Head, Neck & Spine Injuries

What are common mechanisms of head injury?

Motor vehicle crashes, falls, assaults, sports injuries, and direct blows.

What is the first priority in a patient with suspected head injury?

ABCs while maintaining cervical spine stabilization when indicated.

Why is level of consciousness important in head injury?

It is an early clue to brain injury severity and a key trend to reassess.

What physical signs suggest a basilar skull fracture?

Battle sign, raccoon eyes, and possible cerebrospinal fluid leakage from the ears or nose.

What is Battle sign?

Bruising behind the ear over the mastoid area.

What are raccoon eyes?

Periorbital bruising around the eyes.

What might clear fluid from the ears or nose suggest after head trauma?

Cerebrospinal fluid leakage from a skull-base fracture.

What pupil finding is concerning in head injury?

Unequal pupils or abnormal pupil reactivity.

Why are seizures concerning after head trauma?

They may indicate significant brain injury and can worsen oxygen demand and secondary injury.

Why is frequent reassessment important in head injury?

Neurologic deterioration may develop gradually over time.

Should direct pressure be applied over an open skull fracture?

No.

What is the main goal of prehospital head-injury management?

Prevent secondary brain injury while treating immediate life threats and transporting appropriately.

Why may head elevation be useful when not contraindicated?

It can promote venous drainage and help reduce intracranial pressure.

What head position does this course recommend for suspected increased ICP?

About 30 degrees of head elevation when not contraindicated.

Why are normal oxygenation and ventilation important in head injury?

Hypoxia and abnormal ventilation can worsen secondary brain injury.

Why should hypotension be avoided in head injury?

Low blood pressure reduces cerebral perfusion and can worsen brain ischemia.

What three categories make up the Glasgow Coma Scale?

Eye opening, verbal response, and motor response.

What is the highest possible GCS score?

15.

What is the lowest possible GCS score?

3.

What does a GCS of 15 indicate?

A fully alert patient with normal eye, verbal, and motor responses.

What is Eye 4 on the GCS?

Eyes open spontaneously.

What is Eye 3 on the GCS?

Eyes open to command or verbal stimulus.

What is Eye 2 on the GCS?

Eyes open to pain.

What is Eye 1 on the GCS?

No eye opening.

What is Verbal 5 on the GCS?

Oriented.

What is Verbal 4 on the GCS?

Confused but coherent conversation.

What is Verbal 3 on the GCS?

Inappropriate or incoherent words.

What is Verbal 2 on the GCS?

Incomprehensible sounds.

What is Verbal 1 on the GCS?

No verbal response.

What is Motor 6 on the GCS?

Follows commands.

What is Motor 5 on the GCS?

Localizes or purposefully moves toward/away from painful stimulus.

What is Motor 4 on the GCS?

Withdraws from pain.

What is Motor 3 on the GCS?

Abnormal flexion, or decorticate posturing.

What is Motor 2 on the GCS?

Abnormal extension, or decerebrate posturing.

What is Motor 1 on the GCS?

No motor response.

Why are serial GCS scores more useful than one score?

A trend shows neurologic improvement or deterioration over time.

What factors can interfere with accurate GCS scoring?

Language barriers, hearing loss, preexisting neurologic deficits, intoxication, sedation, intubation, or other injuries.

What is the GCS-P?

A modified GCS that subtracts a pupil reactivity score from the standard GCS.

What pupil score is subtracted if both pupils react normally in GCS-P?

0.

What pupil score is subtracted if one pupil is nonreactive in GCS-P?

1.

What pupil score is subtracted if neither pupil reacts in GCS-P?

2.

What is a closed brain injury?

Brain injury without an open skull breach, often from rapid acceleration, deceleration, or shaking.

What is an open or penetrating brain injury?

Brain injury with a break in the skull allowing penetration into the cranial contents.

Why can closed brain injuries be severe?

Swelling and bleeding occur inside a rigid skull with limited room for expansion.

What is a concussion?

A mild traumatic brain injury causing temporary brain dysfunction.

Does a concussion require loss of consciousness?

No. Most concussions occur without loss of consciousness.

What symptoms can occur with concussion?

Headache, confusion, memory problems, nausea, dizziness, light sensitivity, blurred vision, and concentration difficulty.

What is diffuse axonal injury?

Stretching or tearing of axons from rapid acceleration, deceleration, or rotational forces.

What is a brain contusion?

A bruise of brain tissue.

What is an epidural hemorrhage?

Bleeding between the skull and dura mater.

What clinical pattern is classically associated with epidural hemorrhage?

A lucid interval followed by rapid neurologic deterioration.

What is a subdural hemorrhage?

Bleeding beneath the dura, often with slower symptom development.

What is a subarachnoid hemorrhage?

Bleeding into the space surrounding the brain beneath the arachnoid layer.

What is second-impact syndrome?

A potentially fatal brain-swelling syndrome after a second concussion occurs before the first has healed.

What is post-concussive syndrome?

Persistent concussion-related symptoms lasting weeks or months.

What is intracranial pressure?

Pressure inside the skull from brain tissue, blood, and cerebrospinal fluid.

What is Cushing triad?

Hypertension, bradycardia, and irregular respirations.

What does Cushing triad suggest?

Dangerously increased intracranial pressure and possible impending herniation.

What other signs may suggest increasing intracranial pressure?

Declining consciousness, changing pupils, repeated vomiting, and abnormal posturing.

What is decorticate posturing?

Abnormal flexion of the arms toward the body, indicating severe brain injury.

What is decerebrate posturing?

Abnormal extension of the arms, indicating severe brain injury.

Which posturing pattern is generally considered more severe?

Decerebrate posturing.

Why is repeated vomiting concerning after head injury?

It can accompany increased intracranial pressure or significant brain injury.

What should worsening mental status after head injury trigger?

Higher transport priority, rapid reassessment, and consideration of airway support.

Why can alcohol or drugs complicate head-injury assessment?

They can mimic or mask altered mental status and neurologic findings.

Why are patients on anticoagulants high risk after head injury?

They have increased risk of intracranial bleeding even after minor trauma.

Why are elderly patients high risk after minor head trauma?

Age-related brain atrophy and fragile vessels increase bleeding risk and symptoms may be subtle.

Why can children deteriorate suddenly after head injury?

They may compensate physiologically until late in the injury process.

Why do facial injuries often bleed heavily?

The face has an extensive blood supply.

What is a Le Fort I fracture?

A horizontal fracture pattern through the lower maxilla above the teeth.

What is a Le Fort II fracture?

A pyramidal midface fracture pattern involving the nose and maxilla.

What is a Le Fort III fracture?

A severe craniofacial separation in which the face is separated from the skull.

What finding may suggest a Le Fort fracture?

Mobile midface structures or mobile teeth.

What finding commonly suggests mandibular fracture?

Malocclusion or teeth that no longer line up normally.

Why can mandibular fractures threaten the airway?

Bleeding and swelling in the floor of the mouth can obstruct the airway.

What are the main skull-fracture categories emphasized?

Linear, depressed, and basilar fractures.

What is a linear skull fracture?

A simple crack through the skull bone.

What is a depressed skull fracture?

A fracture in which bone fragments are displaced inward toward brain tissue.

What is a basilar skull fracture?

A fracture involving the base of the skull.

Can serious brain injury occur without a visible skull fracture?

Yes.

What airway threats are common with facial trauma?

Blood, teeth, bone fragments, swelling, and distorted anatomy.

Why is suction especially important in facial trauma?

Blood and debris can rapidly obstruct the airway.

What should be done with avulsed teeth?

Preserve them in an appropriate solution and transport them with the patient.

What should be monitored in facial trauma besides bleeding?

Vision, sensation, facial movement, mental status, and airway status.

What is a key transport consideration in severe facial trauma?

Choose a facility capable of managing complex facial and airway injuries when appropriate.

How many vertebrae are in the spinal column?

33.

How many cervical vertebrae are there?

7.

How many thoracic vertebrae are there?

12.

How many lumbar vertebrae are there?

5.

How many sacral vertebrae are there?

5 fused vertebrae.

How many coccygeal vertebrae are there?

4 fused vertebrae.

What structures allow movement between vertebrae?

Facet joints and intervertebral discs.

What is the function of an intervertebral disc?

It acts as a shock absorber between vertebrae.

What does the spinal cord do?

Carries motor and sensory information between the brain and the body.

How many pairs of spinal nerves are there?

31 pairs.

What is a dermatome?

An area of skin supplied primarily by a specific spinal nerve.

What is a complete spinal cord injury?

Loss of motor and sensory function below the injury level, including sacral segments.

What is tetraplegia/quadriplegia?

Partial or total loss of function in all four limbs from cervical spinal cord injury.

Why can high cervical spinal cord injury impair breathing?

It may affect nerve supply to the diaphragm and respiratory muscles.

What mechanisms suggest possible spinal injury?

Falls from height, diving injuries, high-speed crashes, major blunt trauma, and selected penetrating trauma.