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Sinclair Paramedic 2150 > 2- Trauma- Head, Neck, Spine Injuries > Flashcards

2- Trauma- Head, Neck, Spine Injuries Flashcards

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1
Q

What happens to intracranial blood vessels as CO2 changes

A

High CO2- Vessel dilation

Low CO2- Vessel constriction

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2
Q

Define intracranial pressure

A

Pressure of the brain and contents in skull

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3
Q

Define cerebral perfusion pressure

A

Pressure required to perfume the brain

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4
Q

Define mean arterial pressure

A

Pressure maintained in vascular system

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5
Q

Cushings Triad signs, what does it indicate, what to do for it

A
  • Increased systolic pressure
  • BradyC
  • Irregular resp pattern

Indicates Increased intracranial pressure

-20-30 RR for 5 min

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6
Q

Explain cerebral herniation syndrome

A

Brain is forced downward, pressure is applied to the brain stem, LOC decreases, rapid progression to coma

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7
Q

Cerebral herniation syndrome associated symptoms (5)

A
  • Ipsilateral pupil dilation
  • Out/downward deviation
  • Contralateral paralysis or decerebrate posturing
  • Respiratory arrest
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8
Q

What do bilaterally dilated and unreactive pupils suggest

A

Possible brain stem injury

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9
Q

What do bilaterally dilated and reactive pupils suggest

A

Possible ICP

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10
Q

Other causes of pupil changes

A
  • Hypothermia
  • Drugs
  • Anoxia
  • Ocular trauma
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11
Q

What treatment is indicated for herniation syndrome and how much for adult, children and infants and the goal

A
  • Hyperventilation
  • 20 RR, adult

25 RR, children

30 RR, infants

-Maintain 30-35 ETCO2

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12
Q

Concerns of facial injuries (4)

A
  • High vasculature, can bleed briskly
  • Possible airway compromise
  • Aspiration
  • Possible shock
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13
Q

Management of facial injuries (3)

A
  • Direct pressure
  • Airway support/suction
  • Intubate if needed
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14
Q

Management for scalp wounds, stable vs nonstable

A

Stable- Direct pressure with dressings

Nonstable- Dressings, avoid direct pressure

*Always check for instability

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15
Q

3 types of skull fractures

A
  1. Linear
  2. Depressed
  3. Compound
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16
Q

Indications to suspect a skull fracture (2)

A
  • Large contusion

- Darkened swelling

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17
Q

Management for skull fractures

A

-Dressing, avoid excess pressure

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18
Q

What is meningeal layer is damaged from a depressed skull fracture and the cause

A
  • Dura Mater

- Small objects at high speed

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19
Q

Key info of open skull fractures (3)

A
  1. High mortality rate
  2. Multi systems trauma likely
  3. Meningitis likely
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20
Q

What is a DAI brain injury

A

Diffuse atonal injury

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21
Q

Explain a diffuse injury (3)

A
  1. Generalized edema
  2. No structural lesion
  3. Most common injury from severe blunt head trauma
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22
Q

Associated symptoms of diffuse axial injury (2)

A
  • Unconscious

- No focal defects

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23
Q

Explain the diffuse axonal injury - Concussion (2) and symptoms (2)

A
  • No structural injury to the brain
  • Variable period of unconsciousness or confusion, followed by normal consciousness
  • Short term retrograde amnesia
  • Dizzy, headache, nausea, ringing in ears
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24
Q

Explain the diffuse axonal injury - Cerebral contusion (2) and symptoms (2)

A
  • Bruising of the brain, swelling may be rapid and severe
  • Prolonged unconsciousness, profound confusion or amnesia
  • Focal neurological signs
  • May have personality changes
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25
Explain the diffuse axonal injury - Axonic brain injury (2) and what possibly helps with it
- Small cerebral artery spasm due to anoxia - No-reflow phenomenon, can’t be restored after 4 to 6 min, after that irreversible damage occurs -Hypothermia seems protective
26
Name the 3 meninges and the layer it resides (outer, middle, inner)
Dura Mater- Leather like, outer layer Arachnoid Mater- Middle layer Pia Mater- Very thin, inner layer, on the brain
27
Where does an epidural hemorrhage occur
Between the skull and the dura mater
28
What causes an epidural bleed
A linear or depressed skull fracture and the middle meningeal artery tears
29
Signs of an epidural bleed (2)
- Rapid onset | - Lucid interval
30
What is the lucid interval process in terms of head injuries (4)
1. Go unconscious from head injury 2. Regain consciousness 3. Rapid bleed develops 4. Unconsciousness again
31
Where does a subdural bleed occur and what is it
Occurs between dura mater and arachnoid mater and from a venous rupture
32
What causes a subdural bleed and what people is it common in
- Contusion from blunt trauma | - Common in people with repeated falls
33
2 key points about subdural bleeds
1. They have the highest mortality rate for head bleeds | 2. It’s slow developing, can take days to months
34
Where does an intracerebral hemorrhage occur
Directly into the brain tissue
35
Where does a subarachnoid hemorrhage occur
Between the arachnoid mater and pia mater
36
Where does a basilar skull fracture occur and what is it
A fracture at the base of the skull that lacerated an artery
37
What are the 2 sings of a basilar skull fracture and the locations
- Battle sign- Bruising behind ears, can travel down the neck - Raccoon eyes- Blood pools in the upper eye lid area
38
Explain decorticate vs decerebrate
Decorticate- Arms and legs curl in towards midline Decerebrate- Arms and legs extend out
39
Name all the points of the Eye part of the GCS
4- Opens eyes spontaneously 3- Opens eyes to voice 2- Opens eyes to painful stimuli 1- No response
40
Name all the points of the Verbal response part of the GCS
``` 5- Oriented 4- Confused 3- Inappropriate words 2- Incomprehensible sounds 1- Silent ```
41
Name all the points of the Motor response part of the GCS
``` 6- Obeys commands 5- Localizes pain 4- Withdraws from pain 3- Abnormal flexion (decorticate) 2- Abnormal extension (decerebrate) 1- No movement ```
42
Vital signs differences between shock and increased ICP head injury
Shock ICP LOC Decreased Decreased RR Increased Decreased (Varies) HR Increased Decreased BP Decreased Increased Pulse- Narrows Widens Pressure
43
Signs of a head injury (4)
- Loss of consciousness!!! - Retrograde amnesia (Before event) - Anterograde amnesia (After event) - Presence of CSF (Halo Test)
44
Treatment for head injuries
- ABC’s, O2, Monitor, IV, C-spine | - BP of 110-120 systolic
45
What is most important to look for with any trauma patient
A medical reason that may be the cause for the trauma
46
Most important thing for all eye injuries is to
Cover both eyes
47
Treatment for small foreign objects in the eye
Flush with saline from the opposite side of the face
48
Treatment for an impaled object in the eye
- Moist sterile dressing on wound - Immobilize in place - Cover both eyes
49
Treatment for a protruding eyeball
- Cover with moist dressing | - Cover both eyes
50
Treatment for chemical burns of the eye (2)
- Force open eye, flush with saline for 20 minutes | - Bandage both eyes
51
Treatment for thermal eye burns
- Cover both eyes with moist sterile dressing | - Transport to burn center
52
Treatment for light burns to the eye
- Cover with sterile pad and eye shield | - Transport supine
53
Never do what to an eye with a laceration
-Exert pressure or manipulate it
54
An exposed eye ball with a laceration treatment
- Moist, sterile dressing | - Cover with metal eye shield
55
Laceration around an eye treatment
-Direct pressure, not on the eye ball
56
What primarily causes retinal detachment and signs of it
- Blunt trauma | - Pt sees flashing lights and/or specks and injection
57
What do you do with contacts in eye injuries
Leave in place unless there is a chemical burn to the eye
58
Explain the 3 different Le Fort fractures
LF 1. Across face between nose and maxilla LF 2. From cheek, arches above nose through eye socket LF 3. Across top of eye socket
59
What should always be checked with a nose bleed and how to treat
- BP | - Lean forward, pinch nose
60
2 most common causes of nose bleeds
1. Trauma | 2. Hypertension
61
How to treat an ear injury
- Dressing between ear and scalp - If avulsed, wrap in moist/sterile gauze - Foreign body in ear, dont attempt removal
62
What is at risk in a blunt neck injury
Larynx and trachea
63
Blunt neck injury can result in what sign
Subcutaneous emphysema
64
What is the primary damage of a spinal cord injury
- At the time of force - Cut, torn, crushed, cut off blood supply - Usually irreversible
65
What is secondary damage of a spinal cord injury
- After time of force | - HypoT, Hypoxia, Blood vessel injury, Swelling, Compression from hemorrhage
66
How many dermatology are in the body
29
67
What is an axial loading spinal injury
-Vertical compression of spine
68
What is a sign of a hyperflexion spinal injury and explain it
Lipstick sign | -Chin hyperflexes to the chest so hard that it leaves a mark
69
What is a cause of a hyperextension spinal cord injury
Rear ended in MVC, head moves backward as the body goes forward
70
What is a hyperrotation spinal cord injury
Over twisting/turning of the spine
71
What is a distraction spinal cord injury and another name for it
- Pulling of head from the spine | - Hangman’s fracture
72
Around where does the spinal cord end
L2
73
What is central cord syndrome
- From hyperext or hyperflex - Paralysis of arms - Electrical/tingling sensation to the ass and genitals
74
What is anterior cord syndrome
- Flexion injury - Decreased sensation below site of injury - Sense of touch intact - Paralysis is present
75
What is brown sequard syndrome
- Penetrating injury where 1/2 the spinal cord is torn - Same sided weakness, loss of pain - Opposite side loss of temperature senseation
76
What is complete cord transaction
- Complete paralysis and sensation - Bradycardia - Painful priapism
77
Best way to assess pain in an unconscious patient and why
- Periorbital pressure | - Even a paralyzed person can feel it
78
What are 4 complications of spinal mobile restriction
1. Airway compromise and aspiration 2. Head and low back pain 3. Life threatening hypoxia 4. Pressure sores
79
What are 7 mechanisms of injury for back boarding
1. MVC above 40 mph 2. Fall from 3x pts height 3. Axial load injury 4. Diving accident 5. Penetrating wound near spine 6. Sport injury to head/neck 7. Unconscious trauma patient
80
What 5 things make a patient a reliable source
1. Calm 2. Cooperative 3. Sober 4. Alert 5. No distracting injuries
81
What 5 things indicate a patient should be back boarded
1. Mechanism of injury 2. Spinal pain or tenderness 3. Abnormal PMS 4. Unreliable patient 5. EMS provider has any doubt
82
4 parts to spinal mobile restriction
1. Manual stabilization of c-spine 2. C-collar 3. Back board 4. PMS before and after immobilization
83
How to log roll a patient with an unstable pelvis
YOU DONT!!!
84
What patients require side SMR transport
- Unconscious not intubated | - Pregnant (If you can tell they are)
85
Can you immobilize a Peds patient in a car seat
Yes
86
What must be considered with SMR of the elderly
- Curvature of the spine (kyphosis) | - Can immobilize directly on the cot
87
When should you remove a motorcycle helmet
- Poor fitting - Significant neck flexion - Unable to manage the airway
88
When should you remove an anthemic helmet
- Face mask cannot be removed quickly - Airway cannot be controlled - Helmet does not securely hold the head - Helmet prevents stabilization
89
What is best to cover an open sucking neck wound
- Vaseline gauze | - OR electrode/defib pad

Sinclair Paramedic 2150 (16 decks)

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