emt 33

Peripheral nervous system

nerves that pass through the brain/spinal cord

Nervous system role

overall control of thought, sensation, and motor function 

Neurons

nerve cells that transit nervous system impulses

Motor nerves

control voluntary movement, as they run down the brain they cross to opposite sides of the body (contralateral control)

autonomic nervous system

involuntary control

Cranium

portion of the skull that encloses the brain: frontal regions = forehead; partial bones = right/left superior skull; temporal bones = right/left inferior skull; occipital bones = posterior skull

Sutures

immovable joints (fuses cranial bones together except)

Mandible joint

the mandible attaches to the temporal bones to form the TMJ

Upper jaw

2 fused bones (maxillae) each called maxilla, upper 3rd contains 2 nasal bones

Malar

aka checkbone/zygomatic bone meets the maxillae to form orbits

foramen magnum

large hole where the spinal cord meets the brain

Spinal cords protective layers

meninges, tough membranes that also protect the brain/posterior cranium; 33 vertebrae stacked on top one another, linked w ligaments and back muscle; CSF, filled inside vertebrae holes 

Vertebrae breakdown

7 cervical (neck), 12 thoracic (ribs), 5 lumbar (mid-back), 5 sacral (lower back), 4 coccygeal (tailbone)

Spinous process

a bony bump along the center of each vertebra

Scalp injuries care

apply direct pressure/bandage, UNLESS there is a skull injury (visible bone fragments, depression of bone, or exposed brain—use loose gauze dressing and NO pressure) 

Opened v closed head injury

opened: fractured cranium bones, closed: lacerated scalp w cranium bones intact, if unsure always assume its open

Direct v indirect brain injury

direct: opened head injuries when the brain is lacerated/punctured via foreign object, indirect: when shock from impact hits the brain (opened or closed)

Traumatic brain injury TBI

injury that disrupts normal brain function (can be brief or long-term) 

Concussion

mild closed head injury caused by blunt force, no obvious brain damage

Concussion symptoms

loss of consciousness, amnesia, repetitive questioning (feeling “groggy”, headache staring into space)

Contusion

bruised brain, when blunt force ruptures blood vessels, brain hits inside of the skull and bounces side-to-side

2 types of contusions

coup: contusions on the side of the blow contrecoup: contusions on the opposite side of the blow

Hematoma

collection of blood within the skull/brain named according to its location (subdural, epidural, intracerebral) 

Dura

brains protective outer covering

Subdural hematoma

collection of blood between the brain and dura

Epidural hematoma

collection of blood between the dura and skull

Intracerebral hematoma

blood pooling within the brain

Intracranial pressure ICP

pressure inside the skull, increases with hematomas since the skull cannot expand

Increasing ICP–brain

brain tissue compression, decreased mental status, unilateral weakness, pressure/damage on brain, reduced blood flow/perfusion to brain, CO + swelling increase, symptoms are delayed

Cushing reflex

slowed heart rate and hypertension, biggest increased ICP sign, compensates hypoperfusion

Increasing ICP–brain stem

brain is pushed towards foramen magnum putting pressure on brain stem, causes dilated/sluggish pupils, increased systolic, decreased pulse rate

Brain stem functions

breathing, heartbeat, blood pressure

Cheyne-Stokes breathing

quickening and deepening of breathing followed by apnea (ICP sign)

Central neurogenic hyperventilation

a pattern of rapid/deep breathing caused by brainstem injury

Ataxic respirations

irregular and unpredictable breathing, commonly caused by brain injury

Herniation

compression and pushing downward of the brain and brainstem, may cause decorticate/decerebrate posturing

Decorticate posturing

extension of the arms with the shoulders rotated inwards, wrists flexed, and legs extended (flexation)

Decerebrate posturing

arms are extended at the sides, forearms are turned down, wrists are flexed, legs are extended

(extension)

Glasgow Coma Scale (GCS)

used for neurologic assessment, immediate transport to a trauma system if less than 14, calculated en route

GCS eye opening

spontaneous = 4

to voice = 3

to pain = 2

none = 1

GCS verbal response

oriented = 5

confused = 4

inappropriate words = 3

incomprehensible sounds = 2

none = 1

GCS motor response

obeys command = 6

localizes pain = 5

withdraws after pain stimulation = 4

flexion after pain stimulation = 3

extension after pain stimulation = 2

none = 1

Cranial impalements

cut short (hand hacksaw/fine-tooth blade), pad with bulky dressing, stabilize

Facial/jaw fracture

usually caused by impact, injured/dislocated mandible = inability to move lower jaw + difficulty speaking, airway concerns, use jaw thrust if needed

Large vein pressure

lower than atmospheric pressure, aid may be sucked into the vessel and create an air embolism

Air embolism

bubble of air in the bloodstream, can be carried to the lungs (pulmonary air embolism) and mess with circulation and gas exchange

Primary injuries

spinal cord injuries that occurred immediately and as a result of direct force, do not heal well, may cause paralysis

Secondary injuries

spinal cord injuries that occur after the initial insult but can cause the same/even more harm (causes = hypoxia, shock, spinal cord edema, and hypoglycemia)

Identifying spinal injuries

use MOI to build suspicion and confirm it through your physical assessment

Most common spine injury MOI

energy that forces movement of the spine beyond its normal range of motion, flexion/extension injuries are also common

Flexion spinal injury

neck is extended/flexed beyond its normal range of motion (ex, whiplash)

most/least protected vertebrae

least: lumbar and cervical spine (not supported by bone structures) most: thoracic and pelvic-sacral

Osteoporosis

disease that causes bones to become brittle and weak, can cause spine injury in geriatrics

High risk spinal MOI

3ft+ falls/more than 5 stairs, axial loading injury (compression), high speed MV crashes (esp roll over/ejection), bike crashes

Dermatome

an area of the skin that is controlled by only one spinal nerve

Indications of spinal injury (conscious patient

extremity paralysis (most reliable sign),

changes in brain function, loss of sense/motor func or unusual sensations, pain with movement (esp neck/back pain w voluntary movement), priapism, loss of bowel/bladder control, spinal deformity (gap between spinous process of the vertebrae), neurogenic shock

Neurogenic shock

hypoperfusion caused by nerve paralysis, may cause spinal injury

Pediatric spinal injury

soft vertebrae in the neck is less prone to fracture so significant spinal cord injury can be made without the external findings

Basic care for all spinal injuries

oxygen and ventilation, treat severe bleeding, monitor sugar levels

Spinal motation restriction

limiting movement of the spine to prevent additional injury, spine is positioned in inline, neutral, anatomic position

Manual stabilization

keeping head in neutral position to restrict movement, do NOT return to neutral position if the patient complains of pain/the head is not easily moved, stabilize until patient is secured to a backboard

Rigid spine board

used for transport until swapped w a stretcher, may cause discomfort, reassess pms before + after placement 

Scoop stretcher

best when spinal patients must be lifted from the floor to a stretcher, reassess pms before + after placement

Vacuum mattress

hollow bags that allow air to be pumped out of them for rigidity, conforms patient to anatomic position while in backboard form + comfier, may lose leak/lose rigidity, warmer but rob heat from the patient, reassess pms before + after placement 

Seated patient spinal restriction

secure torso first and head last; ensures greater stability during strapping, can help prevent cervical spine compression

Standing patient spinal restriction

apply c-spine and have them carefully sit down onto a stretcher, guide them into supine or semi-sitting position of comfort

When not to remove a helmet

fits strongly and allows little head movement, no impending airway/breathing issues, removal may cause further injury

When to remove a helmet

interferes with airway/breathing management, improperly fitted/too loose, cardiac arrest