Head and Spine Trauma Flashcards
Layers of Scalp
Hair and skin Sub Q tissue Galea Aponeurotica: tendon expansion Loose connective tissue Periosteum: covers surface of bone
Auditory Ossicles
Function in hearing. Located three on each side of the head deep within the cavities of the temporal bone
Cranial Vault
Eight bones that encase and protect the brain:
Parietal, temporal, frontal, occipital, sphenoid, ethmoid bones
Formane Magnum
Brain connects to the spinal cord through a large opening at the base of the skull
Sutures
How the skull bones are connected
Fontanelles
Soft in infants and link the sutures together
Mastoid Process
Base of each temporal bone and is cone shaped
Crista Galli
Prominent bony ridge in the center of the anterior fossa and is point of attachment for meninges
Ciribriform Plate
Surrounds Crista Galli with numerous openings allowing the passage of olfactory Nerve filaments from nasal cavity
Olfactory Nerves
Cranial Nerves for smell, send projections through the foramina in the ciribriform plate and into nasal cavity
Zygomatic Arch
Bone that extends along the front of the skull below the orbit
Brain
Occupies 80% of cranial vault and contains billions of neurons
Major regions
Cerebellum, diencephelon, brainstem, and cerebellum
Brain cont
See neurological emergencies
Frontal Lobe
Voluntary motor actions and emotion
Parietal Lobe
Somatic or voluntary sensory and motor functions, memory and emotions
Occipital
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
Temporal Lobe
Speech center
Limbic System
Influences motivation, emotions, motivation, mood, and sensations of pain and pleasure
Meninges
Protective layer that surround and enfold the entire CNS
Dura Mater
Outside Strong, fibrous layer wrapping brain
Arachnoid
Second layer, delicate transparent membrane
Pai Mater
Third Layer, translucent highly vascular membrane
CSF
Manufactured in the ventricles of the brain
Subarachnoid Space
CSF flows in this space. Located between the pia and arachnoid matters.
CSF Manufactured
Manufactured by cells within the choroid plexus in the ventricles, hollow storage areas in the brain
Vertebral Body
Anterior weight bearing structure is made of bone that provides support and stability
Components of Vertebrae
Spinous Process, Pericles, lamina
Pedicle
Inside of spinous process
Lamina
Groove of branch of spinous process
Spinal Nerves
31 pairs of spinal nerves
Facial and Trigeminal Nerve
Control facial feeling and function
MOI suggest Spinal Injury
Greater than 40mph crash
Unrestrained occupant
12 inch intrusion to vehicle
Fall from three times height
Coup contra coup
Brain hits front of head then hits back of the head after stopping forces applied
Cerebral Perfusion Pressure
At least 60mmHg to perfuse the brain
Hypertensive Head Injury
Do not give fluids
Hypotension head injury
20ml/kg to sustain a BP of at least 110-120 with a TBI and a GCS less than 9
Lower Cervical or Upper Thoracic Injury
Could leave patient breathing with accessory muscles and cause intercostal paralysis
C3-C5 injury
Innervated by the phrenic Nerve and may stop breathing or result to abdominal breathing
Contraindications to NPA
Basillar skull fractures or facial trauma
Consider RSI if…
Patient is awake with an impaired airway or has a detoriorating GCS < 8
RSI with ICP
Preoxygenate Lidocaine bolus (temporarily decreases ICP) 1-1.5mg/kg bolus 2 man intubate stabilized head
ICP patient breathing adequately
Give 100% oxygen via NRB
ICP Grades
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
Blown Pupils
Pressure present around eyes
Myotomes
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
Babinski Reflex
Hen toes move upward in response to stimulation of the sole of the foot. Normal circumstances, toes move downward
Linear Skull Fracture
80% of all fractures
- usually in temporal and parietal region
- risk of infection with laceration and fracture
Depressed Skull Fracture
High energy direct trauma to smalls surface area of head
- frontal and parietal most succeptible
- bony fragments may displace, causing more injury
Basilar Skull Fracture
CSF drainage, raccoon eyes, and battle signs
May show up 24 hours after injury
Open Skull Fracture
Tissue may be exposed
TBI
Traumatic Brain Injury
-classified into primary and secondary
Primary: injury instantaneously from Impact
Secondary: after injuries such as edema, ICP, cerebral ischemia
ICP
Blood or CSF, Edema accumulating inside cranial vault
Normal ICP Ranges : 0-15mmHg
Cerebral Perfusion Pressure=MAP-ICP
Critical Minimum Threshold
Minimum CPP to adequately perfuse brain is 60mmHg in adults
Less will lead to cerebral ischemia
Autoregulation
When body responds to a decrease in CPP by increasing the MAP, resulting in cerebral dialate on and increased cerebral blood flow.
Herniation
Brain is forced through the foramen magnum or the tentorium
Uncal Herniation
When temporal lobe is displaced resulting in compression of cranial Nerve 3, the midbrain, and posterior cerebral artery (decelerate)
Tonsillar Herniation
When cerebellum is displaced through foramen magnum
Decorticate
Cushing Triad
Hypertension( widening pulse pressure )
Bradycardia
Irregular Respirations
and Blown Pupils
Diffuse Brain Injury
Injury that affects entire brain
Cerebral Concussion
When Brain is jarred around in cranial vault
Retrograde Amnesia
Loss of memory of events before injury
Anterograde Amnesia
Loss of memory of events after injury
Diffuse Axonal Injury DAI
Similar to concussion
- involves stretching, shearing or tearing of nerve fibers with axonal damage
- from high speed collision forces
Focal Brain Injury
Observable brain injury on CT scan
Cerebral Contusion
Brain tissue bruised or damaged in a local area
-commonly frontal lobe and caused just like concussion with coup counter coup injuries
Epidural Hematoma
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
Subdural Hematoma
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
Intracerebral Hematoma
Bleeding within brain tissue
- once symptoms present, patient declines quickly
- high mortality rate
Subarachnoid Hematoma
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
Subgaleal Hemorrhage
Bleeding between peritoneum of skull and galea aponeurosis
-body mass that is palpated And able to move around skull
Thermal Management
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
Brain Tissue exposes
Cover moist sterile dressings
Reduce ICP
Lasix, osmitrol
-seizures must be immediately controlled because they further increase ICP
Scalp Lacerations
More serious in children and can cause hypovolemia
SCI
Spinal Cord Injuries
Most devastation but only limited care prehospital
FlexioN Injuries
Forward movement of neck
- can involve C1-2
- can result in anterior wedge fractures
- injuries to ligaments around spinal column
Partial Dislocation of spinal Coumn
Subluxation
Rotation with Flexion
Can produce stable dislocation of spine
-typically cause Fracture rather than dislocation
Vertical Compression
Forces transmitted up spine through feet or head vertically comprssing the spine
-can cause Herniation of disks
Hyperextension
Fractures of ligamentous injuries
-hangmans fracture: C2 results from hyperextension from rapid deceleration
-
Primary SCI
Injury at moment of impact
Spinal Cord Concussion
Temporary dysfunction that lasts 24-48 hours
Secondary SCI
edema, blood resulting after injury cause injury
Complete SCI
Complete disruption of spinal cord with permananet loss of all cord mediated functions beneath injury
-high thoracic injury results in paraplegia
Incomplete SCI
Retains some Cord mediated function
Anterior Cord Syndrome
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
Central Cord Syndrome
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
Posterior Cord Syndrome
Extension injuries
-dorsal columns effected presenting as decreased sensation to light touch, proprioception, and vibration
Cauda Equina Syndrome
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
Brown-Sequard Syndrome
Penetrating trauma and depicts functional hemisection of the cord and complete damage to all spinal tracts on involved side
Spinal shock
Refers to temporary local neurogenic condition that occurs immediately after spinal trauma
Swelling of the cord
Neurogenic Shock
Temporary loss of autonomic function
- hypotension, blood pools, decreased cardiac output
- warm skin, Hypotensive, bradycardia
C Spine
Hold head and jaw with fingers
Unnatural Head Position
If head is crooked and presents with pain or abnormality, splint and do not move or attempt to realign
Supine
Decrease chances of cord hypoxia
KED
Hold c spine, secure torso and hips then head last with void padding
Rapid Extrication
Hold c spine and operate in one full motion as best as possible quickly
Stnding
Hold c spine with collar and lower to the ground in neutral position
Helmets removal
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
Water Board
Completely board and strap patient in water before moving to land
Strain
Tear
Sprain
Pulled muscle
