Chapter 29A: Head + Spine Trauma

Brainstem

Brain region most protected of the 3 major parts (cerebrum, cerebellum, or brainstem)

Regenerate

Cells in the CNS remain undamaged as they are unable to ___ (like most other cell types)

CSF, 3rd

__ is produced in the __ (1st/2nd/3rd) ventricle and is a primary shock absorber

CSF

Patient reports an unusual salty taste at back of the throat after slip and fall in bathroom with + headstrike. What are they most likely tasting?

Sterile gauze

Do NOT pack a wound/ear/nose draining CSF. Instead cover with __ __ and do not bandage tightly

Peripheral, 31, 12

The __ (central or peripheral) nervous system is divided into __ pairs of spinal nerves and __ pairs of cranial nerves

Plexus

Complex networks of motor nerves that control many muscles in arms and legs

Cranial Nerves

From PNS and innervate head and face with diverse functions - control of sight, smell, taste, hearing, facial expressions

Reflexes

Unconscious, sensory/motor/connecting nerves, arc, no brain involvement

Somatic, autonomic

Voluntary activities are controlled by the __ nervous system and involuntary activities controlled by the __ nervous system

Spinal Canal

Encases and protects the spinal cord

Process, C7

The spinous __ is what is palpated during a secondary assessment of the spine, with most prominent being __

Raccoon Eyes

__ __ or Battle’s signs indicate later signs of a basilar skill fracture

Basilar Skull Fracture

Diffuse high-energy impact, extension of linear fracture to base of skull, CSF drainage, raccoon eyes, and battle signs

Linear Skull Fracture

Nondisplaced fracture of skull, no physical signs

Compressed Skull Fracture

High energy trauma with blunt object, frontal/parietal most susceptible to this fracture (aka depressed)

Open Skull Fracture

Fracture involving opening from the brain usually from penetrating trauma and overlying laceration; high mortality rate

Primary Injury

TBIs that instantly occur

Direct and caused by objects or skull itself

Secondary Injury

TBIs that are result of processes increasing severity indirectly

Caused by cerebral edema, intracranial hemorrhage, infection, hypotension

Can occur within few minutes to several days later

Compression, blood clots

Unequal pupil size may indicate __ of the brain by intracranial pressure, or developing __ __

Cushing’s Reflex

Hypertension, bradycardia, and irregular respirations

Indicate increased intracranial pressure

increase, edema

Cushing’s reflex may be related to a __ (increase/decrease) in ICP or cerebral __

High Flow Oxygen

Treatment method for cerebral edema

Coup-Contrecoup Injury

MVA with front-rear impact may result in head falling back against headrest and brain slamming into rear of skull

Epidural Hematoma

• Blood beneath skull and dura

• From direct blow to temple

• Ruptures meningeal artery

• Lucid interval

• Rapid progression/death quickly

Hematoma type

Subdural Hematoma

• Beneath dura and brain

• Usually strong deceleration

• Rupture veins beneath cortex/dura

• Associated with venous bleeding, gradual progression

• Elderly at risk

Hematoma type

Intracerebral Hematoma

• Within brain tissue

• Small, deep hemorrhages

• High mortality

Hematoma type

Subarachnoid Hematoma

• Bleeding with possibly bloody CSF

• Signs of meningeal irritation

• Can be caused by rupture of aneurism

• S/S include neck rigidity, sudden headache, lapses into seizure

Hematoma type

Concussion

Closed head injury with temporary alteration in brain function without demonstrative physical damage

S/S of conscussion

Possible LOC, amnesia, dizziness, nausea/vomiting, headache, visual changes

Retrograde Amnesia

Remembers all except events leading to an injury

Anterograde Amnesia

Remembers all except events after an injury

Contusions, physical

Head __ are worse than concussions and mean __ injury to brain

possible to cause intracranial pressure

Compression Injury

Pushes on the spine and result of fall to head, feet, coccyx

Distraction Injury

Spine pulled along length; hangings; often fracture C1-3

Subluxation Injuries

Vertebrae no longer aligned; hyperextensions, fractures, dislocations, step offs

30

If suspect serious head injury, another method to decrease ICP is to elevate the head __ degrees

Perfusion (Pulse)

Motor

Sensory

PMS - What is assessed before and after movement and C-spine immobilization

Decreased, Breathing, neurogenic, priapism, incontinence

5 signs of spinal cord trauma
Less innervation of diaphragm and __ chest wall expansion

Abdominal __

Inability to maintain body temp (__ shock)

__ (prolonged involuntary erection 4+ hours)

bowel or bladder __

Backboard, extrication

If patient is in need of spinal immobilization from sitting position: use a short __ or short spinal __ device prior to removing patient from vehicle

Helmet

Contact medical control prior to removing an intact __ from patient’s riding bike or motorcycle and in suspected C-spine injury

Padding voids

Critical step to maintain as much contact with backboard as possible and minimize patient movement with suspected C-spine injury