Uppers Head and C Spine Injuries Flashcards
skull bones
frontal parietal temporal -protects 7 cranial nerves sphenoid -forms a portion of the orbit -houses paranasal sinuses occipital ethmoid -between orbits -separates nasal cavity from brain
skull sutures
coronal -between frontal and parietal bones lambdoidal -between parietal and occipital squamosal -between parietal and temporal
function of skull
protecting of the brain
cerebrum function
cognition (conscious thought) memory torage motor and sensory function emotion special senses behavior
cerebellum
balance - coordination
involuntary motor
smooth muscle control information processing
diencephalon
hypothalamus, thalamus controls pituitary gland -homeostasis -hormone regulation circadian rhythm processes and routs sensory information -everything but smell memory emotion control regulates body temperature -hypothalamus
brainstem
pons, medulla oblongata, midbrain basic life functions -HR -respiration peripheral blood flow
meninges
- function
- layers
buffer to brain and spinal cord layers -dura mater -arachnoid mater -pia mater
dura mater
hard mother
outermost, next to skull
contain meningeal arteries
arachnoid mater
spider mother
separated from dura mater by subdural space
pia mater
tender mother
separated from arachnoid mater by subarachnoid space
-location of CSF
brain stem
CSF
originates from choroid plexus
proves padding for brain and spinal cord
vascular anatomy
vertebral artery carotid artery -external -internal Circle of Willis -internal carotid and vertebral arteries work together to supply blood to the brain brain uses 20% of oxygen at rest usage increases 7% per one degree C
intracranial hemorrhage
-types
epidural hematoma
subdural hematoma
epidural hematoma
between dura and skull -dura peeled off skull arterial bleed may occur concomitant to a skull fracture onset of Sx begins w/in hours
epidural hematoma progression of Sx
possible unconsciousness or concussion signs
period of lucid consciousness
patient becomes disoriented, confused, or drowsy
C/O headache with increasing intensity
S/S of cranial nerve disruption
onset of coma
if untreated, death or permanent brain damage occurs
subdural hematoma
forms between brain and dura mater venous bleed Sx take longer to develop Sx -headache -decreased LOC
skull fracture
- fact
- types
skin increases the amount of pressure the skull can withstand from 40 psi to 440-490 psi
types
-linear - no displacement, pain
-comminuted - fragmented
-depressed - refer but check nerves as well
cervical spinal cord trauma
- mechanisms
- death
- cervical fracture or dislocation
mechanisms
-impingement - secondary to bony displacement
-compression - secondary to hemorrhage, edema, ischemia of the cord
trauma above C4 = high probability of death
cervical fracture or dislocation
-bony fragments lacerate the cord
-swelling compresses the cord
-vertebra shifts - narrowing the spinal cord
arriving on the scene
- best-case scenario
- worst-case scenario
- unconscious
- number of responders
best-case scenario -athlete is alert and responsive worst-case scenario -prone athlete is unconscious and has no pulse all unconscious athletes must be treated as if they have a C-spine injury until determined otherwise 2 responders is ideal -first: hold inline stabilization -second: performs assessment
evaluation of athlete’s position
supine prone/side-lying posturing -decorticate rigidity -decerebrate rigidity
decorticate rigidity
above brainstem plantar flexed internally rotated leg elbows flexed shoulders adducted
decerebrate rigidity
brainstem injury a lot of extension arms extended plantarflexed wrists flexed forearm pronated
eye opening scale
spontaneous - 4 - patient is conscious
to verbal command - 3 - opens eyes in response to verbal command
to pain - 2 - opens eyes in response to pain
none - 2 - does not open eyes to any stimuli
verbal scale
oriented, converses - 5 - patient is aware of self and surroundings
disoriented, converses - 4 - patient is articulate, but disoriented
inappropriate words - 3 - random and exclamatory speech
incomprehensible - 2 - “blabbering”
no response - 1 - no audible sounds
motor scale
obeys verbal commands - 6 - readily moves limbs as instructed
localizes painful stimuli - 5 - moves limb in an effort to avoid pain
flexion withdrawl - 4 - pulls away from pain with a flexion motion
abnormal flexion - 3 - decorticate rigidity
extension - 2 - decerebrate rigidity
no response - 1 - flaccid
primary and secondary survey
circulation, airway, breathing
other trauma to the body
C-spine history
location of Sx
mechanism of head injury
location of Sx
cervical pain
head pain
radicular symptoms
pain elsewhere
mechanism of head injuries
coup -occurs at the same side of contact -stationary head, moving object contrecoup -occurs opposite to side of impact -moving head, stationary object repeated subconcussive forces rotational or shear force -whiplash -injury without any external contact C-spine MOI
inspection
bony structures
Battle Sign
eyes
nose and ears
bony structures
position of the head
cervical vertebrae
mastoid process
skull and scalp
Battle Sign
basilar fracture
-fracture of a combination of the temporal, occipital, sphenoid, and ethmoid bone
eyes
general appearance nystagmus pupil size pupil reaction to light -PEARL
nose and ears
bleeding
CSF - Halo test
-take a gauze pad, roll it up, place in ear
-if there is fluid, it will appear as a yellow halo on the gauze
ecchymosis - “raccoon eyes”
palpation
not over obvious deformity bony structures -spinous process -transverse process -skull soft tissue -musculature -throat
functional assessment
behavior
analytical skills
-Serial 7s: count backwards from 100 by 7
information processing
memory
retrograde amnesia -events before the injury -what happened? where are you? what quarter is it? anterograde amnesia -events after the injury -remembering words
balance tests
Romberg test
tandem walking
BESS test (balance error scoring system)
cranial nerves
notes
