Flashcards in Mod 5 Trauma to the Head, Neck, and Spine Deck (57):
-Provides overall control of thought, sensation, and the body's voluntary and involuntary motor functions. Components are brain and spinal cord as well as the nerves that enter and exit the brain and spinal cord and extend to various parts of body.
The central nervous system
-The brain and the spinal cord
Peripheral nervous system
-The nerves that enter and exit the spinal cord between the vertebrae and the twelve pairs of cranial nerves that travel between the brain and organs without passing through the spinal cord and all of the body's other motor and sensory nerves
-Specialized nerve cells that transmit nervous system impulses throughout the body
Autonomic nervous system
- Controls involuntary functions
-The bony structure making up the forehead, top, back, and upper sides of the skull
-The lower jawbone
-Bone that forms part of the side of the skull and floor of the cranial cavity. There are right and left temporal bones.
-The movable joint formed between the mandible and the temporal bone also called the TMJ
-The two fused bones forming the upper jaw.
-The bones that form the upper third or bridge of nose
-The cheekbone. Also called the zygomatic bone
-The bony structures around the eyes AKA the eye sockets
-The opening at the base of the skull through which the spinal cord passes from the brain
-The fluid that surrounds the brain and spinal cord
-A fan of nerves that resembles a horse tail at the lower end of spinal cord
-The bones of the spinal column (singular vertebra)
-There are 33 linked together by ligaments
-Divided into 5 areas: Seven cervical (In neck), twelve thoratic (ribs attach), five lumbar (mid-back), five sacral (lower back), and four coccygeal (in the coccyx, or tail bone).
-The bony part on a vertebra
-Can feel along center of persons back
-May cause profuse bleeding.
-Apply direct pressure dress and bandage as you would other soft tissue injuries
-Classified as direct or indirect injuries
-Direct injuries to brain can occur in open head injuries with brain being lacerated, punctured, or bruised by the broken bones or by a foreign objects such as a bullet
-Indirect injuries to brain may occur with either closed or open head injuries. Include concussions and contusions
Traumatic brain injury
-An injury that disrupts the normal functioning of the brain.
-Mild closed head injury without detectable damage to the brain. Complete recovery is usually expected but effects may linger for weeks months or even years.
-May have brief loss of consciousness, and experience headache, grogginess, and short term memory loss.
Contusion in relation to a brain injury
-A bruised brain caused when the force of a blow to the head is great enough to rupture blood vessels
Laceration in relation to brain injuries
-A cut to the brain
-A collection of blood within the skull or the brain
-Pressure inside the skull
-Brain can be forced downward toward the foramen magnum.
-A small subdural hematoma can take from hours up to two days before serious symptoms.
-Brisk epidural bleed can be instant.
-Increased blood pressure and decreased heart rate are key findings that indicate rising intracranial pressure.
-A distinct pattern of breathing characterized by quickening and deepening respiration's followed by a period of apnea.
Central neurogenic hyperventilation
-A pattern of rapid and deep breathing caused by injury to the brain.
-A pattern of irregular and unpredictable breathing commonly caused by brain injury.
-Pushing of a portion of the brain downward toward the foreman magnum as a result of increased intracranial pressure
Sequence of events with a person with epidural or subdural hematoma
-Falls strikes head, brief loss of consciousness
-Slight altered mental status after 10 mins
-Altered mental status worsens
-Patient now unresponsive to to any stimuli
-Respiration's become slightly irregular
-The patient begins decerebrate posturing
-Neurological posturing where arms and wrists are flexed towards chest and extending of the legs and feet.
-Can be in response to painful stimuli
-Neurological posturing where arms are extended shoulders rotated inward and wrists flexed with legs extended
-Can be in response to painful stimuli
Signs of skull fracture or brain injury
-May have altered mental status
-They may be a deep laceration or severe bruise or hematoma to the scalp or forehead
-Depressions or deformity of the skull, large swellings
- Battle sign
-One eye is sunken
-Bleeding exits from nose or ears
-Clear fluid flows from ears or nose
-Patient displays personality change
-Increase in blood pressure and decreased pulse rate (Crushing reflex)
-Irregular breathing patterns
-Blurred or multiple image vision is present in one or both eyes
-Impaired hearing or ringing
-Equilibrium problems exist
-May experience decorticate or decerebrate posturing
-Paralysis or disability on one side of body
-Seizures may be present
-Deteriorating vital signs
Cranial injuries with impaled objects
-Do not remove object
-Stabilize object in place with bulky dressings
-May have to cut object if it is long
Main concern with injuries to face and jaw
-The main concern is the patients airway. May be obstructed by broken bones or blood.
Always be prepared to suction and use jaw thrust maneuver to open airway.
Nontraumatic brain injuries
-Same as those for a traumatic injury except there will be no evidence of trauma and no mechanism of injury
Glascow Coma Scale
-Check for spontaneous eye opening (If respond 4 points)
-See if they respond to voice. First speak at normal level then shout (If respond 3 points)
-Check for responsiveness to pain (If respond 2 points)
-Check for no eye opening (1 point)
Glascow Coma Scale
-Check if patient is oriented enough to for example communicate (If respond 5 points)
-Check if patient is confused (4 points)
-Check if patient starts speaking inappropriately (3 points)
-Check if patient makes incomprehensible sounds like mumbling (2 points)
-Check if patient has no verbal response (1 point)
Glascow Coma Scale
-See if patient obeys instruction to use motor functions (If respond 6 points)
-Check for responsiveness to localized pain (5 points)
-Check for withdraws after painful stimulation (4 points)
-Check for flexion or decorticate posturing (3 points)
-Check for extension or decerebrate posture (2 ponts)
-Check for no response (1 point)
-A bubble of air in the blood stream
-A massive hemorrhage from a neck wound must be treated to avoid this
-A blockage in the blood circulation of the lung caused by blood clot or air bubble.
-Can be caused by an air embolism
Open neck wound patient care
-Ensure open airway
-Place gloved hand over wound
-Apply occlusive dressing to the wound
-Place dressing over occlusive dressing
-Apply pressure as needed to stop bleeding
-Once bleeding has stopped bandage the dressing in place
-If mechanism of injury could have caused cervical injury immobilize spine
-Injuries that occur immediately and as a result of direct force.
-These injuries occur after the initial insult but can cause same or even more harm.
Mechanisms of spine injury
- Falls from greater than 1 meter (roughly 3 feet) or down more than 5 stairs
-Axial loading (compression injuries) such as those that occur in diving injuries
-High speed motor vehicle crashes especially with rollover or ejection of the patient
-Motorized recreational vehicle crashes
-An area of the skin that is innervated by a single spinal nerve
Indicators of spinal injury
-Paralysis of the extremities
-Changes in neurological function
-Pain with movement
-Tenderness anywhere along the midline spine
-Loss of bowel or bladder control
-A state of shock caused by nerve paralysis that sometimes develops from spinal cord injuries.
Spinal motion restriction
-The immobilization of the spinal column as if it were a single bone to prevent movement of individual vertebrae
Special considerations when applying short board
-Assessment of the back, shoulder blades, arms and collar bones must be done first
-Apply board without jarring or striking patient.
-Uppermost holes must be level with patients shoulders
-Never place chin cup or strap in case of vomiting.
-Avoid over tightening first strap
-Do not pad between collar and board
Tips for applying long spine board
-Will need to log roll patient
-Pad voids between patients head and torso and the board
-When a patient is secured to a long spine board head is secured last
Rapid take down
-Position one person to hold C spine behind standing patient
-Then apply C collar at proper size
-You and another person position long spine board behind patient
-Ensure patient is centered
-Lay patient carefully on the ground
Indications for leaving a helmet in place
-Helmet fits snugly
-No issues with airway
-Removal would cause further injury
-Proper spinal immobilization can be done with helmet in place
-There is no interference with the EMT's ability to assess the airway or breathing