Head & Spine Injuries Flashcards
Basilar skull fracture
Fractures to the floor of the cranium
Basilar skull fracture can lead to?
- CSF drainage from nose and ears
- Battle signs
- Raccoon eyes
Dura mater
Outer most meninges “hard mother” composed of a double layer of tough, fibrous tissue.
Arachnoid
Next layer after the dura mater
Pia Mater
The next layer after arachnoid and in contact with the brain “soft mother”
3 layers of Meninges
- Dura Mater
- Arachnoid
- Pia Mater
Layers of the head
- Cranium
- Dura Mater
- Arachnoid
- Pia Mater
- Cerebral Cortex
- Cerebellum
- Medulla Oblongata
- Spinal Cord
Subarachnoid Space
A lattice of fibrous spongy tissue filled with cerebrospinal fluid that separates the arachnoid membrane and Pia Mater.
Epidural
Bleeding between the dura mater and the skull, usually involves the brain’s outermost arteries.
Subarachnoid Hemorrhage
Bleeding that occurs between the arachnoid membrane and the surface of the brain.
Cerebrum
- Responsible for conscious and sensory functions, emotions, and personality.
- Largest part of the brain, three-fourths of the brain’s volume.
- Divided into two hemispheres (right and left)
- Each hemisphere is made up of four distinct lobes: Frontal, parietal, occipital, and temporal lobe
Cerebellum
-“Little brain” controls equilibrium and coordinates muscle activity.
Brainstem
- Made up of pons, midbrain, and Medulla Oblongata
- Controls Automatic functions of the body including cardiac, respiratory, vasomotor (Blood Pressure), and other functions vital to life.
Medulla Oblongata
- Responsible for involuntary or automatic functions of the body including cardiac, respiratory, and vasomotor
- Connects brain to spinal cord
- All messages between the brain and spinal cord passes through the medulla
Scalp Injuries
- Has a heavy blood supply
- Can lead to difficulty detecting skull fractures
Linear skull fracture
- Most common type
- Resembles a line
- Diagnosed only through a radiograph
Depressed Fracture
-Occurs when the bone ends are pushed inward toward the brain
Primary Brain Injury
- The result of trauma to the brain that occurs at the time of accident.
- EMT can’t do anything to reverse the damage done by primary brain Injury.
Coup-Countercoup Injury
Occurs when one side is hit and then bounces to the opposite side due to the force of the impact.
Brain Contusion
- Bruising or Swelling of brain tissue
- May accompanied by concussion
Subdural hematoma
-Blood gathers between the inner layer of the dura mater and the Arachnoid mater.
-Bleeding due to tearing of blood vessels on the surface of the brain
-Generally venous Bleeding
•Bridging Veins
-Mortality Rate higher than epidural
Epidural Hematoma
-Bleeding between skull and protective covering of brain (Dura Mater)
-Usually arterial Bleeding
•Middle meningeal
-TBI S/Sx and lucid intervals of concussion
Secondary Brain Injury
-The pathophysiologic processes following primary brain injury, can continue for hours to days.
You must prevent these things from happening during secondary brain injury
- Hypotension (Maintain 90 Systolic or above)
- Hypoxia (Maintain O2 sat 95% or above)
Brain Herniation
-Brain is squeezed across structures within the skull due to Herniation from a Hematoma
Cushing’s Triad
- Increased BP
- Bradycardia
- Cheyenne-Stokes respirations
Inter Cranial Pressure (ICP) S/Sx
-Blown pupil on one side
-Weakness or paralysis
-Severe changes of mental status
-Non-purposeful movement
•Decorticate
•Decerebrate
-Cheyne-stokes
-Cushing Reflex
Cushing Reflex
- Increased BP
- Slow Pulse
Concussion
- Mild head injury
- No actual Damage to brain tissue
- Will have traumatic brain injuries but will show immediately and will progressively improve
Concussion S/Sx
- Loss of consciousness
- No recall of event
- Repetitive questioning
Laceration head injury
- Usually Caused by penetrating injury
- Permanent Injury
- May cause nervous system disruption
Assessing head injury pt
-Primary focus on: •Spinal motion restriction •Mental status/AVPU •Purposeful or non purposeful movement •ABC’s (Maintain adequate Oxygenation)
Glasgow coma scale (GCS) score of 13-15
Mild
GCS score of 9-12
Moderate
GCS score of 3-8
Severe
GCS eye scores
1= Eyes doesn’t open
2=Open eyes in response to pain
3=Open eyes in response to voice
4=Opens eyes spontaneously
GCS Verbal score
1=makes no sound 2=makes sounds 3=speak words 4=Confused, disoriented 5=Oriented, converses normally
GCS Motor score
1=makes no movements 2=Decerebrate 3=Decorticate 4=Flexion/Withdrawal to painful stimuli 5=Localizes to painful stimuli 6=Obeys commands
Glasgow coma scale (GCS)
A neurological scale to see a Pt’s conscious state
Decorticate posturing
- Abnormal posturing
- Stiff bent arms towards the body
- Clenched fists held on the chest
- Legs held out straight
Decerebrate posturing
- Abnormal posturing
- Arms extended at the sides
- Wrist rotated internally with fist pointing outwards
- Legs held out straight
How many vertebrae do we have ?
33
Name spinal columns in order
- Cervical (7)
- Thoracic (12)
- Lumbar (5)
- Sacrum (5)
- Coccyx (4)
Spinal Column injury
- Bone injured
- painful
- May or may not include spinal cord injury
- Rx Spinal motion restriction
Spinal Cord injury
- Nervous tissue damage
- Disrupts motor or sensory pathways
- Will have tingling or loss of sensation
- Rx Spinal motion restriction
Complete spinal injury
- Complete severing of the spinal cord
- Will have loss of pain and sensation below injury site
- May lead to spinal shock (Neurogenic)
Spinal shock
- Shock due to injury to spinal cord
- Vessels relax due to loss of impulses
- May resolve itself or may never come back
Assessing spinal injured pt
-Put em in Spinal motion restriction (SMR)
-Pay close attention to MOI and worsening or resolving S/Sx
•Respiratory Symptoms
•Paralysis or loss of sensation
•Priapism
Put Pt’s in SMR if?
- Suspected spinal injuries
- GCS score less than 15
- Has neurologic deficit
- Pain or Tenderness along Spinal column
- Deformity to spinal column
Put pt in backboard if?
If they have complete paralysis, loss of sensation, or signs of complete spinal cord injury
Don’t put pt in backboard if?
Pt have neck or spinal pain but no sign of complete spinal cord injury
Rx for foreign objects or chemical burns in the eye
- Flush with copious amounts of water for minimum of 20 min
- Cover both eyes
Rx for impaled object in eye
- Stabilize object
- Cover both eyes
- Do not remove
Compression spinal injury
- When the weight of the body is driven against the head
- Falling or hitting head first
Flexion spinal injury
-When there is severe forward movement of the head where chin meets the chest
Extension Spinal Injury
- When there is severe backward movement of the head in which the neck is stretched
- Most common with whiplash
Rotation spinal Injury
-twisting movement of the head of spine beyond its normal rotation
Lateral bending spinal injury
When the body or neck is bent severely from the side
Distraction spinal injury
- When vertebrae and spinal cord are stretched and pulled apart.
- Common in hangings
Penetration spinal injury
-Injury from gunshot, stabbing, or other penetrating trauma that involve the cranium or spinal column
