Chapter 26 Head and Spine Injuries

The nervous system is divided into two anatomic parts:

The brain is divided into three major areas:

The cerebrum controls a wide variety of activities, including (two things):

The cerebrum contains about __% of the brain’s total volume and is divided into ____ hemispheres with ____ lobes.

The cerebellum coordinates (two things):

The brain stem controls most functions necessary for life, including the ____ and  ____ systems and nerve function transmissions.

Gray matter in the spinal cord is composed of (two things):

White matter in the spinal cord consists of:

The CNS is further protected by the ____, three distinct layers of tissue that suspend the brain and the spinal cord within the skull and the spinal canal.

The outer layer of the meninges, the ____ ____, is a tough, fibrous layer that forms a sac to contain the CNS.

The inner two layers of the meninges, called the ____ and the ____ mater, contain the blood vessels that nourish the brain and spinal cord.

Cerebral spinal fluid (CSF) is produced in a chamber inside the brain, called the:

There is approximately ____ to ____ mL of CSF in the brain at one time.

CSF primarily acts as a:

__ pairs of spinal nerves

__ pairs of cranial nerves

There are two major types of peripheral nerves:

The ____ nerves are found only in the brain and spinal cord.

The connecting nerves in the spinal cord form a ____ ____.  If a sensory nerve in this arc detects an irritating stimulus, it bypasses the brain and sends the message directly to a motor nerve.

The ____ (voluntary) nervous system handles voluntary activities.

The ____ (involuntary) nervous system handles the body functions that occur without conscious effort.

The autonomic nervous system is divided into two parts:

When confronted with a threatening situation, the ____ nervous system reacts to the stress with a fight-or-flight response.

The cranium is occupied by __% brain tissue, __% blood supply, and __% CSF.

The face is composed of __ bones.

The orbit (eye socket) is made up of two facial bones:

The spinal column has __ bones, called vertebrae, and is divided into five sections:

The front part of the each vertebra consists of a round, solid block of bone called the ____ ____; the back part forms a bony arch.

The vertebrae are connected by ligaments and separated by cushions, called ____ ____.

There are two general types of head injures:

The most common MOI for head injuries:

More than ____-____ of people involved in motor vehicle crashes experience a head injury.

Ecchymosis (bruising) that develops under the eyes due to a skull fracture:

Ecchymosis that develops behind one ear over the mastoid process due to a skull fracture:

Linear skull fractures account for approximately __% of all fractures to the skull

____ skull fractures result from high-energy direct trauma to the head with a blunt object

Skull fracture associated with high-energy trauma, but usually occur following diffuse impact to the head.  These injuries generally result from extension of a linear fracture to the base of the skull and can be difficult to diagnose with radiography.

Signs of a ____ skull fracture include CSF drainage from the ears, raccoon eye, and Battle’s sign.

The National Head Injury Foundation defines a ____ ____ ____ as “a traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes.”

Most serious of all head injuries

Traumatic brain injuries are classified into two broad categories:

____ brain injury results instantaneously from impact to the head.

____ brain injury increases the severity of the primary injury, and may be caused by:
-Cerebral edema
-Intracranial hemorrhage
-Increased intracranial pressure
-Cerebral ischemia
-Infection

The two most common causes of secondary brain injury:

A ____-____ injury can result from striking a windshield in a car crash.  The initial impact injures the front part of the brain.  The head falling back against the headrest then injures the rear part of the brain.

Effects of cerebral edema and increased ICP may be increased systolic blood pressure, decreased pulse rate, and irregular respirations.  This triad of signs is called:

What are the three signs of Cushing's reflex?

An accumulation of blood between the skull and dura mater

An accumulation of blood beneath the dura mater but outside the brain

Involves bleeding within the brain tissue itself

Bleeding occurs into the subarachnoid space, where the CSF circulates

____ are also known as mild TBIs.

A closed injury with a temporary loss or alteration of part or all of the brain’s abilities to function without demonstrable physical damage to the brain.

____ ____ which means he or she can remember everything but the events leading up to the injury.

A ____ on the brain is far more serious than a concussion.

When the spine is pulled along its length, this is called ____, and it can cause injuries.

____ of the spine occurs when the vertebrae are no longer aligned.

The most reliable sign of a head injury.

Hyperventilate your patient via positive-pressure ventilations if the patient shows:

The ideal way to move a patient from the ground to a backboard is the:

If a patient is sitting and if there is time, use a  ____ backboard or other ____ spinal extrication device to immobilize the cervical and thoracic spine.  Then secure the ____ board to the long board.

Immobilize a standing patient to a long backboard will require ____ EMTs.

-Provide preliminary, partial support.
-Should be applied to every patient who has a possible spinal injury based on the MOI, history, or signs and symptoms.

-These devices are designed to stabilize and mobilize the head, neck, and torso.
-Used to immobilize noncritical patients who are found in a sitting position and have possible spinal injuries

These devices provide full body spinal immobilization and motion restriction, and immobilization to the head, neck, torso, pelvis, and extremities.

Removing a helmet should always be at least a ____-person job.

Neck rigidity, bloody CSF, and headache are associated with what kind of bleeding in the brain?

In supine patients with a head injury, the head should be elevated __ degrees to help reduce intracranial pressure.

How many EMTs are required to immobilize a standing patient?

What controls the body's vital organs?
A. somatic nervous system
B. autonomic nervous system
C. the brain
D. sensory nerves

How many vertebrae are in the thoracic region of the spinal cord?

Using the Glasgow Coma Scale, what total score would you give a patient who opens his eyes to your voice, answers all questions correctly, and is able to obey your motor commands?

If you do not have a pediatric backboard, how should you stabilize a child on a regular backboard?

An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is:
A. acute unilateral paralysis following the injury.
B. a progressively lowering blood pressure.
C. an acute increase in the patient's pulse rate.
D. a rapid deterioration of neurologic signs.

Following a head injury, a 20-year-old female opens her eyes spontaneously, is confused, and obeys your commands to move her extremities. You should assign her a GCS score of:

A female patient with a suspected spinal injury is breathing with a marked reduction in tidal volume. The MOST appropriate airway management for her includes:
A. assisting ventilations at an age-appropriate rate.
B. hyperventilating her at 30 breaths/min.
C. ventilation assistance to maintain an oxygen saturation of 90%.
D. administering oxygen via a nonrebreathing mask.

A 45-year-old male was working on his roof when he fell approximately 12′,landing on his feet. He is conscious and alert and complains of an ache in his lower back. He is breathing adequately and has stable vital signs. You should:
A. perform a rapid head-to-toe exam and immobilize his spine.
B. immobilize his spine and perform a focused secondary exam.
C. allow him to refuse transport if his vital signs remain stable.
D. obtain a Glasgow Coma Score value and give him oxygen.

State the Glascow Coma scoring for the eyes:

What are the three components to the Glascow Coma score?

State the Glascow Coma scoring for verbal:

State the Glascow Coma scoring for motor: