Chapter 29 Trauma to the Head, Neck, and Spine

Question 1

Key Terms

a bubble of air in the bloodstream

Answer 1

Air Embolism

Question 2

Key Terms

a pattern of irregular and unpredictable breathing commonly caused by brain injury

Answer 2

Ataxic Respirations

Question 3

Key Terms

controls involuntary functions

Answer 3

Autonomic Nervous System

Question 4

Key Terms

the brain and the spinal cord

Answer 4

Central Nervous System

Question 5

Key Terms

a pattern of rapid and deep breathing caused by injury to the brain

Answer 5

Central Neurogenic Hyperventilation

Question 6

Key Terms

the fluid that surrounds the brain and spinal cord

Answer 6

Cerebrospinal Fluid (CSF)

Question 7

Key Terms

a distinct pattern of breathing characterized by quickening and deepening respirations followed by a period of apnea

Answer 7

Cheyne-Stokes Breathing

Question 8

Key Terms

mild closed head injury without detectable damage to the brain. Complete recovery is usually expected but effects may linger for weeks, months, or even years

Answer 8

Concussion

Question 9

Key Terms

in brain injuries, a bruised brain caused when the force of a blow to the head is great enough to rupture blood vessels

Answer 9

Contusion

Question 10

Key Terms

the bony structure making up the forehead, top, back, and upper sides of the skull

Answer 10

Cranium

Question 11

Key Terms

an area of the skin that is innervated by a single spinal nerve

Answer 11

Dermatome

Question 12

Key Terms

the opening at the base of the skull through which the spinal cord passes from the brain

Answer 12

Foramen Magnum

Question 13

Key Terms

in a head injury, a collection of blood within the skull or brain

Answer 13

Hematoma

Question 14

Key Terms

pushing of a portion of the brain downward toward the foramen magnum as a result of increased intracranial pressure

Answer 14

Herniation

Question 15

Key Terms

pressure inside the skull

Answer 15

Intracranial Pressure (ICP)

Question 16

Key Terms

in brain injuries, a cut to the brain

Answer 16

Laceration

Question 17

Key Terms

the cheekbone. Also called the “zygomatic bone”

Answer 17

Malar

Question 18

Key Terms

the lower jawbone

Answer 18

Mandible

Question 19

Key Terms

the two fused bones forming the upper jaw

Answer 19

Maxillae

Question 20

Key Terms

the bones that form the upper third, or bridge, of the nose

Answer 20

Nasal bones

Question 21

Key Terms

provides overall control of thought, sensation, and the body’s voluntary and involuntary motor functions. The components of the _______ ______ are the brain and the spinal cord as well as the nerves that enter and exit the brain and spinal cord and extend to the various parts of the body

Answer 21

Nervous System

Question 22

Key Terms

a state of shock (hypoperfusion) caused by nerve paralysis that sometimes develops from spinal cord injuries

Answer 22

Neurogenic Shock

Question 23

Key Terms

the bony structures around the eyes; the eye sockets

Answer 23

Orbits

Question 24

Key Terms

the nerves that enter and exit the spinal cord between the vertebrae, the twelve pairs of cranial nerves that travel between the brain and organs without passing through the spinal cord, and all of the body’s other motor and sensory nerves

Answer 24

Peripheral Nervous System

Question 25

Key Terms

a blockage in the blood circulation of the lung caused by a blood clot or air bubble

Answer 25

Pulmonary Embolism

Question 26

Key Terms

the immobilization of the spinal column as if it were a single bone to prevent movement of individual vertebrae

Answer 26

Spinal Motion Restriction

Question 27

Key Terms

the bony bump on a vertebra

Answer 27

Spinous Process

Question 28

Key Terms

bone that forms part of the side of the skull and floor of the cranial cavity. There are right and left ________ ____s.

Answer 28

Temporal Bone

Question 29

Key Terms

the movable joint formed between the mandible and the temporal bone, also called the “TMJ”

Answer 29

Temporomandibular Joint

Question 30

Key Terms

the bones of the spinal column (singular _________).

Answer 30

Vertebrae

Question 31

Critical Decision Making

Which patients require spinal motion restriction, and which do not?

Your patient was the driver of a vehicle that was struck in the rear end while stopped at a light. The patient denies pain, but you observe her rubbing her neck and looking as if she may have some pain.

Answer 31

If the patient appears to have pain (even if she denies it) and she consents to care, she should be immobilized. Sometimes the shock of the crash masks the pain temporarily.

Question 32

Critical Decision Making

Which patients require spinal motion restriction, and which do not?

Your patient was in the backseat of a car that was hit broadside (T-bone). She doesn’t complain of neck pain, but her head was knocked into the side of the car during the collision. She has a large hematoma on the right side of her head from the impact.

Answer 32

The head injury and significant mechanism of injury indicate that immobilization is necessary here.

Question 33

Critical Decision Making

Which patients require spinal motion restriction, and which do not?

Your patient was a passenger in a car that was struck in the driver’s side in a minor collision. She denies all injury and isn’t sure she wants to go to the hospital.

Answer 33

Without significant mechanism of injury, complaint of pain, or distracting condition evident, the patient doesn’t require immobilization.

Question 34

Short Answer

Name the two components of the central nervous system, and discuss their functions.

Answer 34

The two components of the central nervous system are the brain and spinal cord. Messages from all over the body are received by the brain, which decides how to respond to changing conditions both inside and outside the body. The spinal cord functions as a relay between most of the body and the brain.

Question 35

Short Answer

List five signs of a brain injury, and explain why mechanism of injury is important in determining possible brain injury.

Answer 35

Determining possible skull or brain injury can be very difficult. Therefore, you should always assume skull or brain injury when indicated by mechanism of injury. Signs of brain injury can include visible skull fragments, altered mental status, deep laceration or severe bruise to the head, depression or deformity of the skull, severe pain at the site of a head injury, Battle’s sign, raccoon eyes, one eye that appears sunken, bleeding or clear fluid from the ears or nose, personality change, Cushing’s syndrome, irregular breathing patterns, temperature increase, blurred or multiple image vision, impaired hearing or ringing in the ears, equilibrium problems, forceful vomiting, posturing, paralysis on one side of the body, seizure activity, or deteriorating vital signs.

Question 36

Short Answer

Describe the appropriate emergency treatment of a patient with a possible head or brain injury.

Answer 36

Appropriate treatment for a patient with a possible head or brain injury includes taking Standard Precautions. Use the jaw-thrust maneuver to open and maintain the patient’s airway. Monitor changes in breathing. Apply a rigid collar, and immobilize the neck and spine. Administer high-concentration oxygen and artificially ventilate if necessary. Control the patient’s bleeding. Keep the patient at rest. Monitor vital signs every 5 minutes. Talk to the conscious patient, providing emotional support. Dress and bandage open wounds. Manage the patient for shock. Transport promptly.

Question 37

Short Answer

List five high-risk mechanisms of injury associated with high rates of spinal injury.

Answer 37

Any of the following mechanisms of injury will support a suspicion of a spine injury. If a patient was involved in a motor-vehicle or motorcycle collision; was struck by a vehicle; fell to the ground from a height; received blunt trauma to the spine or above the clavicles; sustained penetrating trauma to the head, neck, or torso; was involved in a diving accident; was found hanging by the neck; or was found unconscious due to trauma.

Question 38

Short Answer

Describe the appropriate emergency care for a patient with a possible spine injury.

Answer 38

The appropriate care for a patient with a possible spine injury includes providing manual in-line stabilization for the head and neck. Apply a rigid cervical collar, and maintain manual stabilization. Apply the appropriate immobilization device at the appropriate speed. Administer high-concentration oxygen and evaluate the need for artificial ventilation. Reassess sensory and motor function in all four extremities.

Question 39

Critical Thinking Exercises

Head and spine injuries are among the most dangerous issues to the patient and the most challenging to the EMT. The purpose of this exercise will be to consider how you might manage such patients.

Your twenty-four-year-old patient has been involved in a serious motor-vehicle collision. He complains of back pain and presents with significant hypotension, but his pulse is normal and his skin is pink, warm, and dry. What condition involving the spine could account for this?

Answer 39

This may be neurogenic shock. Injuries to the thoracic or lumbar spine can prevent the sympathetic nervous system from responding as it normally would. Rapid pulse and vasoconstriction may be absent.

Question 40

Critical Thinking Exercises

Head and spine injuries are among the most dangerous issues to the patient and the most challenging to the EMT. The purpose of this exercise will be to consider how you might manage such patients.

You are treating a patient with a head injury. He has an altered mental status and a significant mechanism of injury to the head. Your partner thinks you should hyperventilate. When should you hyperventilate? What are the signs and symptoms that would indicate this is necessary?

Answer 40

Hyperventilation is only performed in cases of increasing intracranial pressure indicated by serious neurological signs and symptoms, including elevated blood pressure, reduced pulse, unequal pupils, and altered mental status.

Question 41

Critical Thinking Exercises

Head and spine injuries are among the most dangerous issues to the patient and the most challenging to the EMT. The purpose of this exercise will be to consider how you might manage such patients.

You are called to the scene of a motor-vehicle collision. After ensuring scene safety and taking Standard Precautions, you approach the car, which has struck a bridge abutment, and note a deformed steering wheel. The driver’s side door is open and, out on the middle of the bridge, you see a person you presume to be the driver wandering erratically toward the opposite side of the bridge. How should you proceed?

Answer 41

Go to the patient, identify yourself, and seek consent for treatment. Due to the mechanism of injury, assume the possibility of injuries to the head and spine. Provide manual in-line stabilization for the head and neck. Assess the ABCs. Quickly assess the sensory and motor function in all four extremities. Assess the head and neck. Apply a rigid collar, and maintain manual stabilization. Apply the appropriate immobilization device at the appropriate speed. Administer high-concentration oxygen and reevaluate the need for artificial ventilation. Reassess sensory and motor function in all four extremities. Control bleeding. Dress and bandage open wounds. Keep the patient at rest. Manage the patient for shock, even if shock is not present. Reassure the patient. Monitor vital signs every 5 minutes.

Question 42

Pathophysiology to Practice

The following question is designed to assist you in gathering relevant clinical information and making accurate decisions in the field.

You encounter patients who experience pain in the areas listed below. From the three choices given for each, choose the dermatome associated with it.

Nipple level (C-4, T-4, or L-2)

Answer 42

T-4

Question 43

Pathophysiology to Practice

The following question is designed to assist you in gathering relevant clinical information and making accurate decisions in the field.

You encounter patients who experience pain in the areas listed below. From the three choices given for each, choose the dermatome associated with it.

Navel (T-10, L-1, or S-3)

Answer 43

T-10

Question 44

Pathophysiology to Practice

The following question is designed to assist you in gathering relevant clinical information and making accurate decisions in the field.

You encounter patients who experience pain in the areas listed below. From the three choices given for each, choose the dermatome associated with it.

Little finger (C-5, C-8, or C-2)

Answer 44

C-8

Question 45

Pathophysiology to Practice

The following question is designed to assist you in gathering relevant clinical information and making accurate decisions in the field.

You encounter patients who experience pain in the areas listed below. From the three choices given for each, choose the dermatome associated with it.

Big toe (S1, L4, or T12)

Answer 45

S-1