Chapter 29- Head and Spine Injuries

Question 1

scalp lacerations

Answer 1

Can be minor or very serious
Even small lacerations can quickly lead to significant blood loss
May contribute to hypovolemia, particularly in children
Usually indicative of deeper, more serious injuries

Question 2

linear skull fractures

Answer 2

If the brain is uninjured and there are no scalp lacerations, linear fractures are not life threatening.
If there is a scalp laceration with the linear fracture—making it an open fracture—there is a risk of infection and bleeding inside the brain.

Question 3

depressed skull fractures

Answer 3

Result from high-energy direct trauma to head with blunt object
Bony fragments may be driven into brain
Scalp may or may not be lacerated
Pts often present with neurologic signs like loss of consciousness

Question 4

signs of a basilar skull fracture

Answer 4

CSF drainage from ears
Raccoon eyes
Battle signs
*raccoon eyes and battle signs may appear quickly but usually don’t→ don’t rule out basilar skull fracture because they are absent

Question 5

primary (direct) brain injury

Answer 5

Injury to the brain and its associated structures that results instantaneously from impact to the head

Question 6

secondary (indirect) brain injury

Answer 6

Processes that increase the severity of a primary brain injury and negatively impact the outcome

Secondary injuries may be caused by cerebral edema, intracranial hemorrhage, increased intracranial pressure, cerebral ischemia, and infection

Question 7

signs of intracranial pressure

Answer 7

Cheyne-Stokes respirations
Ataxic (Biot) respirations
Central neurogenic hyperventilation

decreased pulse rate
headache
nausea/vomiting
decreased alertness
bradycardia
sluggish or nonreactive pupils
decerebrate posturing
increased or widened blood pressure

Question 8

cheyne-stokes respirations

Answer 8

respirations that are fast and then become slow, with intervening periods of apnea

Question 9

ataxic (biot) respirations

Answer 9

characterized by irregular rate, pattern, and volume of breathing with intermittent periods of apnea

Question 10

Central neurogenic hyperventilation

Answer 10

characterized by deep, rapid breathing

this pattern is similar to Kussmaul respirations, but without an acetone breath odor

Question 11

crushing reflex

Answer 11

signifies increased intracranial pressure

Increased systolic blood pressure
Decreased pulse rate
Irregular respirations

Question 12

epidural hematoma

Answer 12

accumulation of blood between skull and dura mater

Question 13

subdrual hematoma

Answer 13

accumulation of blood beneath dura mater but outside the brain

Question 14

subarachnoid hemorrhage

Answer 14

bleeding in the subarachnoid space, where CSF circulates

Results in bloody CSF and signs of meningeal irritation (like neck rigidity, headache)

pt reports sudden severe headache

Question 15

symptoms of concussion

Answer 15

Dizziness
Weakness
Visual changes
Nausea or vomiting
Ringing in the ears
Slurred speech
Inability to focus
Lack of coordination
Delay of motor functions
Inappropriate emotional responses
Disorientation
pt may be confused or have amnesia

Question 16

contusion

Answer 16

more serious than a concussion because it involves physical injury to the brain tissue, which may sustain long-lasting and even permanent damage

Question 17

signs of a spinal injury

Answer 17

An obvious deformity as you gently palpate the spine
Numbness, weakness, or tingling in the extremities
Soft-tissue injuries in the spinal region
Inability to maintain body temperature
Priapism
Loss of bowel or bladder control

Question 18

priapism

Answer 18

prolonged erection

Question 19

cushing triad

Answer 19

Increased blood pressure (hypertension)
Decreased heart rate (bradycardia)
Irregular respirations such as Cheyenne-Stokes respiration and Biot respiration

If the patient exhibits these signs, it is commonly acceptable to perform controlled hyperventilation of your patient via positive pressure ventilations at a rate of 20 breaths/min for adults.