Head & Spine Injuries Flashcards
(148 cards)
1
Q
Two anatomic parts of the nervous system
A
- Central nervous system
- Peripheral nervous system
2
Q
The CNS is composed of the ___
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Brain and the spinal cord, including the nuclei and cell bodies of most nerve cells
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Q
___ link the nuclei and cell bodies of most neve cells to the body’s various organs through openings in the spinal column
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Long nerve fibers
4
Q
The long nerve fibers connecting the body’s various organs to the CNS are part of the ___
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PNS
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Q
Three major areas of the brain
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- Cerebrum
- Cerebellum
- Brainstem
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Q
The cerebrum contains about ___ of the brain’s total volume
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Cerebrum
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Q
Controls a wide variety of activities, including most voluntary motor function and conscious thought
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Cerebrum
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Q
The cerebrum is divided into ___
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Two hemispheres with four lobes
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Q
Underneath the cerebrum lies the ___
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Cerebellum
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Q
Coordinates balance and body movements
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Cerebellum
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Q
The most primitive part of the CNS
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Brainstem
12
Q
Controls virtually all the functions that are necessary for life, including the cardiac and respiratory systems and nerve function transmissions
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Brainstem
13
Q
Best protected part of the CNS
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Brainstem
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Q
The spinal cord is mostly made up of ___
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Fibers that extend from the brain’s nerve cells
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Q
Carries messages between the brain and the body via the gray matter and white matter
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Spinal cord
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Q
Gray matter is composed of ___
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Neural cell bodies and synapses, which are connections between nerve cells
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Q
White matter consists of ___
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Fiber pathways
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Q
Cells of the brain and spinal cord cannot be ___
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Regenerated or reproduced
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Q
Three distinct layers of tissue that suspend the brain and the spinal cord within the skull and the spinal canal
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Meninges
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Q
The outer layer of the meninges
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Dura mater
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Q
Dura mater
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Tough fibrous layer that closely resembles leather
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This layer forms a sac to contain the CNS, with small openings through which the peripheral nerves exit
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Dura mater
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Q
Inner two layers of the meninges
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Arachnoid and the pia mater
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Contain the blood vessels that nourish the brain and spinal cord
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Inner two lays of the meninges
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CSF is produced in ___
A chamber in the brain, called the third ventricle
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CSF is located in ___
The subarachnoid space below the arachnoid, which is a weblike struture
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Amount of CSF in the brain at any one time
125 to 150 mL
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Primarily acts as a shock absorber in the brain
CSF
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If a patient with a head injury has what looks like a runny nose or reports a salty taste at the back of the throat, you should assume the fluid is ___
CSF
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Bleeding within the skull
Intracranial hemorrhage
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Result of intracranial hemorrhage
Increases pressure in the skull and compresses softer brain tissue
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Two anatomic parts of the PNS
1. 31 pairs of spinal nerves
2. 12 pairs of cranial nerves
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Conduct sensory impulses from the skin and other organs to the spinal cord. Also conduct motor impulses from the spinal cord to the muscles
31 pairs of spinal nerves
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Controls the arms
Brachial plexus
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Controls the legs
Lumbosacral plexus
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12 pairs of nerves that emerge from the brainstem and transmit information directly to or from the brain
Cranial nerves
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Perform special functions in the head and face, including sight, smell, taste, hearing, and facial expressions
Cranial nerves
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Two major types of peripheral nerves
1. Sensory nerves
2. Motor nerves
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Nerves with endings that perceive only one type of information, carry that info from the body to the brain via the spinal cord.
Sensory nerves
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One for each muscle, carry info from the CNS to the muscles
Motor nerves
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Connect the sensory and motor nerves with short fibers, which allow the cells on either end to exchange simple messages
Connecting nerves
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Connecting nerves are only found in ___
The brain and spinal cord
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In connecting the sensory and motor nerves of the limbs, the connecting nerves in the spinal cord form a ___
Reflex arc
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If a sensory nerve in the reflex arc detects an irritating stimulus, it will ___
Bypass the brain and send a message directly to the motor nerve, causing a response like pulling away
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The actions that we consciously perform
Voluntary activities
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Actions that are not under our conscious control
Involuntary activities
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The part of the nervous system that regulates or controls our voluntary activities
Somatic nervous system
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The part of the nervous system that regulates the body functions that occur without conscious effort
Autonomic nervous system
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The autonomic nervous system is divided into two sections
1. Sympathetic nervous system
2. Parasympathetic nervous system
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___ reacts to stress with the fight or flight response
Sympathetic nervous system
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During a time of stress, a hormone called ___ is released
Epinephrine (adrenaline)
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Counters the sympathetic nervous system
Parasympathetic nervous system
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The cranium is occupied by ___
80% brain tissue, 10% blood supply, and 10% CSF
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The spinal canal is ___ by birth
Closed
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Neural tube deformities can result in ___
Serious birth defects
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The lower portion of the spine does not close prior to birth
Spina bifida
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Number of vertebrae
7 Cervical
12 Thoracic
5 Lumbar
5 Sacrum
4 Coccyx (fused)
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The front part of each vertebra consists of ___
A round, solid block of bone called the vertebral body
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The back part of each vertebra forms a ___
Bony arch
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From one vertebra to the next, the series of arches for a ___
Tunnel running the length of the spinal column
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Tunnel running the length of the spinal column
Spinal canal
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Vertebrae are connected by ___ and separated by ___
1. Ligaments
2. Cushions
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Cushions that separate each vertebra
Intervertebral disks
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Allow the trunk to bend forward and back, but also limit motion
Ligaments and disks
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Palpable part of the spinal column
Posterior spinous process of some of the vertebrae
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Two types of head injuries
1. Closed head injury
2. Open head injury
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The brain has been injured but there is no opening to the brain
Closed head injury
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An opening exists from the outside to the brain
Open head injury
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Obvious skull deformity with a break in the skin is a sign of ___
An open head injury
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General signs and symptoms of a head injury
1. Lacerations, contusions, or hematomas to the scalp
2. Soft area or skull depression or palpation
3. Visible fractures or deformities of the skull
4. Decreased mentation, confusion
5. Irregular breathing pattern
6. Widening pulse pressure
7. Slow heart rate
8. Ecchymosis about the eyes or behind the ear over the mastoid process
9. Clear or pink CSF leakage
10. Failure of the pupils to react to light
11. Unequal pupil size
12. Loss of sensation and/or motor function
13. Period of unconsciousness
14. Amnesia
15. Seizures
16. Numbness or tingling in the extremities
17. Dizziness
18. Visual complaints
19. Combative or other abnormal behavior
20. Nausea or vomiting
21. Posturing
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Bruising that develops under the eyes
Raccoon eyes
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Bruising behind one ear over the mastoid process
Battle sign
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Raccoon eyes or battle sign are signs of ___
Skull fracture
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Nondisplaced skull fractures
Linear skull fracture
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If there is a laceration with a linear skull fracture, there is a risk of ___
Infection and bleeding inside the brain
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Depressed skull fractures result from ___
High-energy direct trauma to the head with a blunt object
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Part of the skull most susceptible to depressed skull fracture
Frontal and parietal bones
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Patients with depressed skull fractures often present with signs of ___
Neurologic injury
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Basilar skull fractures are associated with ___
High-energy trauma, but usually occur following diffuse impact to the head
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Result from extension of a linear fracture to the base of the skull
Basilar skull facture
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Signs of basilar skull fracture
1. CSF drainage from the nose or ears
2. Raccoon eyes or Battle sign (may not appear for 24 hours)
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Patients with leaking CSF from the nose or ear are at risk for ___
Bacterial meningitis
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A traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes
Traumatic brain injury
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TBI
Traumatic brain injury
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TBIs are classified into two broad categories
1. Primary (direct) injury
2. Secondary (indirect) injury
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Injury to the brain and its associated structures that results instantaneously from impact to the head
Primary brain injury
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A multitude of processes that increase the severity of a primary brain injury and, therefore, negatively affect the outcome
Secondary brain injury
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Two most common causes of secondary brain injury
Hypoxia and hypotension
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A brain injury that occurs when force is applied to the head and energy transmission through the brain tissue causes injury on the opposite side of original impact
Coup-contrecoup injury
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The injured brain begins to swell, initially because of ___. ___ then contributes to further brain swelling
1. Cerebral vasodilation
2. Cerebral edema
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Swelling of the brain
Cerebral edema
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Cerebral edema may not develop until ___
Several hours following the initial injury
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Low ___ in the blood aggravate cerebral edema
Oxygen levels
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Respirations that are fast and then become slow, with intervening periods of apnea
Cheyne-Stokes respirations
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Accumulations of blood within the skull or swelling of the brain can rapidly lead to an increase in ___
Intracranial pressure
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ICP
Intracranial pressure
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Biot respirations
Ataxic respirations
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Respirations characterized by irregular rate, pattern, and volume of breathing with intermittent periods of apnea
Ataxic respirations
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Cheyne-Stokes respirations or ataxic respirations are signs of ___
Increased ICP
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Abnormal breathing pattern associated with increased ICP that is characterized by deep, rapid breathing
Central neurogenic hyperventilation
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Breathing pattern that is similar to Kussmaul respirations, but without an acetone breath odor
Central neurogenic hyperventilation
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Signs and symptoms of ICP
1. Decreased pulse rate
2. Headache
3. Nausea
4. Vomiting
5. Decreased alertness
6. Bradycardia
7. Sluggish or nonreactive pupils
8. Decerebrate posturing
9. Increased or widened pulse pressure
10. Central neurologic ventilation, ataxic, or Cheyne-Stokes respirations
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The triad of increased systolic BP, decreased HR, and irregular respirations
Cushing reflex
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The Cushing reflex signifies increased ___
ICP
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Accumulation of blood between the skull and dura mater
Epidural hematoma
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An epidural hematoma is nearly always the result of ___
A blow to the head that produces a linear fracture of the thin temporal bone
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Artery that runs in the groove in the temporal bone
Middle meningeal artery
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Brief period of consciousness between two periods of unconsciousness
Lucid interval
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As the ICP increases, the pupil on the side of the hematoma becomes ___
Fixed and dilated
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Death will follow an epidural hematoma without ___
Surgery to evacuate the hematoma
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An accumulation of blood beneath the dura mater but outside the brain
Subdural hematoma
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Subdural hematoma usually occurs after ___
Falls or injuries involving strong deceleration forces
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Bleeding within the subdural space typically results from ___
Rupture of the veins that bridge the cerebral cortex and dura
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A subdural hematoma is associated with ___ bleeding
Venous
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Involves bleeding within the brain tissue itself
Intracerebral hematoma
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Intracerebral hematoma may occur following a ___
Penetrating injury to the head or because of rapid deceleration forces
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Most common location for intracerebral hematoma
Frontal and temporal lobes
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Intracerebral hematoma is associated with ___
Other brain injuries
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Bleeding occurs into the subarachnoid space, where the CSF circulates
Subarachnoid hemorrhage
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Results in bloody CSF and signs of meningeal irritation (such as neck rigidity or headache)
Subarachnoid hemorrhage
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Common causes of subarachnoid hemorrhage
Trauma or rupture of an aneurysm
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A patient with a subarachnoid hemorrhage reports a ___
Sudden, severe headache
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As the subarachnoid hemorrhage progresses ___
Increased signs and symptoms of ICP, decreased LOC, changes in pupils, vomiting, and seizures
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Mild TBI
Concussion
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A TBI with a temporary loss or alteration of part or all of the brain's abilities to function without demonstrable physical damage to the brain
Concussion
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A concussion is a ___ change, not a ___ change, in the brain
1. Functional
2. Structural
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Remember everything except the events leading up to the injury
Retrograde amnesia
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Inability to remember events after the injury
Anterograde (posttraumatic) amnesia
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Symptoms of concussion
1. Dizziness
2. Weakness
3. Visual changes
4. Changes in mood
5. Nausea or vomiting
6. Ringing in the ears
7. Slurred speech
8. Inability to focus
9. Lack of coordination or motor functions
10. Inappropriate emotion responses
11. Reports feeling "in a fog" or "just not right"
12. Temporary headache
13. Appear to be disoriented
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History of severe or repeated concussions are associated with ___
Decrease in brain function and severe dementia later in life and death
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Contusion is ___ than a concussion
Far more serious
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Contusion is ___ than a concussion
Far more serious
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Spine injuries are most common at ___
C1 and C2
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Common findings with spine damage
Pain and tenderness on palpation of the region
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Observable deformity in the spine from injury
Step-off
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You should suspect a possible head or spinal injury anytime you encounter one of the following MOIs ___
1. MVCs
2. Pedestrian MVC
3. Fall >20' adult
4. Fall >10' pediatric
5. Blunt trauma
6. Penetrating trauma to the head, neck, back, or torso
7. Rapid deceleration injuries
8. Hangings
9. Axial loading injuries
10. Diving accident
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You should suspect a possible head or spinal injury anytime you encounter one of the following MOIs ___
1. MVCs
2. Pedestrian MVC
3. Fall >20' adult
4. Fall >10' pediatric
5. Blunt trauma
6. Penetrating trauma to the head, neck, back, or torso
7. Rapid deceleration injuries
8. Hangings
9. Axial loading injuries
10. Diving accidents
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Injuries where the load is applied along the vertical or longitudinal axis of the spine
Axial loading injuries
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When to consider not performing spinal motion restriction
1. Patient is absolutely clear in thinking
2. No neurological deficits
3. No spinal pain
4. No tenderness
5. No evidence of intoxication
6. No other illnesses or injuries that may mask a spinal injury or otherwise cause you to doubt the patient's report
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Can develop from prolonged periods on a backboard
Decubitus ulcers
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Questions to ask to determine the chief complaint with a patient with a possible head or spine injury
1. What happened?
2. Where does it hurt?
3. Does your neck or back hurt?
4. Can you move your hands and feet?
5. Did you hit your head?
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Hyperventilation in patients with a head injury should be avoided except in cases where ___
Signs of imminent brainstem herniation have been identified
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Only use hyperventilation in patients with a head injury when ___ is available to ensure ___
1. Capnography
2. An end-tidal carbon dioxide level between 30 and 35 mm Hg
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In supine patients the head should be ___ to help reduce ICP
Elevated 30 degrees
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After the cervical collar has been attached ___
Maintain manual stabilization until the patient is secured in a backboard or vacuum mattress
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Purpose of the four-person log roll
Move a patient from the ground to a backboard or vacuum mattress
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The vacuum mattress cannot be used for patients who weigh more than ___
350 lbs
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When to not take the time to use a short backboard to remove a patient from a car
1. You or the patient is in danger
2. You need to gain immediate access to other patients
3. The patient's injuries justify urgent removal
