Head and Spine Trauma

Question 1

What are the layers of scalp?

Answer 1

• Hair and skin
• Subcutaneous tissue
• Galea Aponeurotica
• Loose connective tissue
• Periosteum: covers the surface of the bone

Question 2

Define:

Foramen Magnum

Answer 2

A large opening at the base of the skull where the brain connects to the spinal cord.

It is the location where the brain can herniate.

Question 3

What is the purpose of sutures on the skull?

Answer 3

It connects the different sections of bones on the skull.

Question 4

What is the purpose of fontanelles?

Answer 4

It links the sutures together.

Question 5

Define:

Crista Galli

Answer 5

A prominent bony ridge in the center of the anterior fossa and is the point of attachment for meninges.

Question 6

Define:

Cribriform Plate

Answer 6

A passage for olfactory nerve filaments from the nasal cavity.

Question 7

What is the function of the olfactory nerves?

Answer 7

smell

Question 8

What are the major regions of the brain?

Answer 8

• Cerebellum
• Diencephelon
• Brainstem
• Cerebrum

Question 9

What is the function of the Frontal lobe?

Answer 9

Voluntary motor actions and emotion.

Question 10

What is the function of the Parietal lobe?

Answer 10

• voluntary sensory and motor functions
• memory and emotions

Question 11

What is the function of the Occipital lobe?

Answer 11

vision

Question 12

What is the function of the Temporal lobe?

Answer 12

speech

Question 13

What is the function of the Limbic System?

Answer 13

• motivation
• emotions
• mood
• sensations of pain and pleasure

Question 14

Define:

Meninges

Answer 14

A protective layer that surrounds the brain and spinal cords.

Question 15

What are the layers of Meninges?

List from top to bottom.

Answer 15

• Dura
• Arachnoid
• Pai

Remember using the acronym “DAP”.

Question 16

_______ ______ _____ is manufactured in the ventricles of the brain.

Answer 16

Cerebral spinal fluid

Question 17

What is the function of Subarachnoid Space?

Answer 17

The space where the CSF flows.

Question 18

What are the components of the vertebrae?

Answer 18

• Spinous Process
• Pericles
• Lamina

Question 19

How many pairs of spinal nerves are there in the human body?

Answer 19

31

Question 20

What is the function of facial and trigeminal nerve?

Answer 20

facial feeling and function

Question 21

What are the MOI criteria that suggest a possible spinal injury?

Answer 21

• Greater than 40 mph crash.
• Unrestrained occupant.
• 12 inch intrusion to vehicle.
• Fall from three times the person’s height.

Question 22

What happens to the brain during a coup contra coup injury?

Answer 22

• Brain hits front of head.
• Brain hits back of the head.

Question 23

Fill in the blank.

You need at least ____ mmHg of Cerebral Perfusion Pressure to perfuse the brain.

Answer 23

60

Question 24

Treatment:

Hypotension with head injury

Answer 24

IVF 20 ml/kg

Blood pressure must be sustained at >110-120 mmHg systolic.

Question 25

# Fill in the blank Injury to **\_\_\_\_** to **\_\_\_** may stop breathing because it is **innervated by the phrenic nerve**. ## Footnote Hint: cervical vertebrae

Answer 25

C3, C5

Question 26

# Fill in the blank. Consider **RSI** in a **head injury** if **GCS** is < \_\_\_.

Answer 26

8

Question 27

# Treatment: RSI with ICP

Answer 27

* **Preoxygenate** * Administer a **lidocaine** bolus of 1 - 1.5 mg/kg. * Use **two-man intubation** to stabilize the head.

Question 28

What are the **three ICP grades** and its indications?

Answer 28

**Mild**: * pupils reactive * increased BP * Cheyne-Stokes respirations * headache * vomiting **Moderate**: * widened pulse pressure * pupils sluggish * bradycardia * Kussmaul respirations * decerebrate posturing **Severe**: * irregular bradycardic pulse * widened BP * Biot respirations * blown pupils unilaterally * decorticate posturing

Question 29

# Define: Babinski Reflex

Answer 29

The toes move upward in response to stimulation of the sole of the foot. ## Footnote In normal circumstances, the toes move downward.

Question 30

What are the indications of **Basilar skull fracture**?

Answer 30

* CSF drainage * raccoon eyes * battle signs ## Footnote May show up 24 hours after injury.

Question 31

What are the **primary** and **secondary** injuries of a **TBI**?

Answer 31

* **Primary**: injury from impact * **Secondary**: edema, ICP, cerebral ischemia after the injury

Question 32

What is the **normal ICP**?

Answer 32

0-15 mmHg

Question 33

# Define: brain herniation

Answer 33

The brain is forced through the **foramen magnum**.

Question 34

What are the indications of the **Cushing's triad**?

Answer 34

* Hypertension (widening pulse pressures) * Bradycardia * Irregular respirations

Question 35

What is a **diffuse brain injury**?

Answer 35

**Injury** that affects the **entire brain**.

Question 36

What causes a **cerebral concussion**?

Answer 36

When the **brain is jarred** in the cranial vault.

Question 37

# Define: Retrograde Amnesia

Answer 37

**Inability to recall memories** that were formed _before_ the onset of amnesia.

Question 38

# Define Anterograde Amnesia

Answer 38

**Inability to recall memories** that were formed _after_ the onset of amnesia.

Question 39

# Define: Diffuse Axonal Injury | DAI

Answer 39

**Stretching of brain tissue** from **twisting** motion at brainstem. ## Footnote Typically caused from high-speed collision forces.

Question 40

What are the **signs/symptoms** of **epidural hematoma**?

Answer 40

* LOC * wakes up, passes back out

Question 41

What are the **signs/symptoms** of **subdural hematoma**?

Answer 41

* Slurred speech * Unilateral Hemiparesis ## Footnote Venous bleed that takes longer to show signs/symptoms.

Question 42

What are the **signs/symptoms** of **subarachnoid hematoma**?

Answer 42

* sudden severe headache * posturing * vomiting * decrease LOC * seizures

Question 43

# Treatment: exposed brain tissue

Answer 43

**Cover** with **moist, sterile dressings**.

Question 44

What are the **complications** of **scalp lacerations**?

Answer 44

serious **blood loss**

Question 45

What is the cause of **flexion injuries**?

Answer 45

**Forward movement** of neck.

Question 46

# Define: subluxation

Answer 46

**Partial dislocation** of the **spinal column**.

Question 47

What is the cause of **vertical compression**?

Answer 47

**Forces transmitted through the spine** from feet or head.

Question 48

What is the cause of **hyperextension**?

Answer 48

**Head and neck** extend **backwards**.

Question 49

What are the **primary** and **secondary** injuries of a **spinal cord injury**?

Answer 49

* **Primary**: injury at impact * **Secondary**: edema after impact

Question 50

What are the **signs/symptoms** of **Anterior Cord Syndrome**?

Answer 50

* Decreased **movement**. * Loss of sensation to **touch, temperature, and pain**.

Question 51

What are the **signs/symptoms** of **Central Cord Syndrome**?

Answer 51

* Decreased **sensation**. * Loss of **sensation to pain and temperature**.

Question 52

What are the **signs/symptoms** of **Posterior Cord Syndrome**?

Answer 52

Loss of **sensation to light**, **vibration**, and **perception of one's body**.

Question 53

# Define: Cauda Equina Syndrome

Answer 53

Compression of distal nerve roots. | Horse's Tail

Question 54

# Define: Brown-Séquard Syndrome

Answer 54

Damage to hemisection of cord causing symptoms on **one half of the lateral body**.

Question 55

How should **rapid extrication with C-spine** precautions be performed?

Answer 55

**Hold C-spine** and extract in **one full motion quickly**.

Question 56

**When** do you **remove a helmet** with suspected spinal injury?

Answer 56

* Remove if chin strap and helmet fail to hold head in line. * Prevents immobilization for transport. * Prevents adequate airway control.

Question 57

How do you treat **C-Spine in the water**?

Answer 57

Completely board and strap patient in water **before moving to land**.

Question 58

What is the formula for **cerebral perfusion pressure**? | CPP

Answer 58

CPP= (MAP)−(ICP)