Unit 10b - Spinal and Head Injuries

Question 1

frontal lobe

Answer 1

problem solving
judgement
planning
personality
emotions
organization
Attention
concentration
smell
movement

Question 2

temporal lobe

Answer 2

memory
hearing
understanding language
Organization
sequencing

Question 3

parietal lobe

Answer 3

sense of touch
spatial perception
visual perception
sensation

Question 4

occipital lobe

Answer 4

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

Question 5

cerebellum

Answer 5

balance
coordination
Skilled motor activity

Question 6

brain stem

Answer 6

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

Question 7

sport related concussion (SRC)

Answer 7

“traumatic brain injury induced by biomechanical forces”

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

Question 8

crushing’s reflex

Answer 8

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)

Question 9

s/s of brain injury

Answer 9

• 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

Question 10

5 SRC defining features

Answer 10

• 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

Question 11

concussion resolution

Answer 11

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

Question 12

coup effect

Answer 12

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

Question 13

countercoup effect

Answer 13

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

Question 14

result of coupe and countercoup

Answer 14

• 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

Question 15

clinical domains

Answer 15

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)

Question 16

concussion s/s

Answer 16

• 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)

Question 17

on field assessment

Answer 17

• 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

Question 18

cranial nerve assessment

Answer 18

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

Question 19

concussion suspected

Answer 19

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

urgent: EMS and spine board

Question 20

SRC off field

Answer 20

• 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

Question 21

concussion in sport

Answer 21

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

Question 22

home instructions

Answer 22

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

Question 23

sleep and cognitive rest

Answer 23

• 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

Question 24

physician referral

Answer 24

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

Question 25

post concussion syndrome

Answer 25

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

Question 26

catastrophic brain injury

Answer 26

SIS and intercranial bleeds

Question 27

second impact syndrome (SIS)

Answer 27

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)

Question 28

risk for s/s

Answer 28

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

Question 29

head injury red flags

Answer 29

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

Question 30

intracranial bleeding injuries

Answer 30

epidural hematoma subdural hematoma subarachnoid hematoma intracerebral hematoma

Question 31

cerebral hematoma

Answer 31

(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

Question 32

epidural hematoma

Answer 32

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

Question 33

subdural hematoma

Answer 33

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)

Question 34

acute subdural hematoma

Answer 34

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

Question 35

chronic subdural hematoma

Answer 35

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

Question 36

subarachnoid hematoma

Answer 36

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

Question 37

intracerebral hematoma

Answer 37

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

Question 38

Cushing reflex

Answer 38

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

Question 39

Chronic Traumatic Encephalopathy (CTE)

Answer 39

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