Head and Spine Trauma Flashcards
1
Q
Layers of Scalp
A
Hair and skin Sub Q tissue Galea Aponeurotica: tendon expansion Loose connective tissue Periosteum: covers surface of bone
2
Q
Auditory Ossicles
A
Function in hearing. Located three on each side of the head deep within the cavities of the temporal bone
3
Q
Cranial Vault
A
Eight bones that encase and protect the brain:
Parietal, temporal, frontal, occipital, sphenoid, ethmoid bones
4
Q
Formane Magnum
A
Brain connects to the spinal cord through a large opening at the base of the skull
5
Q
Sutures
A
How the skull bones are connected
6
Q
Fontanelles
A
Soft in infants and link the sutures together
7
Q
Mastoid Process
A
Base of each temporal bone and is cone shaped
8
Q
Crista Galli
A
Prominent bony ridge in the center of the anterior fossa and is point of attachment for meninges
9
Q
Ciribriform Plate
A
Surrounds Crista Galli with numerous openings allowing the passage of olfactory Nerve filaments from nasal cavity
10
Q
Olfactory Nerves
A
Cranial Nerves for smell, send projections through the foramina in the ciribriform plate and into nasal cavity
11
Q
Zygomatic Arch
A
Bone that extends along the front of the skull below the orbit
12
Q
Brain
A
Occupies 80% of cranial vault and contains billions of neurons
13
Q
Major regions
A
Cerebellum, diencephelon, brainstem, and cerebellum
14
Q
Brain cont
A
See neurological emergencies
15
Q
Frontal Lobe
A
Voluntary motor actions and emotion
16
Q
Parietal Lobe
A
Somatic or voluntary sensory and motor functions, memory and emotions
17
Q
Occipital
A
Optic Nerve originates, responsible for visual information.
Injury to the back of the head mya see stars because the optic Nerve banged against the back of the skull
18
Q
Temporal Lobe
A
Speech center
19
Q
Limbic System
A
Influences motivation, emotions, motivation, mood, and sensations of pain and pleasure
20
Q
Meninges
A
Protective layer that surround and enfold the entire CNS
21
Q
Dura Mater
A
Outside Strong, fibrous layer wrapping brain
22
Q
Arachnoid
A
Second layer, delicate transparent membrane
23
Q
Pai Mater
A
Third Layer, translucent highly vascular membrane
24
Q
CSF
A
Manufactured in the ventricles of the brain
25
Subarachnoid Space
CSF flows in this space. Located between the pia and arachnoid matters.
26
CSF Manufactured
Manufactured by cells within the choroid plexus in the ventricles, hollow storage areas in the brain
27
Vertebral Body
Anterior weight bearing structure is made of bone that provides support and stability
28
Components of Vertebrae
Spinous Process, Pericles, lamina
29
Pedicle
Inside of spinous process
30
Lamina
Groove of branch of spinous process
31
Spinal Nerves
31 pairs of spinal nerves
32
Facial and Trigeminal Nerve
Control facial feeling and function
33
MOI suggest Spinal Injury
Greater than 40mph crash
Unrestrained occupant
12 inch intrusion to vehicle
Fall from three times height
34
Coup contra coup
Brain hits front of head then hits back of the head after stopping forces applied
35
Cerebral Perfusion Pressure
At least 60mmHg to perfuse the brain
36
Hypertensive Head Injury
Do not give fluids
37
Hypotension head injury
20ml/kg to sustain a BP of at least 110-120 with a TBI and a GCS less than 9
38
Lower Cervical or Upper Thoracic Injury
Could leave patient breathing with accessory muscles and cause intercostal paralysis
39
C3-C5 injury
Innervated by the phrenic Nerve and may stop breathing or result to abdominal breathing
40
Contraindications to NPA
Basillar skull fractures or facial trauma
41
Consider RSI if...
Patient is awake with an impaired airway or has a detoriorating GCS < 8
42
RSI with ICP
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Preoxygenate
Lidocaine bolus (temporarily decreases ICP) 1-1.5mg/kg bolus
2 man intubate stabilized head
```
43
ICP patient breathing adequately
Give 100% oxygen via NRB
44
ICP Grades
Mild: pupils reactive, increased BP, Cheyenne stokes resp, headache, vomiting
Moderate: widened pulse pressure, pupils sluggish, bradycardia, kussmaul resp, decelerate Posturing
Severe: irregular bradycardia pulse, widened BP, biot respirations, blown pupils unilaterally
45
Blown Pupils
Pressure present around eyes
46
Myotomes
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Motor components of spinal Nerves in rebate discrete tissues and muscles of the body
C3-C5 diaphragm
C5 elbow flexor biceps, brachioradialis
C6 wrist extensions
C7 triceps
C8 finger flexor
T2-T7 intercostal
L2 hip flexor
L3 knee extension
L4 ankle extension
L5 big toes extension
S1 plantar flexor
S4-5 anus, Bowel, bladder
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47
Babinski Reflex
Hen toes move upward in response to stimulation of the sole of the foot. Normal circumstances, toes move downward
48
Linear Skull Fracture
80% of all fractures
- usually in temporal and parietal region
- risk of infection with laceration and fracture
49
Depressed Skull Fracture
High energy direct trauma to smalls surface area of head
- frontal and parietal most succeptible
- bony fragments may displace, causing more injury
50
Basilar Skull Fracture
CSF drainage, raccoon eyes, and battle signs
| May show up 24 hours after injury
51
Open Skull Fracture
Tissue may be exposed
52
TBI
Traumatic Brain Injury
-classified into primary and secondary
Primary: injury instantaneously from Impact
Secondary: after injuries such as edema, ICP, cerebral ischemia
53
ICP
Blood or CSF, Edema accumulating inside cranial vault
Normal ICP Ranges : 0-15mmHg
Cerebral Perfusion Pressure=MAP-ICP
54
Critical Minimum Threshold
Minimum CPP to adequately perfuse brain is 60mmHg in adults
| Less will lead to cerebral ischemia
55
Autoregulation
When body responds to a decrease in CPP by increasing the MAP, resulting in cerebral dialate on and increased cerebral blood flow.
56
Herniation
Brain is forced through the foramen magnum or the tentorium
57
Uncal Herniation
When temporal lobe is displaced resulting in compression of cranial Nerve 3, the midbrain, and posterior cerebral artery (decelerate)
58
Tonsillar Herniation
When cerebellum is displaced through foramen magnum
| Decorticate
59
Cushing Triad
Hypertension( widening pulse pressure )
Bradycardia
Irregular Respirations
and Blown Pupils
60
Diffuse Brain Injury
Injury that affects entire brain
61
Cerebral Concussion
When Brain is jarred around in cranial vault
62
Retrograde Amnesia
Loss of memory of events before injury
63
Anterograde Amnesia
Loss of memory of events after injury
64
Diffuse Axonal Injury DAI
Similar to concussion
- involves stretching, shearing or tearing of nerve fibers with axonal damage
- from high speed collision forces
65
Focal Brain Injury
Observable brain injury on CT scan
66
Cerebral Contusion
Brain tissue bruised or damaged in a local area
| -commonly frontal lobe and caused just like concussion with coup counter coup injuries
67
Epidural Hematoma
Accumulation of blood between skull and dura mater
- from blow to head and produces linear fracture of thin temporal bone
- brisk arterial bleeding common
- LOC from injury, wakes up, then passes back out
68
Subdural Hematoma
Accumulation of blood beneath dura matter but outsid of brain
- associated with skull fracture
- associated with venous bleeding, typically takes more time to develop Signs and symptoms
- slurred speech and fluctuation of symptoms
69
Intracerebral Hematoma
Bleeding within brain tissue
- once symptoms present, patient declines quickly
- high mortality rate
70
Subarachnoid Hematoma
Subarachnoid space where CSF is bleeding occurs
- common from aneurysm or atriovenous malformation
- sudden severe headache
- signs of ICP as it progresses
- survival usually means permanent damage
71
Subgaleal Hemorrhage
Bleeding between peritoneum of skull and galea aponeurosis
| -body mass that is palpated And able to move around skull
72
Thermal Management
Do not allow patient to be overheated
- patients with head injury can develop high temperatures (hyperpyrexia)
- do not cover with blankets if room temp is 70F
73
Brain Tissue exposes
Cover moist sterile dressings
74
Reduce ICP
Lasix, osmitrol
| -seizures must be immediately controlled because they further increase ICP
75
Scalp Lacerations
More serious in children and can cause hypovolemia
76
SCI
Spinal Cord Injuries
| Most devastation but only limited care prehospital
77
FlexioN Injuries
Forward movement of neck
- can involve C1-2
- can result in anterior wedge fractures
- injuries to ligaments around spinal column
78
Partial Dislocation of spinal Coumn
Subluxation
79
Rotation with Flexion
Can produce stable dislocation of spine
| -typically cause Fracture rather than dislocation
80
Vertical Compression
Forces transmitted up spine through feet or head vertically comprssing the spine
-can cause Herniation of disks
81
Hyperextension
Fractures of ligamentous injuries
-hangmans fracture: C2 results from hyperextension from rapid deceleration
-
82
Primary SCI
Injury at moment of impact
83
Spinal Cord Concussion
Temporary dysfunction that lasts 24-48 hours
84
Secondary SCI
edema, blood resulting after injury cause injury
85
Complete SCI
Complete disruption of spinal cord with permananet loss of all cord mediated functions beneath injury
-high thoracic injury results in paraplegia
86
Incomplete SCI
Retains some Cord mediated function
87
Anterior Cord Syndrome
Displacement of bony fragments into anterior portion of spinal cord due to flexion injuries or fractures
- disruption in flow in anterior spinal artery
- paralysis below injury with loss of sensation to touch, temperature and pain
88
Central Cord Syndrome
Hyperextension injuries to cervical area present with edema or blood to cervical areas
- risk with cervical spondylosis and arthritic changes in elderly
- motor and efferent fibers disturbed
- loss in upper extremities than lower
- many have good outcomes
89
Posterior Cord Syndrome
Extension injuries
| -dorsal columns effected presenting as decreased sensation to light touch, proprioception, and vibration
90
Cauda Equina Syndrome
Compression of bundle of Nerve roots that resembles horses tail at the end of the spinal column
-lower back pain, paresthesia, acute bladder or Bowel dysfunction
91
Brown-Sequard Syndrome
Penetrating trauma and depicts functional hemisection of the cord and complete damage to all spinal tracts on involved side
92
Spinal shock
Refers to temporary local neurogenic condition that occurs immediately after spinal trauma
Swelling of the cord
93
Neurogenic Shock
Temporary loss of autonomic function
- hypotension, blood pools, decreased cardiac output
- warm skin, Hypotensive, bradycardia
94
C Spine
Hold head and jaw with fingers
95
Unnatural Head Position
If head is crooked and presents with pain or abnormality, splint and do not move or attempt to realign
96
Supine
Decrease chances of cord hypoxia
97
KED
Hold c spine, secure torso and hips then head last with void padding
98
Rapid Extrication
Hold c spine and operate in one full motion as best as possible quickly
99
Stnding
Hold c spine with collar and lower to the ground in neutral position
100
Helmets removal
Remove if chin strap and helmet fail to hold head properly
Prevents immobilization for transport
Can not be removed after attempts
Prevent adequate airway control
101
Water Board
Completely board and strap patient in water before moving to land
102
Strain
Tear
103
Sprain
Pulled muscle
