Head and Spine Injuries Flashcards
1
Q
Central nervous system
A
Composed of brain and spinal cord
2
Q
Peripheral nervous system
A
conducts sensory and motor impulses to and from the skin, muscles, and other organs to spinal cord
3
Q
What is the cranium occupied with?
A
80% brain tissue
10% blood supply
10% CSF
4
Q
The most prominent and most easily palpable spinous process is?
A
C-7
5
Q
Major regions of the brain
A
Cerebrum
Diencephalon
Brainstem
Cerebellum
6
Q
How much glucose and oxygen does the brain use?
A
Glucose : 25%
Oxygen : 20%
7
Q
What arteries supply blood to the brain?
A
Carotid and vertebral
8
Q
A loss of blood flow from to the brain for ______ will result in unresponsiveness.
A
5-10 seconds
9
Q
Cerebrum contains ___ if the brain’s total volume.
A
75%
10
Q
Injury to cerebral cortex may result in?
A
Paresthesia, weakness, and paralysis of extremities
11
Q
Function of frontal lobe
A
Voluntary motor action and personality
12
Q
Function of parietal lobe
A
Controls somatic and voluntary sensory and motor function. Memory and emotions.
13
Q
Function of occipital lobe
A
Processing visual information
14
Q
Function of temporal lobe
A
Speech center, long-term memory, hearing, taste, and smell.
15
Q
Function of cerebellum
A
Coordinates body movements. Maintenance of posture and equilibrium and the coordination of skilled movement.
16
Q
Reticular activating system
A
Responsible for maintenance of consciousness, specifically one’s level of arousal.
17
Q
Function of lower brainstem
A
HR, BP, and repsiration
18
Q
Basal ganglia
A
Role of coordination of motor movements and posture
19
Q
Midbrain
A
Lies immediately below the diencephalon and is the smallest region of the brainstem. Pupillary size and reactivity
20
Q
Pins
A
Lies below the midbrain and above the medulla. Controls nerve fibers involved with sleep, respiration, and the medullary respiratory center.
21
Q
Medulla
A
Continuous inferiorly with the spinal cord;
22
Q
Medulla
A
Continuous inferiorly with the spinal cord and serves as a conduction pathway from ascending and descending nerve tracts. Coordinates HR, blood vessel diameter, breathing, swallowing, vomiting, coughing, and sneezing.
23
Q
cauda equina
A
location where the spinal cord separates @ L2
24
Q
Meninges
A
Protective layer that surround and enfold the entire CNS - specifically the brain and spinal cord.
25
Dura mater
covers the entire brain
26
Where are the meningeal arteries located?
Between the dura mater and skull
27
Arachnoid
Second meningeal layer. Contains blood vessels.
28
Pia matter
Third meningeal layer. Highly vascular that firmly adheres directly to the surface of the brain.
29
Tentorium
Separates the cerebral hemispheres from the cerebellum and brainstem
30
Somatic nervous system
Regulates or controls voluntary activities, including all coordinated muscular activities.
31
Primary function of cranial nerves
Special functions in head and face, including sight, smell, taste, hearing, and facial expression.
32
Two types of peripheral nerves
sensory and motor
33
Sensory nerves
Transmit sensory input from the body to CNS. i.e. touch, taste, heat, cold, and pain.
34
Motor nervces
Carry information from the CNS to muscles.
35
Connecting nerves
Short fibers that connect the sensory and motor which allow the cells on either end to exchange messages.
36
Which nerve network controls the arms and legs?
Arms : brachial plexus
| Legs : lumbosacral plexus
37
Sympathetic nervous system
Controlled by hypothalamus.
38
Alpha receptor of SNS
Induce smooth muscle contraction in blood vessels and bronchioles
39
Beta receptor of SNS
Produces relaxation of smooth muscle in blood vessels and bronchioles. Chronotopic and inotropic effects on myocardial cells.
40
Chronotropic
Affecting HR
41
Inotropic
Affecting contractility
42
SNS is also responsible for
Sweating
Pupil dilation
Temperature regulation
Shunting blood from periphery to core during flight-or-fight
43
Spinal cord injuries at or above level ____ may disrupt flow of sympathetic communication.
T6
44
What would happen if there was a loss of sympathetic stimulation?
Disrupt homeostatsis and leave the body poorly equipped to deal with changes in its environment
45
Parasympathetic nervous system
Responsible for conserving energy and maintaining organ function.
46
What parasympathetic nerves supply the reproductive nerves, pelvis, and leg?
S2 through S4
47
Disruption of the lower parasympathetic nerves in the sacrum results in :
Loss of bowel/bladder tone and sexual function
48
Closed head injury is usually associated with blunt trauma and may result in :
Skull fx
Focal brain injuries
Diffuse brain injuries
Which can all be complicated by increased ICP
49
s/s of head injury
Lacerations, contusion, or hematomas to the scalp
Soft area or depression noted on palpation of the scalp
Visible skull fx or deformities
Battle sign or raccoon eyes
CSF rhinorrhea or otorrhea
50
s/s TBI
```
Pupillary abnormalities
Period of unresponsiveness
Confusion or disorientation
Perseveration
Amnesia
Combativeness or other abnormal behavior
Numbness of tingling in the extremities
Loss of sensation and/or motor function
Focal neurologic deficits
Seizures
Cushing triad
Dizziness
Visual disturbances
Seeing "stars"
N/V
Posturing
```
51
When should you maintain a high index of suspicion of a frature?
Head appears deformed
Visible crack in the skull w/in a scalp laceration
Raccoon eyes
Battle sign
52
What are the four types of skull fractures?
Linear
Depressed
Basilar
Open
53
Linear skull fracture
Nondisplaced. Account for approximately 80% of skull fractures.
54
Depressed skull fracture
Result from high-energy direct trauma w/ a blunt object. Often have neurologic signs such as LOC.
55
What part of the skull is more susceptible to depressed skull fractures?
Frontal and parietal
56
Basilar skull fracture
High-energy trauma.
| Extension of a linear fracture to the base of the skull.
57
Signs of basilar skull fractuer
CSF drainage from ears
Raccoon eyes
Battle sign
58
why does the absence of raccoon eyes and Battle sign does not r/o basilar skull fracture?
They may not appear until up to 24 hours following injury depending on the extent of the damage.
59
Open skull fracture
Severe forces applied to head and are often associated w/ multisystem trauma.
60
Two classifications of TBI
Primary injury and secondary injury
61
Primary injury
Injury to the brain and its associated structued that results instantaneously from impact to the head.
62
Secondary injury
Processes that increase the severity of a primary brain injury and negatively impact the outcome.
63
Potential causes of secondary injury
```
Cerebral edema
Intracranial hemorrhage
Increased ICP
Cerebral ischemia
Infection
Hypoxia
Hypotension
```
64
When can the secondary injury occur?
Few minutes to several days following initial head injury.
65
What happens when you hyperventilate a TBI patient?
Vessel size decreasing diminishing blood flow and oxygenation to deprived brain cells.
66
What happens when the brain is deprived of oxygen and CO2 levels increase?
The vessels dilate to bring more oxygenated blood to hypoxic tissue which, in turn, increased ICP, making it harder for blood to flow to swollen tissues.
67
What is the only indication for hyperventilation?
Signs of cerebral herniation
68
Signs of cerebral herniation
Unilateral dilated pupil that is unresponsive to light.
| Decrease by 2 or more points in the GCS in a patient whose GCS score is less than 8.
69
What does appearance of clear or pink, watery CSG from the nose, the ear, or an open scalp wound indicate?
Dura and skull have been penetrated
70
Cushing triad
Increased BP
Decreased HR
Irregular respirations
71
Healthy adult ICP range
5 to 15 mmHg
72
Cerebral perfusion pressure
Pressure of blood flow through the brain. CPP = MAP - ICP
73
Minimum CPP require to adequately perfuse the brain is :
60 mmHg
74
What will happen if the CPP is less than 60 mmHG?
Cerebral ischemia will result causing potentially permanent neurologic impairment or even death.
75
Autoregulation
Body's response to a decrease in CPP by increasing MAP, resulting in cerebral vasodilation and increased cerebral blood flow.
76
Early s/s of decreased ICP
Vomiting
HA
Altered LOC
Seizures
```
More-ominous, later:
HTN
Bradycardia
Cushing triad
Unilaterally unequal and nonreactive pupils
Coma
Posturing
```
77
Decorticate posturing
Character by flexion of the arms and extension of the legs.
78
Decerebrate posturing
Characterized by extension of the arms and legs
79
Clinical indications of mild elevation in ICP
```
Increased blood pressure
Decreased HR
Pupils still reactive
Cheyne-Stokes respiration
Attempts to localize and remove painful stimuli
Vomiting
HA
Altered LOC
Seizures
```
80
Cheyne-Stokes respiration
Respirations that are fast and then become slow w/ intervening periods of apnea
81
Clinical indications of moderate elevation in ICP
Widened pulse pressure and bradycardia
Pupils sluggish or nonreactive
Central neurogenic hyperventilation
Decerebrate posturing
82
What does a moderation elevation in ICP indicate?
Middle brainstem involvement
83
Central neurogenic hyperventilation
Deep, rapid respirations
Similar to Kussmaul but w/o acetone odor
84
Clinical indications of marked elevation in ICP
```
Unilaterally fixed and dilated pupil
Biot respirations
Flaccid response to painful stimuli
Irregular pulse rate
Fluctuating BP - hypotension common
```
85
Survival rate of each elevation level in ICP
Mild elevation : effects usually reversible w/ prompt and appropriate treatment
Moderate elevation : survival possible but often w/ some permanent neurologic deficit
Marked elevations : high mortality rate
86
Biot respirations
Irregular pattern, rate, and depth of breathing w/ intermittent periods of apnea
87
Focal brain injury
Specific, grossly observable brain injury
88
Examples of focal brain injuries
```
Cerebral contusion
Epidural hematoma
Subdural hematoma
Intracerebral hematoma
Subarachnoid hemorrhage
```
89
Cerebral contusion
Brain tissue is bruised and damaged in a specific area
90
Which area of the brain is most commonly affected by cerebral contusion?
Frontal lobe
91
Epidural hematoma
Accumulation of blood b/n the skull and dura mater
92
What is nearly always the result of an epidural hematoma?
Blow to the head that produces a linear fracture of the temporal lobe
93
Subdural hematoma
Accumulation of blood beneath the dura matter but outside the brain
94
What is a subdural hematoma typically from?
Rupture of the vein that bridge the cerebral cortex and dura
95
Classic presentation of epidural hematoma
LOC immediately following injury, which is then followed by a brief period of consciousness, after which the patient lapses back into unresponsiveness.
As ICP increases, pupil on the side of the hematoma becomes fixed and dilated.
96
Classifications of subdural hematomas
Acute : clinical signs develop w/in 48 hours following injury
Subacute : sings develop b/n 2 and 14 days after the injury
Chronic : symptoms may not appear for as long as 2 weeks
97
Which classification of subdural hematoma is more common in older adults, alcoholics, bleeding disease, and take anticoagulants?
Chronic subdural hematoma
98
Why are older patients and those with hx of alcohol use at higher risk for development of subdural hematoma?
Atrophy of the brain tissues increases the stretching of the bridging veins.
99
Common signs of subdural hematoma
Fluctuating LOC
Focal neurolgic signs
Slurred speech
100
Intracerebral hematoma
Bleeding w/in brain tissue itself. Occurs following penetrating injury to the head or rapid deceleration forces
101
Subarachnoid hemorrhage
Bleeding occurs into the subarachnoid space where the CSF circulates. Common causes include trauma or rupture of an aneurysm or arteriovenous malformation.
102
As bleeding into the subarachnoid space increases, the patient experiences s/s of increases ICP :
```
Decreased LOC
Pupillary changes
Posturing
Vomiting
Seizures
```
103
Diffuse brain injury
Any injury that affects the entire brain
104
Cerebral concussion is usually caused by "
Acceleration-deceleration forces
105
Concussion
Results in cerebral dysfunction that usually resolved spontaneously and rapidly w/o demonstrable physical damage to the brain or permanent neurologic impairment.
106
s/s of concussion
```
Dizziness
Weakness
Visual changes
N/V
Tinnitus
Slurred speech
Inability to focus
```
Severe concussion: Lack of coordination
Delay of motor functions
Inappropriate emotional responses
107
Diffuse axonal injury
Stretching, shearing, or tearing of nerve fibers w/ consequent axonal damage.
108
When does DAI most often?
High-speed, rapid acceleration-deceleration forces
