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Emergency Medical Technician > Head & Spine Injuries > Flashcards

Head & Spine Injuries Flashcards

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Royal College: Emergency Medicine flashcards USMLE® Step 1 flashcards
1
Q

Two anatomic parts of the nervous system

A
  1. Central nervous system
  2. Peripheral nervous system
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2
Q

The CNS is composed of the ___

A

Brain and the spinal cord, including the nuclei and cell bodies of most nerve cells

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3
Q

___ link the nuclei and cell bodies of most neve cells to the body’s various organs through openings in the spinal column

A

Long nerve fibers

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4
Q

The long nerve fibers connecting the body’s various organs to the CNS are part of the ___

A

PNS

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5
Q

Three major areas of the brain

A
  1. Cerebrum
  2. Cerebellum
  3. Brainstem
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6
Q

The cerebrum contains about ___ of the brain’s total volume

A

Cerebrum

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7
Q

Controls a wide variety of activities, including most voluntary motor function and conscious thought

A

Cerebrum

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8
Q

The cerebrum is divided into ___

A

Two hemispheres with four lobes

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9
Q

Underneath the cerebrum lies the ___

A

Cerebellum

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10
Q

Coordinates balance and body movements

A

Cerebellum

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11
Q

The most primitive part of the CNS

A

Brainstem

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12
Q

Controls virtually all the functions that are necessary for life, including the cardiac and respiratory systems and nerve function transmissions

A

Brainstem

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13
Q

Best protected part of the CNS

A

Brainstem

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14
Q

The spinal cord is mostly made up of ___

A

Fibers that extend from the brain’s nerve cells

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15
Q

Carries messages between the brain and the body via the gray matter and white matter

A

Spinal cord

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16
Q

Gray matter is composed of ___

A

Neural cell bodies and synapses, which are connections between nerve cells

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17
Q

White matter consists of ___

A

Fiber pathways

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18
Q

Cells of the brain and spinal cord cannot be ___

A

Regenerated or reproduced

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19
Q

Three distinct layers of tissue that suspend the brain and the spinal cord within the skull and the spinal canal

A

Meninges

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20
Q

The outer layer of the meninges

A

Dura mater

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21
Q

Dura mater

A

Tough fibrous layer that closely resembles leather

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22
Q

This layer forms a sac to contain the CNS, with small openings through which the peripheral nerves exit

A

Dura mater

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23
Q

Inner two layers of the meninges

A

Arachnoid and the pia mater

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24
Q

Contain the blood vessels that nourish the brain and spinal cord

A

Inner two lays of the meninges

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25
Q

CSF is produced in ___

A

A chamber in the brain, called the third ventricle

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26
Q

CSF is located in ___

A

The subarachnoid space below the arachnoid, which is a weblike struture

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27
Q

Amount of CSF in the brain at any one time

A

125 to 150 mL

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28
Q

Primarily acts as a shock absorber in the brain

A

CSF

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29
Q

If a patient with a head injury has what looks like a runny nose or reports a salty taste at the back of the throat, you should assume the fluid is ___

A

CSF

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30
Q

Bleeding within the skull

A

Intracranial hemorrhage

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31
Q

Result of intracranial hemorrhage

A

Increases pressure in the skull and compresses softer brain tissue

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32
Q

Two anatomic parts of the PNS

A
  1. 31 pairs of spinal nerves
  2. 12 pairs of cranial nerves
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33
Q

Conduct sensory impulses from the skin and other organs to the spinal cord. Also conduct motor impulses from the spinal cord to the muscles

A

31 pairs of spinal nerves

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34
Q

Controls the arms

A

Brachial plexus

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35
Q

Controls the legs

A

Lumbosacral plexus

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36
Q

12 pairs of nerves that emerge from the brainstem and transmit information directly to or from the brain

A

Cranial nerves

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37
Q

Perform special functions in the head and face, including sight, smell, taste, hearing, and facial expressions

A

Cranial nerves

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38
Q

Two major types of peripheral nerves

A
  1. Sensory nerves
  2. Motor nerves
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39
Q

Nerves with endings that perceive only one type of information, carry that info from the body to the brain via the spinal cord.

A

Sensory nerves

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40
Q

One for each muscle, carry info from the CNS to the muscles

A

Motor nerves

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41
Q

Connect the sensory and motor nerves with short fibers, which allow the cells on either end to exchange simple messages

A

Connecting nerves

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42
Q

Connecting nerves are only found in ___

A

The brain and spinal cord

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43
Q

In connecting the sensory and motor nerves of the limbs, the connecting nerves in the spinal cord form a ___

A

Reflex arc

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44
Q

If a sensory nerve in the reflex arc detects an irritating stimulus, it will ___

A

Bypass the brain and send a message directly to the motor nerve, causing a response like pulling away

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45
Q

The actions that we consciously perform

A

Voluntary activities

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46
Q

Actions that are not under our conscious control

A

Involuntary activities

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47
Q

The part of the nervous system that regulates or controls our voluntary activities

A

Somatic nervous system

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48
Q

The part of the nervous system that regulates the body functions that occur without conscious effort

A

Autonomic nervous system

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49
Q

The autonomic nervous system is divided into two sections

A
  1. Sympathetic nervous system
  2. Parasympathetic nervous system
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50
Q

___ reacts to stress with the fight or flight response

A

Sympathetic nervous system

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51
Q

During a time of stress, a hormone called ___ is released

A

Epinephrine (adrenaline)

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52
Q

Counters the sympathetic nervous system

A

Parasympathetic nervous system

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53
Q

The cranium is occupied by ___

A

80% brain tissue, 10% blood supply, and 10% CSF

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54
Q

The spinal canal is ___ by birth

A

Closed

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55
Q

Neural tube deformities can result in ___

A

Serious birth defects

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56
Q

The lower portion of the spine does not close prior to birth

A

Spina bifida

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57
Q

Number of vertebrae

A

7 Cervical
12 Thoracic
5 Lumbar
5 Sacrum
4 Coccyx (fused)

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58
Q

The front part of each vertebra consists of ___

A

A round, solid block of bone called the vertebral body

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59
Q

The back part of each vertebra forms a ___

A

Bony arch

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60
Q

From one vertebra to the next, the series of arches for a ___

A

Tunnel running the length of the spinal column

61
Q

Tunnel running the length of the spinal column

A

Spinal canal

62
Q

Vertebrae are connected by ___ and separated by ___

A
  1. Ligaments
  2. Cushions
63
Q

Cushions that separate each vertebra

A

Intervertebral disks

64
Q

Allow the trunk to bend forward and back, but also limit motion

A

Ligaments and disks

65
Q

Palpable part of the spinal column

A

Posterior spinous process of some of the vertebrae

66
Q

Two types of head injuries

A
  1. Closed head injury
  2. Open head injury
67
Q

The brain has been injured but there is no opening to the brain

A

Closed head injury

68
Q

An opening exists from the outside to the brain

A

Open head injury

69
Q

Obvious skull deformity with a break in the skin is a sign of ___

A

An open head injury

70
Q

General signs and symptoms of a head injury

A
  1. Lacerations, contusions, or hematomas to the scalp
  2. Soft area or skull depression or palpation
  3. Visible fractures or deformities of the skull
  4. Decreased mentation, confusion
  5. Irregular breathing pattern
  6. Widening pulse pressure
  7. Slow heart rate
  8. Ecchymosis about the eyes or behind the ear over the mastoid process
  9. Clear or pink CSF leakage
  10. Failure of the pupils to react to light
  11. Unequal pupil size
  12. Loss of sensation and/or motor function
  13. Period of unconsciousness
  14. Amnesia
  15. Seizures
  16. Numbness or tingling in the extremities
  17. Dizziness
  18. Visual complaints
  19. Combative or other abnormal behavior
  20. Nausea or vomiting
  21. Posturing
71
Q

Bruising that develops under the eyes

A

Raccoon eyes

72
Q

Bruising behind one ear over the mastoid process

A

Battle sign

73
Q

Raccoon eyes or battle sign are signs of ___

A

Skull fracture

74
Q

Nondisplaced skull fractures

A

Linear skull fracture

75
Q

If there is a laceration with a linear skull fracture, there is a risk of ___

A

Infection and bleeding inside the brain

76
Q

Depressed skull fractures result from ___

A

High-energy direct trauma to the head with a blunt object

77
Q

Part of the skull most susceptible to depressed skull fracture

A

Frontal and parietal bones

78
Q

Patients with depressed skull fractures often present with signs of ___

A

Neurologic injury

79
Q

Basilar skull fractures are associated with ___

A

High-energy trauma, but usually occur following diffuse impact to the head

80
Q

Result from extension of a linear fracture to the base of the skull

A

Basilar skull facture

81
Q

Signs of basilar skull fracture

A
  1. CSF drainage from the nose or ears
  2. Raccoon eyes or Battle sign (may not appear for 24 hours)
82
Q

Patients with leaking CSF from the nose or ear are at risk for ___

A

Bacterial meningitis

83
Q

A traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes

A

Traumatic brain injury

84
Q

TBI

A

Traumatic brain injury

85
Q

TBIs are classified into two broad categories

A
  1. Primary (direct) injury
  2. Secondary (indirect) injury
86
Q

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

A

Primary brain injury

87
Q

A multitude of processes that increase the severity of a primary brain injury and, therefore, negatively affect the outcome

A

Secondary brain injury

88
Q

Two most common causes of secondary brain injury

A

Hypoxia and hypotension

89
Q

A brain injury that occurs when force is applied to the head and energy transmission through the brain tissue causes injury on the opposite side of original impact

A

Coup-contrecoup injury

90
Q

The injured brain begins to swell, initially because of ___. ___ then contributes to further brain swelling

A
  1. Cerebral vasodilation
  2. Cerebral edema
91
Q

Swelling of the brain

A

Cerebral edema

92
Q

Cerebral edema may not develop until ___

A

Several hours following the initial injury

93
Q

Low ___ in the blood aggravate cerebral edema

A

Oxygen levels

94
Q

Respirations that are fast and then become slow, with intervening periods of apnea

A

Cheyne-Stokes respirations

95
Q

Accumulations of blood within the skull or swelling of the brain can rapidly lead to an increase in ___

A

Intracranial pressure

96
Q

ICP

A

Intracranial pressure

97
Q

Biot respirations

A

Ataxic respirations

98
Q

Respirations characterized by irregular rate, pattern, and volume of breathing with intermittent periods of apnea

A

Ataxic respirations

99
Q

Cheyne-Stokes respirations or ataxic respirations are signs of ___

A

Increased ICP

100
Q

Abnormal breathing pattern associated with increased ICP that is characterized by deep, rapid breathing

A

Central neurogenic hyperventilation

101
Q

Breathing pattern that is similar to Kussmaul respirations, but without an acetone breath odor

A

Central neurogenic hyperventilation

102
Q

Signs and symptoms of ICP

A
  1. Decreased pulse rate
  2. Headache
  3. Nausea
  4. Vomiting
  5. Decreased alertness
  6. Bradycardia
  7. Sluggish or nonreactive pupils
  8. Decerebrate posturing
  9. Increased or widened pulse pressure
  10. Central neurologic ventilation, ataxic, or Cheyne-Stokes respirations
103
Q

The triad of increased systolic BP, decreased HR, and irregular respirations

A

Cushing reflex

104
Q

The Cushing reflex signifies increased ___

A

ICP

105
Q

Accumulation of blood between the skull and dura mater

A

Epidural hematoma

106
Q

An epidural hematoma is nearly always the result of ___

A

A blow to the head that produces a linear fracture of the thin temporal bone

107
Q

Artery that runs in the groove in the temporal bone

A

Middle meningeal artery

108
Q

Brief period of consciousness between two periods of unconsciousness

A

Lucid interval

109
Q

As the ICP increases, the pupil on the side of the hematoma becomes ___

A

Fixed and dilated

110
Q

Death will follow an epidural hematoma without ___

A

Surgery to evacuate the hematoma

111
Q

An accumulation of blood beneath the dura mater but outside the brain

A

Subdural hematoma

112
Q

Subdural hematoma usually occurs after ___

A

Falls or injuries involving strong deceleration forces

113
Q

Bleeding within the subdural space typically results from ___

A

Rupture of the veins that bridge the cerebral cortex and dura

114
Q

A subdural hematoma is associated with ___ bleeding

A

Venous

115
Q

Involves bleeding within the brain tissue itself

A

Intracerebral hematoma

116
Q

Intracerebral hematoma may occur following a ___

A

Penetrating injury to the head or because of rapid deceleration forces

117
Q

Most common location for intracerebral hematoma

A

Frontal and temporal lobes

118
Q

Intracerebral hematoma is associated with ___

A

Other brain injuries

119
Q

Bleeding occurs into the subarachnoid space, where the CSF circulates

A

Subarachnoid hemorrhage

120
Q

Results in bloody CSF and signs of meningeal irritation (such as neck rigidity or headache)

A

Subarachnoid hemorrhage

121
Q

Common causes of subarachnoid hemorrhage

A

Trauma or rupture of an aneurysm

122
Q

A patient with a subarachnoid hemorrhage reports a ___

A

Sudden, severe headache

123
Q

As the subarachnoid hemorrhage progresses ___

A

Increased signs and symptoms of ICP, decreased LOC, changes in pupils, vomiting, and seizures

124
Q

Mild TBI

A

Concussion

125
Q

A TBI with a temporary loss or alteration of part or all of the brain’s abilities to function without demonstrable physical damage to the brain

A

Concussion

126
Q

A concussion is a ___ change, not a ___ change, in the brain

A
  1. Functional
  2. Structural
127
Q

Remember everything except the events leading up to the injury

A

Retrograde amnesia

128
Q

Inability to remember events after the injury

A

Anterograde (posttraumatic) amnesia

129
Q

Symptoms of concussion

A
  1. Dizziness
  2. Weakness
  3. Visual changes
  4. Changes in mood
  5. Nausea or vomiting
  6. Ringing in the ears
  7. Slurred speech
  8. Inability to focus
  9. Lack of coordination or motor functions
  10. Inappropriate emotion responses
  11. Reports feeling “in a fog” or “just not right”
  12. Temporary headache
  13. Appear to be disoriented
130
Q

History of severe or repeated concussions are associated with ___

A

Decrease in brain function and severe dementia later in life and death

131
Q

Contusion is ___ than a concussion

A

Far more serious

132
Q

Contusion is ___ than a concussion

A

Far more serious

133
Q

Spine injuries are most common at ___

A

C1 and C2

134
Q

Common findings with spine damage

A

Pain and tenderness on palpation of the region

135
Q

Observable deformity in the spine from injury

A

Step-off

136
Q

You should suspect a possible head or spinal injury anytime you encounter one of the following MOIs ___

A
  1. MVCs
  2. Pedestrian MVC
  3. Fall >20’ adult
  4. Fall >10’ pediatric
  5. Blunt trauma
  6. Penetrating trauma to the head, neck, back, or torso
  7. Rapid deceleration injuries
  8. Hangings
  9. Axial loading injuries
  10. Diving accident
137
Q

You should suspect a possible head or spinal injury anytime you encounter one of the following MOIs ___

A
  1. MVCs
  2. Pedestrian MVC
  3. Fall >20’ adult
  4. Fall >10’ pediatric
  5. Blunt trauma
  6. Penetrating trauma to the head, neck, back, or torso
  7. Rapid deceleration injuries
  8. Hangings
  9. Axial loading injuries
  10. Diving accidents
138
Q

Injuries where the load is applied along the vertical or longitudinal axis of the spine

A

Axial loading injuries

139
Q

When to consider not performing spinal motion restriction

A
  1. Patient is absolutely clear in thinking
  2. No neurological deficits
  3. No spinal pain
  4. No tenderness
  5. No evidence of intoxication
  6. No other illnesses or injuries that may mask a spinal injury or otherwise cause you to doubt the patient’s report
140
Q

Can develop from prolonged periods on a backboard

A

Decubitus ulcers

141
Q

Questions to ask to determine the chief complaint with a patient with a possible head or spine injury

A
  1. What happened?
  2. Where does it hurt?
  3. Does your neck or back hurt?
  4. Can you move your hands and feet?
  5. Did you hit your head?
142
Q

Hyperventilation in patients with a head injury should be avoided except in cases where ___

A

Signs of imminent brainstem herniation have been identified

143
Q

Only use hyperventilation in patients with a head injury when ___ is available to ensure ___

A
  1. Capnography
  2. An end-tidal carbon dioxide level between 30 and 35 mm Hg
144
Q

In supine patients the head should be ___ to help reduce ICP

A

Elevated 30 degrees

145
Q

After the cervical collar has been attached ___

A

Maintain manual stabilization until the patient is secured in a backboard or vacuum mattress

146
Q

Purpose of the four-person log roll

A

Move a patient from the ground to a backboard or vacuum mattress

147
Q

The vacuum mattress cannot be used for patients who weigh more than ___

A

350 lbs

148
Q

When to not take the time to use a short backboard to remove a patient from a car

A
  1. You or the patient is in danger
  2. You need to gain immediate access to other patients
  3. The patient’s injuries justify urgent removal

Emergency Medical Technician (100 decks)

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