucose : 25%

Oxygen : 20%

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7
Q

What arteries supply blood to the brain?

A

Carotid and vertebral

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8
Q

A loss of blood flow from to the brain for ______ will result in unresponsiveness.

A

5-10 seconds

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9
Q

Cerebrum contains ___ if the brain’s total volume.

A

75%

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10
Q

Injury to cerebral cortex may result in?

A

Paresthesia, weakness, and paralysis of extremities

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11
Q

Function of frontal lobe

A

Voluntary motor action and personality

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12
Q

Function of parietal lobe

A

Controls somatic and voluntary sensory and motor function. Memory and emotions.

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13
Q

Function of occipital lobe

A

Processing visual information

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14
Q

Function of temporal lobe

A

Speech center, long-term memory, hearing, taste, and smell.

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15
Q

Function of cerebellum

A

Coordinates body movements. Maintenance of posture and equilibrium and the coordination of skilled movement.

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16
Q

Reticular activating system

A

Responsible for maintenance of consciousness, specifically one’s level of arousal.

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17
Q

Function of lower brainstem

A

HR, BP, and repsiration

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18
Q

Basal ganglia

A

Role of coordination of motor movements and posture

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19
Q

Midbrain

A

Lies immediately below the diencephalon and is the smallest region of the brainstem. Pupillary size and reactivity

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20
Q

Pins

A

Lies below the midbrain and above the medulla. Controls nerve fibers involved with sleep, respiration, and the medullary respiratory center.

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21
Q

Medulla

A

Continuous inferiorly with the spinal cord;

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22
Q

Medulla

A

Continuous inferiorly with the spinal cord and serves as a conduction pathway from ascending and descending nerve tracts. Coordinates HR, blood vessel diameter, breathing, swallowing, vomiting, coughing, and sneezing.

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23
Q

cauda equina

A

location where the spinal cord separates @ L2

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24
Q

Meninges

A

Protective layer that surround and enfold the entire CNS - specifically the brain and spinal cord.

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25
Q

Dura mater

A

covers the entire brain

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26
Q

Where are the meningeal arteries located?

A

Between the dura mater and skull

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27
Q

Arachnoid

A

Second meningeal layer. Contains blood vessels.

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28
Q

Pia matter

A

Third meningeal layer. Highly vascular that firmly adheres directly to the surface of the brain.

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29
Q

Tentorium

A

Separates the cerebral hemispheres from the cerebellum and brainstem

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30
Q

Somatic nervous system

A

Regulates or controls voluntary activities, including all coordinated muscular activities.

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31
Q

Primary function of cranial nerves

A

Special functions in head and face, including sight, smell, taste, hearing, and facial expression.

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32
Q

Two types of peripheral nerves

A

sensory and motor

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33
Q

Sensory nerves

A

Transmit sensory input from the body to CNS. i.e. touch, taste, heat, cold, and pain.

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34
Q

Motor nervces

A

Carry information from the CNS to muscles.

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35
Q

Connecting nerves

A

Short fibers that connect the sensory and motor which allow the cells on either end to exchange messages.

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36
Q

Which nerve network controls the arms and legs?

A

Arms : brachial plexus

Legs : lumbosacral plexus

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37
Q

Sympathetic nervous system

A

Controlled by hypothalamus.

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38
Q

Alpha receptor of SNS

A

Induce smooth muscle contraction in blood vessels and bronchioles

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39
Q

Beta receptor of SNS

A

Produces relaxation of smooth muscle in blood vessels and bronchioles. Chronotopic and inotropic effects on myocardial cells.

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40
Q

Chronotropic

A

Affecting HR

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41
Q

Inotropic

A

Affecting contractility

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42
Q

SNS is also responsible for

A

Sweating
Pupil dilation
Temperature regulation
Shunting blood from periphery to core during flight-or-fight

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43
Q

Spinal cord injuries at or above level ____ may disrupt flow of sympathetic communication.

A

T6

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44
Q

What would happen if there was a loss of sympathetic stimulation?

A

Disrupt homeostatsis and leave the body poorly equipped to deal with changes in its environment

45
Q

Parasympathetic nervous system

A

Responsible for conserving energy and maintaining organ function.

46
Q

What parasympathetic nerves supply the reproductive nerves, pelvis, and leg?

A

S2 through S4

47
Q

Disruption of the lower parasympathetic nerves in the sacrum results in :

A

Loss of bowel/bladder tone and sexual function

48
Q

Closed head injury is usually associated with blunt trauma and may result in :

A

Skull fx
Focal brain injuries
Diffuse brain injuries
Which can all be complicated by increased ICP

49
Q

s/s of head injury

A

Lacerations, contusion, or hematomas to the scalp
Soft area or depression noted on palpation of the scalp
Visible skull fx or deformities
Battle sign or raccoon eyes
CSF rhinorrhea or otorrhea

50
Q

s/s TBI

A 
Pupillary abnormalities
Period of unresponsiveness
Confusion or disorientation
Perseveration
Amnesia
Combativeness or other abnormal behavior
Numbness of tingling in the extremities
Loss of sensation and/or motor function
Focal neurologic deficits
Seizures
Cushing triad
Dizziness
Visual disturbances
Seeing "stars"
N/V 
Posturing
51
Q

When should you maintain a high index of suspicion of a frature?

A

Head appears deformed
Visible crack in the skull w/in a scalp laceration
Raccoon eyes
Battle sign

52
Q

What are the four types of skull fractures?

A

Linear
Depressed
Basilar
Open

53
Q

Linear skull fracture

A

Nondisplaced. Account for approximately 80% of skull fractures.

54
Q

Depressed skull fracture

A

Result from high-energy direct trauma w/ a blunt object. Often have neurologic signs such as LOC.

55
Q

What part of the skull is more susceptible to depressed skull fractures?

A

Frontal and parietal

56
Q

Basilar skull fracture

A

High-energy trauma.

Extension of a linear fracture to the base of the skull.

57
Q

Signs of basilar skull fractuer

A

CSF drainage from ears
Raccoon eyes
Battle sign

58
Q

why does the absence of raccoon eyes and Battle sign does not r/o basilar skull fracture?

A

They may not appear until up to 24 hours following injury depending on the extent of the damage.

59
Q

Open skull fracture

A

Severe forces applied to head and are often associated w/ multisystem trauma.

60
Q

Two classifications of TBI

A

Primary injury and secondary injury

61
Q

Primary injury

A

Injury to the brain and its associated structued that results instantaneously from impact to the head.

62
Q

Secondary injury

A

Processes that increase the severity of a primary brain injury and negatively impact the outcome.

63
Q

Potential causes of secondary injury

A 
Cerebral edema
Intracranial hemorrhage
Increased ICP
Cerebral ischemia
Infection
Hypoxia
Hypotension
64
Q

When can the secondary injury occur?

A

Few minutes to several days following initial head injury.

65
Q

What happens when you hyperventilate a TBI patient?

A

Vessel size decreasing diminishing blood flow and oxygenation to deprived brain cells.

66
Q

What happens when the brain is deprived of oxygen and CO2 levels increase?

A

The vessels dilate to bring more oxygenated blood to hypoxic tissue which, in turn, increased ICP, making it harder for blood to flow to swollen tissues.

67
Q

What is the only indication for hyperventilation?

A

Signs of cerebral herniation

68
Q

Signs of cerebral herniation

A

Unilateral dilated pupil that is unresponsive to light.

Decrease by 2 or more points in the GCS in a patient whose GCS score is less than 8.

69
Q

What does appearance of clear or pink, watery CSG from the nose, the ear, or an open scalp wound indicate?

A

Dura and skull have been penetrated

70
Q

Cushing triad

A

Increased BP
Decreased HR
Irregular respirations

71
Q

Healthy adult ICP range

A

5 to 15 mmHg

72
Q

Cerebral perfusion pressure

A

Pressure of blood flow through the brain. CPP = MAP - ICP

73
Q

Minimum CPP require to adequately perfuse the brain is :

A

60 mmHg

74
Q

What will happen if the CPP is less than 60 mmHG?

A

Cerebral ischemia will result causing potentially permanent neurologic impairment or even death.

75
Q

Autoregulation

A

Body’s response to a decrease in CPP by increasing MAP, resulting in cerebral vasodilation and increased cerebral blood flow.

76
Q

Early s/s of decreased ICP

A

Vomiting
HA
Altered LOC
Seizures

More-ominous, later:
HTN
Bradycardia
Cushing triad
Unilaterally unequal and nonreactive pupils
Coma
Posturing
77
Q

Decorticate posturing

A

Character by flexion of the arms and extension of the legs.

78
Q

Decerebrate posturing

A

Characterized by extension of the arms and legs

79
Q

Clinical indications of mild elevation in ICP

A 
Increased blood pressure
Decreased HR
Pupils still reactive
Cheyne-Stokes respiration
Attempts to localize and remove painful stimuli
Vomiting
HA
Altered LOC
Seizures
80
Q

Cheyne-Stokes respiration

A

Respirations that are fast and then become slow w/ intervening periods of apnea

81
Q

Clinical indications of moderate elevation in ICP

A

Widened pulse pressure and bradycardia
Pupils sluggish or nonreactive
Central neurogenic hyperventilation
Decerebrate posturing

82
Q

What does a moderation elevation in ICP indicate?

A

Middle brainstem involvement

83
Q

Central neurogenic hyperventilation

A

Deep, rapid respirations

Similar to Kussmaul but w/o acetone odor

84
Q

Clinical indications of marked elevation in ICP

A 
Unilaterally fixed and dilated pupil
Biot respirations
Flaccid response to painful stimuli
Irregular pulse rate
Fluctuating BP - hypotension common
85
Q

Survival rate of each elevation level in ICP

A

Mild elevation : effects usually reversible w/ prompt and appropriate treatment
Moderate elevation : survival possible but often w/ some permanent neurologic deficit
Marked elevations : high mortality rate

86
Q

Biot respirations

A

Irregular pattern, rate, and depth of breathing w/ intermittent periods of apnea

87
Q

Focal brain injury

A

Specific, grossly observable brain injury

88
Q

Examples of focal brain injuries

A 
Cerebral contusion
Epidural hematoma
Subdural hematoma
Intracerebral hematoma
Subarachnoid hemorrhage
89
Q

Cerebral contusion

A

Brain tissue is bruised and damaged in a specific area

90
Q

Which area of the brain is most commonly affected by cerebral contusion?

A

Frontal lobe

91
Q

Epidural hematoma

A

Accumulation of blood b/n the skull and dura mater

92
Q

What is nearly always the result of an epidural hematoma?

A

Blow to the head that produces a linear fracture of the temporal lobe

93
Q

Subdural hematoma

A

Accumulation of blood beneath the dura matter but outside the brain

94
Q

What is a subdural hematoma typically from?

A

Rupture of the vein that bridge the cerebral cortex and dura

95
Q

Classic presentation of epidural hematoma

A

LOC immediately following injury, which is then followed by a brief period of consciousness, after which the patient lapses back into unresponsiveness.
As ICP increases, pupil on the side of the hematoma becomes fixed and dilated.

96
Q

Classifications of subdural hematomas

A

Acute : clinical signs develop w/in 48 hours following injury
Subacute : sings develop b/n 2 and 14 days after the injury
Chronic : symptoms may not appear for as long as 2 weeks

97
Q

Which classification of subdural hematoma is more common in older adults, alcoholics, bleeding disease, and take anticoagulants?

A

Chronic subdural hematoma

98
Q

Why are older patients and those with hx of alcohol use at higher risk for development of subdural hematoma?

A

Atrophy of the brain tissues increases the stretching of the bridging veins.

99
Q

Common signs of subdural hematoma

A

Fluctuating LOC
Focal neurolgic signs
Slurred speech

100
Q

Intracerebral hematoma

A

Bleeding w/in brain tissue itself. Occurs following penetrating injury to the head or rapid deceleration forces

101
Q

Subarachnoid hemorrhage

A

Bleeding occurs into the subarachnoid space where the CSF circulates. Common causes include trauma or rupture of an aneurysm or arteriovenous malformation.

102
Q

As bleeding into the subarachnoid space increases, the patient experiences s/s of increases ICP :

A 
Decreased LOC
Pupillary changes
Posturing
Vomiting
Seizures
103
Q

Diffuse brain injury

A

Any injury that affects the entire brain

104
Q

Cerebral concussion is usually caused by “

A

Acceleration-deceleration forces

105
Q

Concussion

A

Results in cerebral dysfunction that usually resolved spontaneously and rapidly w/o demonstrable physical damage to the brain or permanent neurologic impairment.

106
Q

s/s of concussion

A 
Dizziness
Weakness
Visual changes
N/V
Tinnitus
Slurred speech
Inability to focus

Severe concussion: Lack of coordination
Delay of motor functions
Inappropriate emotional responses

107
Q

Diffuse axonal injury

A

Stretching, shearing, or tearing of nerve fibers w/ consequent axonal damage.

108
Q

When does DAI most often?

A

High-speed, rapid acceleration-deceleration forces

Advanced EMT (33 decks)

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