EMT-B Chapter 28 – Head and Spine Injuries

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Meninges

-three distinct layers of tissue that surround and protect the brain and the spinal cord within the skull and the spinal canal

Connecting Nerves

-nerves in the spinal cord that connect the motor and sensory nerves

Voluntary Activities

-actions that we consciously perform, in which sensory input or conscious thought determines a specific muscular activity

Involuntary Activities

-actions of the body that are not under a person’s conscious control

Intervertebral Disks

-the cushion that lies between two vertebrae

Closed Head Injuries

-injury in which the brain has been injured but the skin has not been broken and there is no obvious bleeding

Open Head Injury

-injury to the head often caused by a penetrating object in which there may be bleeding and exposed brain tissue

Raccoon Eyes

-bruising under the eyes that may indicate a skull fracture

Battle’s Sign

-bruising behind an ear over the mastoid process that may indicate a skull fracture

Linear Skull Fractures

-account for 80% of skull fractures -also referred to as nondisplaced skull fractures -commonly occur in the temporal-parietal region of the skull -not associated with deformities to the skull

Basilar Skull Fractures

-usually occur following diffuse impact to the head (such as falls, motor vehicle crashes) -generally result from extension of a linear fracture to the base of the skull and can be difficult to diagnose with a radiograph (x-ray)

Traumatic Brain Injury (TBI)

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

Primary (Direct) Injury

-an injury to the brain and its associated structures that is a direct result of impact to the head

Secondary (Indirect) Injury

-the "after effects" of the primary injury -includes abnormal processes such as cerebral edema, increased intracranial pressure, cerebral ischemia and hypoxia, and infection -onset is often delayed following the primary brain injury

Coup-Contrecoup Injury

-dual impacting of the brain into the skull -coup injury occurs at the point of impact -contrecoup injury occurs on the opposite side of impact, as the brain rebounds

Cerebral Edema

-swelling of the brain

Intracranial Pressure (ICP)

-the pressure within the cranial vault

Epidural Hematoma

-an accumulation of the blood between the skull and the dura mater

Subdural Hematoma

-an accumulation of blood beneath the dura mater but outside the brain

Intracerebral Hematoma

-bleeding within the brain tissue (parenchyma) itself -also referred to as an intraparenchymal hematoma

Subarachnoid Hemorrhage

-bleeding into the subarachnoid space, where the cerebrospinal fluid circulates

Concussion

-a temporary loss or alteration of part or all of the brain’s abilities to function without actual physical damage to the brain

Retrograde Amnesia

-the inability to remember events leading up to a head injury

Anterograde (Posttraumatic) Amnesia

-inability to remember events after an injury

Distraction

-the action of pulling the spine along its length

Subluxation

-a partial or incomplete dislocation

Eyes-Forward Position

-a head position in which the patient’s eyes are looking straight ahead and the head and torso are in line

Four-Person Log Roll

-the recommended procedure for moving a patient with a suspected spinal injury from the ground to a long backboard

An epidural hematoma is MOST accurately defined as:

-bleeding between the skull and dura mater

The MOST common and serious complication of a significant head injury is:

-cerebral edema

Which of the following head injuries would cause the patient’s condition to deteriorate MOST rapidly?

-epidural hematoma

When activated, the sympathetic nervous system produces all of the following effects, EXCEPT:

-pupillary constriction

You should be MOST suspicious that a patient has experienced a significant head injury if his or her pulse is:

-slow

Moderate elevation in intracranial pressure with middle brain stem involvement is characterized by:

-sluggish reactive pupils, widened pulse pressure, bradycardia, and posturing

A reflex arc occurs when:

-a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the motor nerve

The spinal cord is encased in and protected by the:

-spinal canal

The MOST important treatment for patients with a head injury, regardless of severity, is to:

-establish an adequate airway

A patient who presents with profound cyanosis following a chest injury:

-requires prompt ventilation and oxygenation

A female patient with a suspected spinal injury is breathing with a marked reduction in tidal volume. The MOST appropriate airway management for her includes:

assisting ventilations at an age-appropriate rate.

During your primary assessment of a semiconscious 30-year-old female with closed head trauma, you note that she has slow, shallow breathing and a slow, bounding pulse. As your partner maintains manual in-line stabilization of her head, you should:

instruct him to assist her ventilations while you perform a rapid assessment.

A temporary loss or alteration of part or all of the brain’s abilities to function without physical damage to the brain MOST accurately describes a(n):

cerebral concussion.

An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is:

a rapid deterioration of neurologic signs.

It would be MOST appropriate to perform a focused secondary assessment on a patient who:

fainted and fell to the ground from a standing position.

The MOST common and serious complication of a significant head injury is:

cerebral edema.

The MOST important treatment for patients with a head injury, regardless of severity, is

establish an adequate airway.

A patient who cannot remember the events that preceded his or her head injury is experiencing

retrograde amnesia

Which of the following statements regarding a basilar skull fracture is correct?

The absence of raccoon eyes or Battle’s sign does not rule it out.

Bleeding within the brain tissue itself is called a(n)

intracerebral hematoma.

When immobilizing a trauma patient’s spine, the EMT manually stabilizing the head should not let go until:

the patient has been completely secured to the backboard.

Which of the following statements regarding motor nerves is correct

They carry information from the CNS to the muscles.

Which of the following head injuries would cause the patient’s condition to deteriorate MOST rapidly?

epidural hematoma

A tight-fitting motorcycle helmet should be left in place unless:

it interferes with your assessment of the airway.

When immobilizing a child on a long backboard, you should:

place padding under the child’s shoulders as needed.

An epidural hematoma is MOST accurately defined as:

bleeding between the skull and dura mater.

The central nervous system (CNS) is composed of the:

brain and spinal cord.

The _________ nervous system consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves.

peripheral

When immobilizing a patient on a long backboard, you should:

ensure that you secure the torso before securing the head.

Which of the following statements regarding motor nerves is correct?

They carry information from the CNS to the muscles.

In contrast to a cerebral concussion, a cerebral contusion:

involves physical injury to the brain tissue.

The body’s functions that occur without conscious effort are regulated by the _________ nervous system.

autonomic

The hormone responsible for the actions of the sympathetic nervous system is:

epinephrine.

The five sections of the spinal column, in descending order, are the:

cervical, thoracic, lumbar, sacral, and coccygeal.

The MOST reliable sign of a head injury is:

a decreased level of consciousness.

When immobilizing a seated patient with a short backboard or vest-style immobilization device, you should apply a cervical collar:

after assessing distal neurovascular functions.

When the parasympathetic nervous system is activated:

the heart rate decreases and the blood vessels dilate.

Coordination of balance and body movement is controlled by the:

cerebellum.

Lacerations to the scalp

may be an indicator of deeper, more serious injuries.

Which of the following nerves carry information from the body to the brain via the spinal cord?

sensory

Which of the following sets of vital signs depicts Cushing’s triad?

blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min

During your primary assessment of a 19-year-old unconscious male who experienced severe head trauma, you note that his respirations are rapid, irregular, and shallow. He has bloody secretions draining from his mouth and nose. You should:

suction his oropharynx for up to 15 seconds.

Rapid deceleration of the head, such as when it impacts the windshield, causes:

compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain.

A patient with a head injury presents with abnormal flexion of his extremities. What numeric value should you assign to him for motor response?

3

When caring for a patient with a possible head injury, it is MOST important to monitor the patient’s:

level of consciousness.

Following a head injury, a 20-year-old female opens her eyes spontaneously, is confused, and obeys your commands to move her extremities. You should assign her a GCS score of:

14

If you do not have the appropriate size cervical collar, you should:

use rolled towels to immobilize the patient’s head.

Bleeding within the brain tissue itself is called a(n):

intracerebral hematoma.

Which of the following skull fractures would be the LEAST likely to present with palpable deformity or other outward signs?

linear

Which of the following statements regarding the cranium is correct?

Eighty percent of the cranium is occupied by brain tissue.

Common signs and symptoms of a serious head injury include all of the following, EXCEPT:

constricted pupils.

The _________ contain(s) about 75% of the brain’s total volume.

cerebrum

An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is:

a rapid deterioration of neurologic signs.

When assessing a conscious patient with an MOI that suggests spinal injury, you should:

determine if the strength in all extremities is equal.

You should be MOST suspicious that a patient has experienced a significant head injury if his or her pulse is:

slow.

The _________ is the best-protected part of the CNS and controls the functions of the cardiac and respiratory systems.

brain stem

The meninges, along with the cerebrospinal fluid (CSF) that circulates in between each meningeal layer, function by:

acting as a shock absorber for the brain and spinal cord.

Which of the following nerves allow sensory and motor impulses to be sent from one nerve directly to another?

connecting

When controlling bleeding from a scalp laceration with a suspected underlying skull fracture, you should:

avoid excessive pressure when applying the bandage.

When opening the airway of a patient with a suspected spinal injury, you should use the:

jaw-thrust maneuver.

After your partner assumes manual in-line stabilization of the patient’s head, you should:

assess distal neurovascular status in the extremities.

The frontal and parietal bones of the skull are especially susceptible to:

compressed skull fractures.

Which of the following statements regarding secondary brain injury is correct?

Hypoxia and hypotension are the two most common causes of secondary brain injury.

Distraction injuries of the spine are MOST commonly the result of:

hangings.

Common signs of a skull fracture include all of the following, EXCEPT:
a) mastoid process bruising
b) ecchymosis around the eyes
c) noted deformity to the skull
d) superficial scalp lacerations

d) superficial scalp lacerations

The Glasgow Coma Scale (GCS) is used to assess:

eye-opening, verbal response, and motor response

Coordination of body movement is controlled by the:

cerebellum

Which of the following statements regarding cervical collars is MOST correct?
a) The patient’s head should be forced into a neutral position to apply a cervical collar
b) A cervical collar is used in addition to, not instead of, manual immobilization
c) Once a cervical collar is applied, you can cease manual head stabilization
d) Cervical collars are contraindicated in patients with numbness to the extremities

b) A cervical collar is used in addition to, not instead of, manual immobilization

What nerves allow sensory and motor impulses to be sent from one nerve directly to another?

connecting

An epidural hematoma is MOST accurately defined as:

bleeding between the skull and dura mater

Which of the following head injuries would cause the patient’s condition to deteriorate MOST rapidly? a) Epidural hemorrhage b) Cerebral contusion c) Subdural hematoma d) Cerebral concussion

a) Epidural hemorrhage

The effectiveness of positive-pressure ventilations when treating a head-injured patient can ONLY be determined by:

immediate reassessment following the intervention.

The mesentary is/are:

membranous folds that attach the intestines to the walls of the body

You arrive at the scene of a major motor-vehicle crash. The patient, a 50-year-old female, was removed from her vehicle prior to your arrival. Bystanders who removed her state that she was not wearing a seatbelt. The patient is unconscious, tachycardic, and diaphoretic. Your rapid trauma assessment reveals bilaterally equal breath sounds, a midline trachea, and collapsed jugular veins. You should be MOST suspicious that this patient has experienced a:

laceration of the aorta.

Airbags, in conjunction with properly worn seatbelts, are of MOST benefit when a person is involved in a:

head-on crash

Common signs and symptoms of a chest injury include all of the following, EXCEPT: a) tachypnea b) hematemesis c) localized pain d) chest wall ecchymosis

b) hematemesis

When a hollow organ is punctured during a penetrating injury to the abdomen:

peritonitis may not develop for several hours

Because the depth of an open abdominal wound is often difficult to determine:

prompt transport to the hospital is essential.

You are dispatched to a residence for a young female who was kicked in the abdomen by her boyfriend. While en route to the scene, you should ask the dispatcher if:

law enforcement is at the scene

During your rapid trauma assessment of a patient with blunt chest trauma, you note paradoxical movement of the left chest wall. As your partner is administering oxygen to the patient, you should:

stabilize the chest wall with a bulky dressing.

Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, reduced tidal volume, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You should:

provide some form of positive-pressure ventilation.

Which of the following is NOT a symptom of a concussion?
A. Dizziness
B. Weakness
C. Muscle tremors
D. Visual changes

C. Muscle tremors

A female patient with a suspected spinal injury is breathing with a marked reduction in tidal volume. The MOST appropriate airway management for her includes:

assisting ventilations at an age-appropriate rate.

During your primary assessment of a semiconscious 30-year-old female with closed head trauma, you note that she has slow, shallow breathing and a slow, bounding pulse. As your partner maintains manual in-line stabilization of her head, you should:

instruct him to assist her ventilations while you perform a rapid assessment.

A 45-year-old male was working on his roof when he fell approximately 12′,landing on his feet. He is conscious and alert and complains of an ache in his lower back. He is breathing adequately and has stable vital signs. You should:

immobilize his spine and perform a focused secondary exam.

A temporary loss or alteration of part or all of the brain’s abilities to function without physical damage to the brain MOST accurately describes a(n):

cerebral concussion.

It would be MOST appropriate to perform a focused secondary assessment on a patient who:

fainted and fell to the ground from a standing position.

What part of the nervous system controls the body’s voluntary activities?

somatic

The tough, fibrous outer meningeal layer is called the:

dura mater

When a patient experiences a severe spinal injury, he or she:

may lose sensation below level of injury

A short backboard or vest-style immobilization device is indicated for patients who:

are in a sitting position and are clinically stable

A man jumped from the roof of his house and landed on his feet. He complains of pain to his heels, knees, and lower back. This mechanism of injury is an example of:
a) hyperextension.
b) distraction.
c) axial loading.
d) hyperflexion.

c) axial loading.

Which of the following interventions may be used to help reduce intracranial pressure?
a) Maintaining SpO2 at 90%
b) Increasing the patient’s body temperature
c) Supine with the legs elevated
d) 30-degree elevation of the head

d) 30-degree elevation of the head

Helmets must be removed in all of the following cases, EXCEPT:
a) when cardiac arrest is involved.
b) when there are no impending airway or breathing problems.
c) when the helmet allows for excessive movement.
d) when a shield cannot be removed for access to the airway.

b) when there are no impending airway or breathing problems.

When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his right ear. This indicates:
a) significant pressure and bleeding in between the skull and dura mater.
b) rupture of the tympanic membrane following diffuse impact to the head.
c) fractures to the internal structures of the ear following direct trauma.
d) a linear skull fracture and a significant increase in intracranial pressure.

b) rupture of the tympanic membrane following diffuse impact to the head.

Which of the following breathing patterns is MOST indicative of increased intracranial pressure?
a) Slow, shallow, occasional gasps that progress to prolonged periods of apnea
b) Increased rate with a normal inspiratory time and a prolonged expiratory time
c) Irregular rate, pattern, and volume of breathing with intermittent periods of apnea
d) Increased rate and depth with the distinct odor of acetone on the patient’s breath

c) Irregular rate, pattern, and volume of breathing with intermittent periods of apnea

Common signs and symptoms of a serious head injury include all of the following, EXCEPT:
a) widening pulse pressure.
b) CSF leakage from the ears.
c) decerebrate posturing.
d) a rapid, thready pulse.

d) a rapid, thready pulse.

Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless:
a) it causes a problem managing the airway.
b) sensory and motor functions remain intact.
c) lateral immobilization has been applied.
d) the patient adamantly denies neck pain.

a) it causes a problem managing the airway.

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