Ch.34 Head And Spine Trauma

Front 1

Galea aponeurotica

Back 1

A tendon expansion that connects frontal and occipital muscles of cranium

Front 2

The skull
Consists of _______ bones in three anatomic groups

Back 2

28

Front 3

Cranial vault consists of eight bones that protect the brain:

Back 3

Parietal
Temporal
Frontal
Occipital
Sphenoid
Ethmoid

Front 4

Foramen magnum

Back 4

Large opening at the base of the skull where the brain connects to the spinal cord

Front 5

sutures

Back 5

Special joints where the bones of skull are connected

Front 6

Sagittal suture joins together the

Back 6

parietal bones

Front 7

Coronal suture joins together the

Back 7

parietal bones and the frontal bone

Front 8

Lambdoid suture joins together the

Back 8

occipital bone and the parietal bone

Front 9

Fontanelles

Back 9

Fibrous tissues that link the sutures

Front 10

Sutures solidify and fontanelles close at______ months of age

Back 10

18

Front 11

Mastoid process

Back 11

: Cone-shaped section of bone at the base of each temporal bone
a. Attachment site for various muscles

Front 12

The floor of the cranial vault is
Divided into three compartments.

Back 12

Anterior fossa
Middle fossa
Posterior fossa

Front 13

Crista galli

Back 13

Prominent bony ridge in the center of the anterior fossa

Front 14

Cribriform plate

Back 14

Horizontal bone on the other side of the crista galli

Front 15

The brain Major regions include

Back 15

a. Cerebrum
b. Diencephalon (thalamus and hypothalamus)
c. Brainstem (medulla, pons, midbrain)
d. Cerebellum

Front 16

The brain must have a constant flow of_____________.

Back 16

constant source of oxygen and glucose via cerebral blood flow.

Front 17

The cerebrum

Back 17

Largest portion of the brain
Responsible for higher functions, such as reasoning
Divided into right and left hemispheres

Front 18

Cerebral cortex

Back 18

voluntary skeletal movement and the level of awareness
Injury may result in paresthesia, weakness, and paralysis of extremities

Front 19

Frontal lobe controls

Back 19

voluntary motor action and personality traits

Front 20

Parietal lobe controls

Back 20

somatic or voluntary sensory and motor functions for the opposite side of the body, as well as memory and emotions.

Front 21

Occipital lobe processes

Back 21

visual information

Front 22

Temporal lobe controls

Back 22

speech, long-term memory, hearing, taste, and smell

Front 23

Thalamus processes

Back 23

sensory input
influnces mood and general body movements.

Front 24

Hypothalamus controls many body functions such as.

Back 24

(1) Heart rate
(2) Digestion
(3) Sexual development
(4) Temperature regulation
(5) Emotion
(6) Hunger and thirst
(7) Vomiting
(8) Regulation of the sleep cycle

Front 25

The cerebellum

Back 25

Responsible for maintenance of posture, equilibrium, and coordination

Front 26

The brainstem consists of

Back 26

midbrain, pons, and medulla

Front 27

the brainstem connects the spine to the

Back 27

brain

Front 28

Limbic system

Back 28

Influences emotions, motivation, mood, and sensations of pain and pleasure

Front 29

The pons control

Back 29

sleep, respiration, and the medullary respiratory center

Front 30

the medulla coordinates

Back 30

Coordinates heart rate, blood vessel diameter, breathing, swallowing, vomiting, coughing, and sneezing

Front 31

Dura matter forms the

Back 31

tentorium (structure that separates the hemispheres from the cerebellum and brainstem)

Front 32

Dure matter is the ________most layer

Back 32

outer

Front 33

Arachnoid is located

Back 33

second layer

Front 34

pia matter is located

Back 34

3rd
Thin, translucent, and highly vascular
Adheres directly to surface of the brain

Front 35

cerebrospinal fluid (CSF) is made in the

Back 35

choroid plexus in the ventricles

Front 36

the spine has ______ bones and shape is_______

Back 36

33 irregular

Front 37

atlas is located at

Back 37

c1

Front 38

axis

Back 38

c2

Front 39

The thoracic spine consists of 12 vertebrae and is stabilized by the

Back 39

rib attachments

Front 40

Lumber has ______ vertebra and carrys

Back 40

5
large portion of upper body weight

Front 41

As the body ages the disk of the spine

Back 41

become thinner and causes height lose

Front 42

how many pairs of spinal nerves

Back 42

31 on each side

Front 43

Posterior horns that carry

Back 43

sensory input

Front 44

Anterior horns that innervate the

Back 44

motor nerve of that segment

Front 45

Ascending tracts carry information to the

Back 45

brain

Front 46

Descending tracts carry information to the

Back 46

body

Front 47

the spinal nerves are named for _____ and ________.

Back 47

region
level

Front 48

The sympathetic nervous system
Controlled by the

Back 48

hypothalamus

Front 49

The sympathetic nervous system
controlles

Back 49

sweating
pupil dilation, temperature regulation, and “flight or fight” responses.

Front 50

Loss of sympathetic stimulation can disrupt homeostasis and cause.

Back 50

bradycardia
vasodilation

Front 51

The parasympathetic nervous system
Includes fibers arising from

Back 51

brainstem and upper spinal cord

Front 52

Sonorous respirations indicate a _____problem.

Back 52

positional

Front 53

Gurgling respirations indicate need for

Back 53

suction

Front 54

If intubation is required with head trauma administer

Back 54

1 to 1.5mg/kg of lidocaine IV push

Front 55

Monitor oxygen saturation, and maintain at _____ or higher. and ventilate at ____breaths/min

Back 55

95%
10

Front 56

Optimally, you should ventilate the patient to maintain the ETCO2 between

Back 56

30 and 40 mm Hg

Front 57

Do not apply excessive pressure to scalp lacerations in which an underlying _____ is suspected

Back 57

fracture

Front 58

Patients in severe pain may require an alternative method of transfer

Back 58

scoop strecher

Front 59

Down side of using scoop strecher

Back 59

visual inspection of the back is no longer possible.

Front 60

chest assessment for _______ of chest wall movement, work of breathing, and use of_______

Back 60

symmetry and accessory muscles

Front 61

Signs of ICP are

Back 61

postering (decerbrate,decorticate)
Hypotension or hypertension
abnormal pupils signs

Front 62

Hyperesthesia

Back 62

Hyperacute pain to touch

Front 63

abnormal sensations due to a spinal injury

Back 63

Pins and needles
Electric shock
hyperesthesia

Front 64

Spinal injury pt you wouls assess from ______starting point

Back 64

feet up

Front 65

Two general types of head injuries

Back 65

closed and open

Front 66

closed injury caused by

Back 66

blunt trauma

Front 67

4 types of skull fracture

Back 67

linear
depressed
basilar
open skull

Front 68

Linear skull fractures occur in the

Back 68

temporal-parietal region of the skull

Front 69

Depressed skull fractures result from high-energy direct trauma to________ surface area of the head with a blunt object to the ________and _______regions

Back 69

small
frontal
parietal

Front 70

Basilar skull fractures cause CSF drainage from the _____

Back 70

ears

Front 71

Ecchymosis behind the ear

Back 71

Battle signs

Front 72

Periorbital ecchymosis that develops around the eyes

Back 72

raccoon eyes

Front 73

primary brain injury results from

Back 73

instantaneously from impact to head

Front 74

Secondary brain injury refers to

Back 74

after effects
Cerebral edema
Intracranial hemorrhage
Increased ICP
Cerebral ischemia and hypoxia
Infection

Front 75

The most common cause of brain injury is a _______ crash

Back 75

motor vehicle

Front 76

Coupe-contrecoup: ________type of injury

Back 76

front and rear
Results in compression injury to the anterior portion of the brain and stretching or tearing of the posterior portion

Front 77

_______ = Difference between mean arterial pressure (MAP) and ICP

Back 77

CPP

Front 78

The critical minimum threshold (minimum CPP required to perfuse the brain) is_______ mm Hg in an adult

Back 78

60
CPP of less than 60 mm Hg leads to cerebral ischemia

Front 79

Body responds to decrease in CPP by increasing MAP (process known as ________.

Back 79

autoregulation

Front 80

autoregulation results in

Back 80

Results in cerebral vasodilation and increased cerebral blood flow

Increase in cerebral blood flow causes further increase in ICP.

Front 81

Prehospital treatment should focus on maintaining ______while mitigating _______

Back 81

CPP
ICP

Front 82

Early warning signs of ICP

Back 82

i. Vomiting
ii. Headache
iii. Altered level of consciousness
iv. Seizures

Front 83

More ominous signs of ICP include

Back 83

i. Hypertension
ii. Bradycardia
iii. Irregular respirations (Cushing triad)
iv. Nonreactive pupil
v. Coma
vi. Posturing

Front 84

Cerebral concussion is caused by

Back 84

rapid deceleration. brain is jarred around

Front 85

Cerebral concussion signs

Back 85

(a) Confusion
(b) Disorientation
(c) Loss of consciousness
(d) Retrograde amnesia: Loss of memory relating to events that occurred before injury
(e) Autograde (posttraumatic) amnesia: Loss of memory relating to events that occurred after injury

Front 86

never release c spine manual neck stabilization until

Back 86

entire spine is immobilized

Front 87

Retrograde amnesia

Back 87

Loss of memory relating to events that occurred before injury

Front 88

Autograde (posttraumatic) amnesia

Back 88

Loss of memory relating to events that occurred after injury

Front 89

(DAI)
Associated with or similar to a concussion

Back 89

Diffuse axonal injury

Front 90

__________ Involves stretching, shearing, tearing of nerve fibers and axonal damage

Back 90

Diffuse axonal injury

Front 91

Epidural hematoma between the _____and ______

Back 91

skull and dura matter

Front 92

Patient often immediately loses consciousness, regains it for a brief period, and loses it again.

Back 92

Epidural hematoma

Front 93

Subdural hematoma is accumulation of blood beneath _____ mater outside the _____

Back 93

dura
brain

Front 94

Patient often experiences a fluctuating level of consciousness, focal neurologic signs, or slurred speech and happens acute or chronic. up to 24 hrs

Back 94

Subdural hematoma

Front 95

Intracerebral hematoma is bleeding in the

Back 95

brain

Front 96

Subarachnoid hemorrhage results in

Back 96

bloody CSF and meningeal irritation

Front 97

Subarachnoid hemorrhage causes include

Back 97

trauma or rupture of aneurysm.

Front 98

Subgaleal hemorrhage is bleeding between____and _____. Can result in enough blood loss to precipitate hypovolemia in _____

Back 98

periosteum and galea aponeurosis

Infants

Front 99

Pharmacologic therapy for ICP

Back 99

i. Mannitol (Osmitrol)
ii. Furosemide (Lasix)

Front 100

Seizures must be terminated as soon as possible with________ or it will increase _______

Back 100

Benzodiazepines

ICP

Front 101

Flexion injuries result from ________movement of head
and rapid ________or direct blow to the

Back 101

forward
deceleration
occiput

Front 102

subluxation

Back 102

partial dislocation

Front 103

at the level of _______can produce an unstable dislocation with or without a fracture

Back 103

c1 c2

Front 104

roation with flexion spine that allows for significant rotation is

Back 104

c1
c2

Front 105

verticle compression transmittes through the

Back 105

verticle bodies
reslut from a blow to the crown rapid deceleration from a fall through the feet, legs, and pelvis

Front 106

results in fractures and ligamentous injury of variable stability

Back 106

hyperextension

Front 107

primary spinal injury occurs at the moment of

Back 107

impact

Front 108

Spinal cord concussion characterized by a temporary dysfunction that lasts

Back 108

from 24 to 48 hours

Front 109

Secondary spinal cord injury occurs when________ factors permit a progression of the primary SCI

Back 109

multiple

Front 110

Anterior cord syndrome result of displacement of bony fragments into the ______of the spinal cord .
Physical findings include paralysis below the level of insult with loss of sensation to pain, temperature, and touch.

Back 110

anterior portion

Front 111

Central cord syndrome hyperextension injuries to the cervical area present with______ .
often occurs in conjunction with tears to the anterior longitudinal ligament

Back 111

hemorrhage or edema

Front 112

Patient presents with greater loss of function in upper extremities than in lower extremities

Back 112

Central cord syndrome

Front 113

Posterior cord syndrome associated with

Back 113

extension

Front 114

Cauda equina syndrome

Back 114

Compression of bundle of nerve roots located at end of spinal cord

Front 115

Brown-Séquard syndrome Accompanied by functional _________ of the cord and complete damage to all spinal tracts on the ________ side

Back 115

hemisection
involved

Front 116

Spinal shock is due to ______ local neurologic condition that occurs immediately after spinal trauma.
Swelling and edema begin within _____ minutes.

Back 116

temporary
30

Front 117

Neurologic shock results from temporary loss of autonomic function at the level of _______.hemodynamic and systemic effects are seen.

Back 117

injury

Front 118

Neurologic shock signs

Back 118

(a) Hypotension
(b) Hypovolemia and sensitivity to sudden position changes
(c) Decreased stroke volume and cardiac output
(d) Bradycardia
(e) Hypothermia and absence of sweating
(f) Paralytic ileus (paralysis of the small bowel)

Front 119

The patient may not require immobilization if he or she:

(If there is any doubt, the patient should be immobilized.)

Back 119

i. Has no neurologic deficit
ii. Is not under the influence of alcohol, drugs, or medications
iii. Has no distracting injuries
iv. Has no motor or sensory deficit
v. Has no pain or tenderness on movement or palpation

Front 120

Rapid extrication includes uses of

Back 120

c collar and spine board only

Front 121

The Inter-Association Task Force for the Appropriate Care of the Spine-Injured Athlete recommended helmet removal in the following situations

Back 121

i. The helmet and chin strap fail to hold the head securely.
ii. The helmet and chin strap design prevent adequate airway control.
iii. A helmet with a face mask cannot be removed after a reasonable amount of time.
iv. The helmet prevents proper immobilization for transport.

Front 122

Complications of spinal cord injury ________(also called autonomic hyperreflexia) is a late complication. is common found at injuries to the ____--____.

Back 122

Autonomic dysreflexia

T4-T6

Front 123

Autonomic dysreflexia (also called autonomic hyperreflexia) signs

Back 123

i. Cool, pale extremities
ii. Systolic blood pressures of greater than 200 mm Hg
iii. Diastolic blood pressures of 130 mm Hg or greater
iv. Vagal compensation causes bradycardia and vasodilation of peripheral and visceral vessels above the level of the lesion

Front 124

Anterior spinothalamic (asending) carry

Back 124

carry touch sensation and pressure sensation to the brain

Front 125

Disk herniation may be caused in patients with preexisting disk degeneration Typically affects men between ages _____ and _____ years
ii. May result from poor lifting technique
iii. Most commonly occurs at ____ and ____

Back 125

30 and 50
L4-L5
L5-S1

Front 126

ventral response nerves

Back 126

motor

Front 127

dorsal response nerves

Back 127

sensory

Front 128

spinal cord stops at the _____vertebra

Back 128

L2

Front 129

signs of cerebral herniation is

Back 129

asymmetric pupils.(unequal) or dilated or fixed
Decebrate or no motor response

Front 130

Decadron is used also for

Back 130

ICP inflammation. and spinal cord inflammation

Front 131

Solumedrol is also used for

Back 131

spinal cord inflammation

Front 132

Levels of ICP
Mild

Back 132

BP elevated
cheyne-stokes. fast then slow and periods of apnea
Altered LOC
seizures
vomiting

Front 133

Levels of ICP
Moderate (middle brainstem involved)

Back 133

widened pulse pressure and bradycardia
pupils sluggish
Central neurogenic hyperventilation (deep and rapid)
decebrate posturing

Front 134

Levels of ICP
severe
Lower portion of brainstem

Back 134

Biots resp
fixed or dilated pupil
hypotensive
changes in qrs complex, st segments or t wave.
irregular pulse.

Front 135

c3-c5 control

Back 135

diaphragm

Front 136

hyperpyrexia

Back 136

high body temt

Front 137

spinal cord vertebre in children are and can easly be dislocate and relocate quickly

Back 137

curved

Front 138

near drowning the lungs are

Back 138

dry