Head, Face, Neck Trauma

Front 1

Cushing's Triad

Back 1

increased systolic pressure
widened pulse pressure
decrease in pulse and respiratory rates

results from increased intracranial pressure (ICP)

Front 2

contrecoup

Back 2

an injury that occurs at a site opposite the side of impact

Front 3

coup

Back 3

local damage that occurs at the site of impact

Front 4

Battle's Sign

Back 4

echymossis over the mastoid process caused by fracture of the temporal bone

Front 5

cerebral perfusion pressure

Back 5

a measure of the amount of blood flow to the brain calculated by subtracting the intracranial pressure from the mean systolic arterial blood pressure

normal range: 70-80mmHg

60mmHg is the critical minimum to adequately perfuse the brain

Front 6

decerebrate posturing

Back 6

a position in which a comatose patient's arms are extended and internally rotated and the legs are extended with the feet in forced plantar flexion; usually observed in patient's who have compression of the brainstem

Front 7

decorticate posturing

Back 7

a position in which the comatose patient's upper extremities are rigidly flexed at the elbows and at the wrists; usually observed in patients who have a lesion in the mesencephalic region of the brain

Front 8

epidural hematoma

Back 8

accumulation of blood between the dura mater and the cranium

rapid developed lesion (arterial)

possible lucid period

Front 9

raccoon's eyes

Back 9

ecchymosis of one or both orbits caused by fracture of the base of the sphenoid sinus

Front 10

subarachnoid hematoma

Back 10

a collection of blood or fluid in the subarachnoid space

sudden and severe headache

Front 11

subdural hematoma

Back 11

a collection of blood in the subdural space (dura and surface of the brain) - venous

more common than epidural hematoma

acute - symptoms within 24 hours
subacute - symptoms between 2-10 days
chronic - symptoms after 2 weeks

Front 12

Head injuries - Paramedic should obtain this info

Back 12

- Mechanism of injury
- events leading up to injury
- time of injury
- associated medical problems
- allergies
- medications
- last oral intake

Front 13

dental malocclusion

Back 13

misalignment of teeth (often caused by mandibular fractures)

Front 14

Le Fort I fracture

Back 14

involves the maxilla up to the level of the nasal fossa

Front 15

Le Fort II fracture

Back 15

involves the nasal bones and medial orbits (generally shaped like a pyramid)

Front 16

Le Fort III fracture

Back 16

complex fracture in which the facial bones are separated from the cranial bones

Front 17

Signs and Symptoms of an eye contusion injury

Back 17

- traumatic dilation or constriction of the pupil
- pain
- photophobia (abnormal sensitivity to light)
- blurred vision
- tear-shaped pupil

Front 18

Signs and Symptoms of traumatic hyphema

Back 18

- traumatic dilation or, less commonly, constriction of the pupil
- decrease in visual acuity
- blood in the anterior chamber (may be visible w/ penlight)

Front 19

Signs and Symptoms of globe or scleral rupture

Back 19

- decrease in visual acuity to hand movements or light perception
- lowered intraocular pressure (soft eye)
- pupil irregularity
- hyphema

Front 20

linear fractures

Back 20

seen as straight lines on x-ray film. account for 80% of all fractures to the skull.

Front 21

basilar skull fracture

Back 21

major impact trauma. signs and symptoms include battle's sign, raccoon's eyes, hemotympanum, and CSF leakage.

Front 22

Cranial nerve I (olfactory nerve)

Back 22

- loss of smell
- impaired taste (dependent on food aroma)
- Hallmark of basilar skull fracture

Front 23

Cranial nerve II (optic nerve)

Back 23

- blindness in one or both eyes
- visual field defects

Front 24

Cranial nerve III (oculomotor nerve)

Back 24

- ipsilateral, dilated, fixed pupil
- especially compression by the temporal lobe
- mimics direct ocular trauma

Front 25

Cranial nerve VII (facial nerve)

Back 25

- immediate or delayed facial paralysis
- basilar skull fracture

Front 26

Cranial nerve VIII (auditory nerve)

Back 26

- deafness
- basilar skull fracture

Front 27

Mean arterial pressure (MAP)

Back 27

diastolic pressure plus 1/3 pulse pressure (systolic - diastolic)

Normal range: 85-95mmHg

Maintaining a systolic blood pressure of at least 90mmHg also may help maintain adequate MAP

Front 28

Intracranial pressure (ICP)

Back 28

normal range: 10-15mmHg

Front 29

Cerebral blood flow

Back 29

as ICP approached MAP the gradient for flow decreases and cerebral blood flow decreases.

when ICP increases - CPP decreases

as CPP decreases, vessels in the brain dilate - results in increased ICP and further cerebral vasodilation

Front 30

Early signs and symptoms of increased ICP

Back 30

headache, nausea and vomiting, altered LOC

Front 31

Glasgow Come Scale < or = 8

Back 31

Tracheal intubation and ventilatory support is recommended

Front 32

neurogenic shock

Back 32

- a relatively bradycardic response (e.g., a pulse rate of 80 with a blood pressure of 80mmHg
- Warm and Dry skin
- no evidence of significant blood loss or hypovolemia
- paralysis and loss of spinal reflexes

Front 33

Cerebrum

Back 33

sensory, emotions, willed movement, memory

Front 34

cerebellum

Back 34

motor coordination, smooth movement

Front 35

brainstem

Back 35

essential functions include heart rate, respirations, temperature regulation

Front 36

The Brain

Back 36

- Intracranial volume = 1900cc's in adults
- occupies 80% of the cranial volume
- normal blood flow = 800ml/min
- O2 consumption = 20% of the total body
- Only 2% of total body weight, yet gets 15% of cardiac output

Front 37

Reticular Activating System

Back 37

responsible for the state of alertness

Front 38

decussation of pyramids

Back 38

cross over point for pyramid nerve fiber from the cerebrum down the brain stem to the opposite sides of the body (contralateral physical findings)

Front 39

Diffuse Axonal Injury Presentation

Back 39

- unconsciousness
- hypertension ( > 140mmHg)
- Hyperthermic (104-105 degrees F)
- posturing (decorticate or decerebrate)
- excessive sweating

Front 40

CO2 is a potent vasodilator

Back 40

PaCO2 above 45 torr = cerebral blood vessels DILATE = increased vascular volume = Increased ICP

PaCO2 below 30 torr = cerebral blood vessels CONSTRICT = decreased vascular volume = decreased ICP

Front 41

head injury assessment

Back 41

- history/mechanism of injury
- level of consciousness (most important)
- AVPU
- Glascow Coma Scale q 5 mins
- vital signs q 5 mins
- Pupil assessment
- if unilateral dilation, document which side
- motor, sensory, pulse X 4 extremities

Front 42

increasing intracranial pressure signs (initial)

Back 42

- decreased LOC/unconscious
- pupils - unilateral/bilateral enlargement,maybe reactive to light
- decorticate posturing with pain stimulus
- cheyne-stokes breathing

Front 43

increasing intracranial pressure signs (ongoing)

Back 43

- unconscious
- pupils - unilateral/bilateral may be reactive to light or fixed
- decerebrate posturing with pain stimulus
- central neurogenic hyperventitlation

Front 44

increasing intracranial pressure signs (late)

Back 44

- unconscious
- pupils - unilateral/bilateral dilation, fixed, non-reactive
- flaccid posturing
- ataxic (or medullary) breathing

Front 45

head trauma management

Back 45

- airway/c-spine
- GCS <9 or takes an oral airway - Intubate!
- BVM 100% O2, 12-15 BPM, watch SpO2
- If herniation continues, increase ventilations up to 20BPM
- early aggressive hyperventilation may drop PaCO2 too rapidly and may worsen situation
- start 1-2 large bore IV's depending on other injuries
- monitor BP, do not allow hypotension (SBP < 90) to occur
- head bleeds do not cause hypotension. if the BP is dropping the patient is bleeding from somewhere else!
- reassess the LOC and GCS q 5 mins