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Z- AET 260 > Unit 10b - Spinal and Head Injuries > Flashcards

Unit 10b - Spinal and Head Injuries Flashcards

1
Q

frontal lobe

A

problem solving
judgement
planning
personality
emotions
organization
Attention
concentration
smell
movement

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2
Q

temporal lobe

A

memory
hearing
understanding language
Organization
sequencing

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3
Q

parietal lobe

A

sense of touch
spatial perception
visual perception
sensation

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4
Q

occipital lobe

A

vision
speech (L side)
abstract concepts (R side)

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5
Q

cerebellum

A

balance
coordination
Skilled motor activity

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6
Q

brain stem

A

breathing
heart rate
arousal, consciousness
sleep and wake cycles
attention, concentration

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7
Q

sport related concussion (SRC)

A

“traumatic brain injury induced by biomechanical forces”

  • force cause shaking of brain in skull resulting in the brain swelling, bleeding, shear/tear nerve fibers
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8
Q

crushing’s reflex

A

body’s natural response to an increase in intracranial pressure and often indicates severe head injury
- respiration changes (deep, irregular)
- increase BP (bigger gap btwn SBP and DBP)
- bradycardia (slower heart rate)

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9
Q

s/s of brain injury

A
  • change in LOR
  • paralysis or flaccidity of muscles (usually one side)
  • unequal facial mvmnts or disturbance of vision/pupils
  • ringing in ears or hearing disturbances
  • limb rigidity
  • lose balance
  • rapid, weak pulse
  • high BP and slow pulse
  • breathing problems
  • vomiting
  • incontinence
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10
Q

5 SRC defining features

A
  • direct blow to head/face/neck or elsewhere w impulsive force transmitted to the head
  • result in rapid onset of short lived neurological impairments that resolve spontaneously
  • neuropathological changes but acute clinical s/s reflect functional disturbance, not structural
  • may not have gone unconscious; resolve in sequential course

-cannot be explained by intoxications, other injuries or comorbidities

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11
Q

concussion resolution

A

80-90% of concussions resolve on their own with in 7-10 days.
- they are no longer graded as minor/mild/severe
- recovery time longer in kids and teens

  • not RTP
  • not left alone
  • assess, monitor constantly for change/deterioration
  • evaluated by medical doctor
  • follow RTP process and listen to doctor
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12
Q

coup effect

A

force causes direct damage to the brain
- where brain hits the skull
- ex: hit forehead on wall

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13
Q

countercoup effect

A

external force cause brain to accelerate and hit skull (coupe) and decelerate and hit opposite side of skull (countercoup) –> 2 points of contact of brain on skull
- ex: whiplash

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14
Q

result of coupe and countercoup

A
  • edema of brain (swelling)
  • decrease blood flow to brain
  • changes in cerebral metabolism
  • loss of brain’s ability to autoregulate
  • changes in EEG activity
  • changes in higher cortical function
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15
Q

clinical domains

A
  1. symptoms (somatic, cognitive, emotional)
  2. physical signs(ex: lose conc, amnesia, neurological deficit)
  3. balance impairment (ex: gait unsteady)
  4. behavior changes (ex: irritable)
  5. cognitive impairment (ex: slowed rxn times)
  6. sleep disturbances (ex: drowsy, wide awake)
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16
Q

concussion s/s

A
  • lose consciousness
  • seizure or convulsion
  • headache
  • pain in neck
  • “foggy” feeling
  • “not feel right”
  • dizzy
  • blurred speech
  • tinnitus
  • sensitive to light, noise
  • hard to remember or concentrate
  • fatigue, low energy
  • confusion
  • sad, anger, irritable, nervous
  • nystagmus (involuntary eye mvnmnt)
  • retrograde amnesia (events prior)
  • anterograde amnesia (events after)
17
Q

on field assessment

A
  • MOI, CC
  • use or rule out SMR
  • primary assessment
  • EMS if needed
  • assess injury/illness per MOI
  • history (SAMPLE)
  • physical assessment
  • vitals (GCS baseline)
  • concussion present (somatic, cognitive, behavioral, emotional changes)
  • cranial nerve assessment
18
Q

cranial nerve assessment

A
  • optic (II): visual acuity
  • oculomotor (III): pupil reaction
  • trochlear (IV): eye movement
  • facial (VII): facial movements
19
Q

concussion suspected

A

not urgent: progressively stand and walk of field for further treatment; no SMR needed, GCS and vitals normal

urgent: EMS and spine board

20
Q

SRC off field

A
  • standardized concussion test (SCAT 5) 10 min after
  • monitor athlete for 30 min and reassess unless EMS arrives
  • assess GCS: time 0, 2-3hrs, 24 hrs, 48, 72 hrs post
21
Q

concussion in sport

A

the real danger is the s/s of internal bleed can be delayed for hours, even days.
- delayed intracranial bleeds cause pressure resulting in severe damage and/or death

22
Q

home instructions

A

call clinic/EMS if these occur at home: change in behaviour, vomit (more than 3 for kid, more than 1 for adult), dizzy, worse headache, double vision, excessively drowsy

-rest, avoid physical/mental activity for 24 hours
- no alcohol or sleeping pills
- paracetamol or codeine for headaches (no aspirin or anti-inflammatories)
- no driving, playing/training until medically cleared

23
Q

sleep and cognitive rest

A
  • do not wake athlete unless they are in too deep of sleep or exhibit irregular sleep behaviour
  • no screen time or reading; dim lights
  • monitor after sleep
  • if in doubt, wake them up
24
Q

physician referral

A

all concussions are referred to a physician. remain in contact for 48-72
- urgent: assess for intracranial bleed (see s/s)
- same day referral
- post concussion referral: s/s not go away or need to return to work/play

25
Q

post concussion syndrome

A

Symptoms not dissipating after 7-10 days:
- persistant headaches
- anxiety, irritable, fatigue
- depression
-unable to concentrate
- impaired memory
- visual disturbances

26
Q

catastrophic brain injury

A

SIS and intercranial bleeds

27
Q

second impact syndrome (SIS)

A

Rare and fatal condition of a seemingly mild blow to previously concussed brain leads to massive brain swelling (“concussion missed and allowed to carry on”)

brain cannot regulate flow > blood vessel engorgement > cerebral edema > intracranial pressure > rapid respiratory failure > coma > neurological death > DEATH (AED not work)

28
Q

risk for s/s

A

people under 18 are greatest risk for SIS
- brain not fully developed
- blood vessels in brain tear more easily
- skull is thinner

29
Q

head injury red flags

A

scalp wound
facial fracture
swelling, bruising
lose consciousness
nasal discharge
stiff neck

30
Q

intracranial bleeding injuries

A

epidural hematoma
subdural hematoma
subarachnoid hematoma
intracerebral hematoma

31
Q

cerebral hematoma

A

(intracranial bleed)
- skull fit tight to brain
- any bleeding = increase intracranial pressure, lead to permanent neurological death or injury

  • worse s/s
  • unequal or unreactive pupils
  • disorientation
  • mental status deteriorate
  • lose consciousness
  • seizures
  • cranial nerve deficits
  • increase BP gradually
  • decrease RR or HR
  • s/s present after initial lucid period
32
Q

epidural hematoma

A

Skull fracture leading to laceration of meningeal arteries ; rapid blood accumulation btwn skull and dura. Quicker than subdural hematoma

-asymptomatic lucid period, headache, nausea, dizzy, ipsilateral pupil dilation (dilate same side as injured), LOR change, drowsy, decrease HR, periorbital/auricular ecchymosis
- lose, regain, lose consciousness
- sluggish, non reactive pupils

33
Q

subdural hematoma

A

low pressure venous bleeding btwn dura and brain
- skull fracture is less common
- acute or chronic
- instant or delayed s/s (headache, visual disturbances, personality changes, difficulty speaking, deficit motor functions)

34
Q

acute subdural hematoma

A

48-72 hours post trauma
- alert w no focal neurological deficits
- slip into coma (look into sleep patterns)
- sizable hematoma&raquo_space; neurological deficits (n/t, motor skills, LOR)&raquo_space; altered LOR&raquo_space; coma

35
Q

chronic subdural hematoma

A

“hematoma present 3+ weeks after injury”
- small venous bleed not stop/coagulate&raquo_space; intracranial bleed pressure
- take up to 30 days to appear
- personality change, neurological deficits, progressive/severe headache

36
Q

subarachnoid hematoma

A

arterial bleed in subarachnoid space (btwn arachnoid and pia mater path wher ecnf circulates) due to spontaneous rupture of cerebral aneurysm/head injury
- severe, rapid headache; vomit; seizure; decrease LOR, confusion; CSF exit via nose/ears

37
Q

intracerebral hematoma

A

bleeding with in cerebrum
- life threatening bleed, cerebral infarction, necrosis, edema
- most common traumatic head injuries
- present normal&raquo_space; neurological deficits and coma

38
Q

Cushing reflex

A

increase Systolic BP in response to low blood supply to brain while attempt to lower heart rate; also have irregular breathing

cushing’s triad: respiration changes, increase BP, bradycardia

39
Q

Chronic Traumatic Encephalopathy (CTE)

A

form of dementia caused by repeated head trauma such as concussions
- atrophy of cerebral hemispheres
- abnormal protein deposit in brain
- only diagnosed post mortem
- often die from suicide

Gradual + progressive neurological deterioration, memory disturbances, Dementia, Behavioural + personality changes, Parkinsonism, Speech + gait abnormalities

Z- AET 260 (11 decks)

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