Chapter 26 Head and Spine Injuries

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hiker0001
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271901
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Chapter 26 Head and Spine Injuries
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2014-04-25 19:43:38
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head spine injuries
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Chapter 26 Head and Spine Injuries
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Chapter 26 Head and Spine Injuries
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  1. The nervous system is divided into two anatomic parts:
    • Central nervous system
    • Peripheral nervous system
  2. The brain is divided into three major areas:
    • Cerebrum
    • Cerebellum
    • Brain stem
  3. The cerebrum controls a wide variety of activities, including (two things):
    • most voluntary motor function
    • conscious thought
  4. The cerebrum contains about __% of the brain’s total volume and is divided into ____ hemispheres with ____ lobes.
    • 75
    • two
    • four
  5. The cerebellum coordinates (two things):
    • balance
    • body movements
  6. The brain stem controls most functions necessary for life, including the ____ and  ____ systems and nerve function transmissions.
    • cardiac
    • respiratory
  7. Gray matter in the spinal cord is composed of (two things):
    • neural cell bodies
    • synapses
  8. White matter in the spinal cord consists of:
    fiber pathways.
  9. 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.
    meninges
  10. The outer layer of the meninges, the ____ ____, is a tough, fibrous layer that forms a sac to contain the CNS.
    dura mater
  11. The inner two layers of the meninges, called the ____ and the ____ mater, contain the blood vessels that nourish the brain and spinal cord.
    • arachnoid
    • pia
  12. Cerebral spinal fluid (CSF) is produced in a chamber inside the brain, called the:
    third ventricle.
  13. There is approximately ____ to ____ mL of CSF in the brain at one time.
    125 to 150
  14. CSF primarily acts as a:
    shock absorber.
  15. __ pairs of spinal nerves
    31
  16. __ pairs of cranial nerves
    12
  17. There are two major types of peripheral nerves:
    • Sensory nerve
    • Motor nerves
  18. The ____ nerves are found only in the brain and spinal cord.
    connecting
  19. 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.
    reflex arc
  20. The ____ (voluntary) nervous system handles voluntary activities.
    somatic
  21. The ____ (involuntary) nervous system handles the body functions that occur without conscious effort.
    autonomic
  22. The autonomic nervous system is divided into two parts:
    • sympathetic
    • parasympathetic
  23. When confronted with a threatening situation, the ____ nervous system reacts to the stress with a fight-or-flight response.
    sympathetic
  24. The cranium is occupied by __% brain tissue, __% blood supply, and __% CSF.
    • 80
    • 10
    • 10
  25. The face is composed of __ bones.
    14
  26. The orbit (eye socket) is made up of two facial bones:
    • maxilla
    • zygoma
  27. The spinal column has __ bones, called vertebrae, and is divided into five sections:
    • 33
    • Cervical
    • Thoracic
    • Lumbar
    • Sacral
    • Coccygeal
  28. The front part of the each vertebra consists of a round, solid block of bone called the ____ ____; the back part forms a bony arch.
    vertebral body
  29. The vertebrae are connected by ligaments and separated by cushions, called ____ ____.
    intervertebral disks
  30. There are two general types of head injures:
    • closed head injuries
    • open head injuries
  31. The most common MOI for head injuries:
    Motor vehicle crashes
  32. More than ____-____ of people involved in motor vehicle crashes experience a head injury.
    two-thirds
  33. Ecchymosis (bruising) that develops under the eyes due to a skull fracture:
    raccoon eyes
  34. Ecchymosis that develops behind one ear over the mastoid process due to a skull fracture:
    Battle’s sign
  35. Linear skull fractures account for approximately __% of all fractures to the skull
    80
  36. ____ skull fractures result from high-energy direct trauma to the head with a blunt object
    Compressed
  37. 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.
    Basilar
  38. Signs of a ____ skull fracture include CSF drainage from the ears, raccoon eye, and Battle’s sign.
    basilar
  39. The National Head Injury Foundation defines a ____ ____ ____ as “a traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes.”
    Traumatic brain injury (TBI)
  40. Most serious of all head injuries
    traumatic brain injury
  41. Traumatic brain injuries are classified into two broad categories:
    • primary (direct) injury
    • secondary (indirect) injury
  42. ____ brain injury results instantaneously from impact to the head.
    Primary
  43. ____ brain injury increases the severity of the primary injury, and may be caused by:
    -Cerebral edema
    -Intracranial hemorrhage
    -Increased intracranial pressure
    -Cerebral ischemia
    -Infection
    Secondary
  44. The two most common causes of secondary brain injury:
    • Hypoxia
    • Hypotension
  45. 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.
    coup-countercoup
  46. 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:
    Cushing’s reflex.
  47. What are the three signs of Cushing's reflex?
    • increased systolic blood pressure
    • decreased pulse rate
    • irregular respirations
  48. An accumulation of blood between the skull and dura mater
    Epidural hematoma
  49. An accumulation of blood beneath the dura mater but outside the brain
    Subdural hematoma
  50. Involves bleeding within the brain tissue itself
    Intracerebral hematoma
  51. Bleeding occurs into the subarachnoid space, where the CSF circulates
    Subarachnoid hemorrhage
  52. ____ are also known as mild TBIs.
    Concussions
  53. 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.
    concussion
  54. ____ ____ which means he or she can remember everything but the events leading up to the injury.
    Retrograde amnesia
  55. A ____ on the brain is far more serious than a concussion.
    contusion
  56. When the spine is pulled along its length, this is called ____, and it can cause injuries.
    distraction
  57. ____ of the spine occurs when the vertebrae are no longer aligned.
    Subluxation
  58. The most reliable sign of a head injury.
    decreased level of consciousness
  59. Hyperventilate your patient via positive-pressure ventilations if the patient shows:
    Cushing's triad
  60. The ideal way to move a patient from the ground to a backboard is the:
    four-person log roll.
  61. 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.
    short
  62. Immobilize a standing patient to a long backboard will require ____ EMTs.
    three
  63. -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.
    Cervical collars
  64. -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
    Short backboards
  65. These devices provide full body spinal immobilization and motion restriction, and immobilization to the head, neck, torso, pelvis, and extremities.
    Long backboards
  66. Removing a helmet should always be at least a ____-person job.
    two
  67. Neck rigidity, bloody CSF, and headache are associated with what kind of bleeding in the brain?
    subarachnoid hemorrhage
  68. In supine patients with a head injury, the head should be elevated __ degrees to help reduce intracranial pressure.
    30
  69. How many EMTs are required to immobilize a standing patient?
    three
  70. What controls the body's vital organs?
    A. somatic nervous system
    B. the brain
    C. sensory nerves
    D. autonomic nervous system
    D. autonomic nervous system
    (this multiple choice question has been scrambled)
  71. How many vertebrae are in the thoracic region of the spinal cord?
    12
  72. 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?
    14
  73. If you do not have a pediatric backboard, how should you stabilize a child on a regular backboard?
    Pad the shoulders
  74. 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.
    D. a rapid deterioration of neurologic signs.
    (this multiple choice question has been scrambled)
  75. 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:
    14
  76. 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. administering oxygen via a nonrebreathing mask.
    B. ventilation assistance to maintain an oxygen saturation of 90%.
    C. assisting ventilations at an age-appropriate rate.
    D. hyperventilating her at 30 breaths/min.
    C. assisting ventilations at an age-appropriate rate.
    (this multiple choice question has been scrambled)
  77. 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.
    B. immobilize his spine and perform a focused secondary exam.
    (this multiple choice question has been scrambled)
  78. State the Glascow Coma scoring for the eyes:
    • 1 - Does not open eyes
    • 2 - Opens eyes in response to painful stimuli
    • 3 - Opens eyes in response to voice
    • 4 - Opens eyes spontaneously
  79. What are the three components to the Glascow Coma score?
    • eyes
    • verbal
    • motor
  80. State the Glascow Coma scoring for verbal:
    • 1 - Makes no sounds
    • 2 - Incomprehensible sounds
    • 3 - Utters inappropriate words
    • 4 - Confused, disoriented
    • 5 - Oriented, converses normally
  81. State the Glascow Coma scoring for motor:
    • 1 - Makes no movements
    • 2 - Extension to painful stimuli (decerebrate response)
    • 3 - Abnormal flexion to painful stimuli (decorticate response)
    • 4 - Flexion / Withdrawal to painful stimuli
    • 5 - Localizes painful stimuli
    • 6 - Obeys commands

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