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Paramedic 02 > Head and Spine Trauma > Flashcards

Head and Spine Trauma Flashcards

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1
Q

Layers of Scalp

A 
Hair and skin
Sub Q tissue
Galea Aponeurotica: tendon expansion 
Loose connective tissue
Periosteum: covers surface of bone
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2
Q

Auditory Ossicles

A

Function in hearing. Located three on each side of the head deep within the cavities of the temporal bone

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3
Q

Cranial Vault

A

Eight bones that encase and protect the brain:

Parietal, temporal, frontal, occipital, sphenoid, ethmoid bones

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4
Q

Formane Magnum

A

Brain connects to the spinal cord through a large opening at the base of the skull

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5
Q

Sutures

A

How the skull bones are connected

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6
Q

Fontanelles

A

Soft in infants and link the sutures together

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7
Q

Mastoid Process

A

Base of each temporal bone and is cone shaped

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8
Q

Crista Galli

A

Prominent bony ridge in the center of the anterior fossa and is point of attachment for meninges

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9
Q

Ciribriform Plate

A

Surrounds Crista Galli with numerous openings allowing the passage of olfactory Nerve filaments from nasal cavity

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10
Q

Olfactory Nerves

A

Cranial Nerves for smell, send projections through the foramina in the ciribriform plate and into nasal cavity

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11
Q

Zygomatic Arch

A

Bone that extends along the front of the skull below the orbit

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12
Q

Brain

A

Occupies 80% of cranial vault and contains billions of neurons

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13
Q

Major regions

A

Cerebellum, diencephelon, brainstem, and cerebellum

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14
Q

Brain cont

A

See neurological emergencies

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15
Q

Frontal Lobe

A

Voluntary motor actions and emotion

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16
Q

Parietal Lobe

A

Somatic or voluntary sensory and motor functions, memory and emotions

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17
Q

Occipital

A

Optic Nerve originates, responsible for visual information.

Injury to the back of the head mya see stars because the optic Nerve banged against the back of the skull

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18
Q

Temporal Lobe

A

Speech center

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19
Q

Limbic System

A

Influences motivation, emotions, motivation, mood, and sensations of pain and pleasure

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20
Q

Meninges

A

Protective layer that surround and enfold the entire CNS

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21
Q

Dura Mater

A

Outside Strong, fibrous layer wrapping brain

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22
Q

Arachnoid

A

Second layer, delicate transparent membrane

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23
Q

Pai Mater

A

Third Layer, translucent highly vascular membrane

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24
Q

CSF

A

Manufactured in the ventricles of the brain

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25
Q

Subarachnoid Space

A

CSF flows in this space. Located between the pia and arachnoid matters.

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26
Q

CSF Manufactured

A

Manufactured by cells within the choroid plexus in the ventricles, hollow storage areas in the brain

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27
Q

Vertebral Body

A

Anterior weight bearing structure is made of bone that provides support and stability

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28
Q

Components of Vertebrae

A

Spinous Process, Pericles, lamina

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29
Q

Pedicle

A

Inside of spinous process

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30
Q

Lamina

A

Groove of branch of spinous process

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31
Q

Spinal Nerves

A

31 pairs of spinal nerves

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32
Q

Facial and Trigeminal Nerve

A

Control facial feeling and function

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33
Q

MOI suggest Spinal Injury

A

Greater than 40mph crash
Unrestrained occupant
12 inch intrusion to vehicle
Fall from three times height

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34
Q

Coup contra coup

A

Brain hits front of head then hits back of the head after stopping forces applied

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35
Q

Cerebral Perfusion Pressure

A

At least 60mmHg to perfuse the brain

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36
Q

Hypertensive Head Injury

A

Do not give fluids

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37
Q

Hypotension head injury

A

20ml/kg to sustain a BP of at least 110-120 with a TBI and a GCS less than 9

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38
Q

Lower Cervical or Upper Thoracic Injury

A

Could leave patient breathing with accessory muscles and cause intercostal paralysis

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39
Q

C3-C5 injury

A

Innervated by the phrenic Nerve and may stop breathing or result to abdominal breathing

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40
Q

Contraindications to NPA

A

Basillar skull fractures or facial trauma

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41
Q

Consider RSI if…

A

Patient is awake with an impaired airway or has a detoriorating GCS < 8

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42
Q

RSI with ICP

A 
Preoxygenate
Lidocaine bolus (temporarily decreases ICP) 1-1.5mg/kg bolus
2 man intubate stabilized head
43
Q

ICP patient breathing adequately

A

Give 100% oxygen via NRB

44
Q

ICP Grades

A

Mild: pupils reactive, increased BP, Cheyenne stokes resp, headache, vomiting
Moderate: widened pulse pressure, pupils sluggish, bradycardia, kussmaul resp, decelerate Posturing
Severe: irregular bradycardia pulse, widened BP, biot respirations, blown pupils unilaterally

45
Q

Blown Pupils

A

Pressure present around eyes

46
Q

Myotomes

A 
Motor components of spinal Nerves in rebate discrete tissues and muscles of the body
C3-C5 diaphragm
C5 elbow flexor biceps, brachioradialis
C6 wrist extensions
C7 triceps 
C8 finger flexor
T2-T7 intercostal
L2 hip flexor
L3 knee extension
L4 ankle extension
L5 big toes extension
S1 plantar flexor
S4-5 anus, Bowel, bladder
47
Q

Babinski Reflex

A

Hen toes move upward in response to stimulation of the sole of the foot. Normal circumstances, toes move downward

48
Q

Linear Skull Fracture

A

80% of all fractures

  • usually in temporal and parietal region
  • risk of infection with laceration and fracture
49
Q

Depressed Skull Fracture

A

High energy direct trauma to smalls surface area of head

  • frontal and parietal most succeptible
  • bony fragments may displace, causing more injury
50
Q

Basilar Skull Fracture

A

CSF drainage, raccoon eyes, and battle signs

May show up 24 hours after injury

51
Q

Open Skull Fracture

A

Tissue may be exposed

52
Q

TBI

A

Traumatic Brain Injury
-classified into primary and secondary
Primary: injury instantaneously from Impact
Secondary: after injuries such as edema, ICP, cerebral ischemia

53
Q

ICP

A

Blood or CSF, Edema accumulating inside cranial vault
Normal ICP Ranges : 0-15mmHg
Cerebral Perfusion Pressure=MAP-ICP

54
Q

Critical Minimum Threshold

A

Minimum CPP to adequately perfuse brain is 60mmHg in adults

Less will lead to cerebral ischemia

55
Q

Autoregulation

A

When body responds to a decrease in CPP by increasing the MAP, resulting in cerebral dialate on and increased cerebral blood flow.

56
Q

Herniation

A

Brain is forced through the foramen magnum or the tentorium

57
Q

Uncal Herniation

A

When temporal lobe is displaced resulting in compression of cranial Nerve 3, the midbrain, and posterior cerebral artery (decelerate)

58
Q

Tonsillar Herniation

A

When cerebellum is displaced through foramen magnum

Decorticate

59
Q

Cushing Triad

A

Hypertension( widening pulse pressure )
Bradycardia
Irregular Respirations
and Blown Pupils

60
Q

Diffuse Brain Injury

A

Injury that affects entire brain

61
Q

Cerebral Concussion

A

When Brain is jarred around in cranial vault

62
Q

Retrograde Amnesia

A

Loss of memory of events before injury

63
Q

Anterograde Amnesia

A

Loss of memory of events after injury

64
Q

Diffuse Axonal Injury DAI

A

Similar to concussion

  • involves stretching, shearing or tearing of nerve fibers with axonal damage
  • from high speed collision forces
65
Q

Focal Brain Injury

A

Observable brain injury on CT scan

66
Q

Cerebral Contusion

A

Brain tissue bruised or damaged in a local area

-commonly frontal lobe and caused just like concussion with coup counter coup injuries

67
Q

Epidural Hematoma

A

Accumulation of blood between skull and dura mater

  • from blow to head and produces linear fracture of thin temporal bone
  • brisk arterial bleeding common
  • LOC from injury, wakes up, then passes back out
68
Q

Subdural Hematoma

A

Accumulation of blood beneath dura matter but outsid of brain

  • associated with skull fracture
  • associated with venous bleeding, typically takes more time to develop Signs and symptoms
  • slurred speech and fluctuation of symptoms
69
Q

Intracerebral Hematoma

A

Bleeding within brain tissue

  • once symptoms present, patient declines quickly
  • high mortality rate
70
Q

Subarachnoid Hematoma

A

Subarachnoid space where CSF is bleeding occurs

  • common from aneurysm or atriovenous malformation
  • sudden severe headache
  • signs of ICP as it progresses
  • survival usually means permanent damage
71
Q

Subgaleal Hemorrhage

A

Bleeding between peritoneum of skull and galea aponeurosis

-body mass that is palpated And able to move around skull

72
Q

Thermal Management

A

Do not allow patient to be overheated

  • patients with head injury can develop high temperatures (hyperpyrexia)
  • do not cover with blankets if room temp is 70F
73
Q

Brain Tissue exposes

A

Cover moist sterile dressings

74
Q

Reduce ICP

A

Lasix, osmitrol

-seizures must be immediately controlled because they further increase ICP

75
Q

Scalp Lacerations

A

More serious in children and can cause hypovolemia

76
Q

SCI

A

Spinal Cord Injuries

Most devastation but only limited care prehospital

77
Q

FlexioN Injuries

A

Forward movement of neck

  • can involve C1-2
  • can result in anterior wedge fractures
  • injuries to ligaments around spinal column
78
Q

Partial Dislocation of spinal Coumn

A

Subluxation

79
Q

Rotation with Flexion

A

Can produce stable dislocation of spine

-typically cause Fracture rather than dislocation

80
Q

Vertical Compression

A

Forces transmitted up spine through feet or head vertically comprssing the spine
-can cause Herniation of disks

81
Q

Hyperextension

A

Fractures of ligamentous injuries
-hangmans fracture: C2 results from hyperextension from rapid deceleration
-

82
Q

Primary SCI

A

Injury at moment of impact

83
Q

Spinal Cord Concussion

A

Temporary dysfunction that lasts 24-48 hours

84
Q

Secondary SCI

A

edema, blood resulting after injury cause injury

85
Q

Complete SCI

A

Complete disruption of spinal cord with permananet loss of all cord mediated functions beneath injury
-high thoracic injury results in paraplegia

86
Q

Incomplete SCI

A

Retains some Cord mediated function

87
Q

Anterior Cord Syndrome

A

Displacement of bony fragments into anterior portion of spinal cord due to flexion injuries or fractures

  • disruption in flow in anterior spinal artery
  • paralysis below injury with loss of sensation to touch, temperature and pain
88
Q

Central Cord Syndrome

A

Hyperextension injuries to cervical area present with edema or blood to cervical areas

  • risk with cervical spondylosis and arthritic changes in elderly
  • motor and efferent fibers disturbed
  • loss in upper extremities than lower
  • many have good outcomes
89
Q

Posterior Cord Syndrome

A

Extension injuries

-dorsal columns effected presenting as decreased sensation to light touch, proprioception, and vibration

90
Q

Cauda Equina Syndrome

A

Compression of bundle of Nerve roots that resembles horses tail at the end of the spinal column
-lower back pain, paresthesia, acute bladder or Bowel dysfunction

91
Q

Brown-Sequard Syndrome

A

Penetrating trauma and depicts functional hemisection of the cord and complete damage to all spinal tracts on involved side

92
Q

Spinal shock

A

Refers to temporary local neurogenic condition that occurs immediately after spinal trauma
Swelling of the cord

93
Q

Neurogenic Shock

A

Temporary loss of autonomic function

  • hypotension, blood pools, decreased cardiac output
  • warm skin, Hypotensive, bradycardia
94
Q

C Spine

A

Hold head and jaw with fingers

95
Q

Unnatural Head Position

A

If head is crooked and presents with pain or abnormality, splint and do not move or attempt to realign

96
Q

Supine

A

Decrease chances of cord hypoxia

97
Q

KED

A

Hold c spine, secure torso and hips then head last with void padding

98
Q

Rapid Extrication

A

Hold c spine and operate in one full motion as best as possible quickly

99
Q

Stnding

A

Hold c spine with collar and lower to the ground in neutral position

100
Q

Helmets removal

A

Remove if chin strap and helmet fail to hold head properly
Prevents immobilization for transport
Can not be removed after attempts
Prevent adequate airway control

101
Q

Water Board

A

Completely board and strap patient in water before moving to land

102
Q

Strain

A

Tear

103
Q

Sprain

A

Pulled muscle

Paramedic 02 (27 decks)

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