Head and Spine Trauma Flashcards Preview

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Flashcards in Head and Spine Trauma Deck (103):
1

Layers of Scalp

Hair and skin
Sub Q tissue
Galea Aponeurotica: tendon expansion
Loose connective tissue
Periosteum: covers surface of bone

2

Auditory Ossicles

Function in hearing. Located three on each side of the head deep within the cavities of the temporal bone

3

Cranial Vault

Eight bones that encase and protect the brain:
Parietal, temporal, frontal, occipital, sphenoid, ethmoid bones

4

Formane Magnum

Brain connects to the spinal cord through a large opening at the base of the skull

5

Sutures

How the skull bones are connected

6

Fontanelles

Soft in infants and link the sutures together

7

Mastoid Process

Base of each temporal bone and is cone shaped

8

Crista Galli

Prominent bony ridge in the center of the anterior fossa and is point of attachment for meninges

9

Ciribriform Plate

Surrounds Crista Galli with numerous openings allowing the passage of olfactory Nerve filaments from nasal cavity

10

Olfactory Nerves

Cranial Nerves for smell, send projections through the foramina in the ciribriform plate and into nasal cavity

11

Zygomatic Arch

Bone that extends along the front of the skull below the orbit

12

Brain

Occupies 80% of cranial vault and contains billions of neurons

13

Major regions

Cerebellum, diencephelon, brainstem, and cerebellum

14

Brain cont

See neurological emergencies

15

Frontal Lobe

Voluntary motor actions and emotion

16

Parietal Lobe

Somatic or voluntary sensory and motor functions, memory and emotions

17

Occipital

Optic Nerve originates, responsible for visual information.
Injury to the back of the head mya see stars because the optic Nerve banged against the back of the skull

18

Temporal Lobe

Speech center

19

Limbic System

Influences motivation, emotions, motivation, mood, and sensations of pain and pleasure

20

Meninges

Protective layer that surround and enfold the entire CNS

21

Dura Mater

Outside Strong, fibrous layer wrapping brain

22

Arachnoid

Second layer, delicate transparent membrane

23

Pai Mater

Third Layer, translucent highly vascular membrane

24

CSF

Manufactured in the ventricles of the brain

25

Subarachnoid Space

CSF flows in this space. Located between the pia and arachnoid matters.

26

CSF Manufactured

Manufactured by cells within the choroid plexus in the ventricles, hollow storage areas in the brain

27

Vertebral Body

Anterior weight bearing structure is made of bone that provides support and stability

28

Components of Vertebrae

Spinous Process, Pericles, lamina

29

Pedicle

Inside of spinous process

30

Lamina

Groove of branch of spinous process

31

Spinal Nerves

31 pairs of spinal nerves

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Facial and Trigeminal Nerve

Control facial feeling and function

33

MOI suggest Spinal Injury

Greater than 40mph crash
Unrestrained occupant
12 inch intrusion to vehicle
Fall from three times height

34

Coup contra coup

Brain hits front of head then hits back of the head after stopping forces applied

35

Cerebral Perfusion Pressure

At least 60mmHg to perfuse the brain

36

Hypertensive Head Injury

Do not give fluids

37

Hypotension head injury

20ml/kg to sustain a BP of at least 110-120 with a TBI and a GCS less than 9

38

Lower Cervical or Upper Thoracic Injury

Could leave patient breathing with accessory muscles and cause intercostal paralysis

39

C3-C5 injury

Innervated by the phrenic Nerve and may stop breathing or result to abdominal breathing

40

Contraindications to NPA

Basillar skull fractures or facial trauma

41

Consider RSI if...

Patient is awake with an impaired airway or has a detoriorating GCS < 8

42

RSI with ICP

Preoxygenate
Lidocaine bolus (temporarily decreases ICP) 1-1.5mg/kg bolus
2 man intubate stabilized head

43

ICP patient breathing adequately

Give 100% oxygen via NRB

44

ICP Grades

Mild: pupils reactive, increased BP, Cheyenne stokes resp, headache, vomiting
Moderate: widened pulse pressure, pupils sluggish, bradycardia, kussmaul resp, decelerate Posturing
Severe: irregular bradycardia pulse, widened BP, biot respirations, blown pupils unilaterally

45

Blown Pupils

Pressure present around eyes

46

Myotomes

Motor components of spinal Nerves in rebate discrete tissues and muscles of the body
C3-C5 diaphragm
C5 elbow flexor biceps, brachioradialis
C6 wrist extensions
C7 triceps
C8 finger flexor
T2-T7 intercostal
L2 hip flexor
L3 knee extension
L4 ankle extension
L5 big toes extension
S1 plantar flexor
S4-5 anus, Bowel, bladder

47

Babinski Reflex

Hen toes move upward in response to stimulation of the sole of the foot. Normal circumstances, toes move downward

48

Linear Skull Fracture

80% of all fractures
-usually in temporal and parietal region
-risk of infection with laceration and fracture

49

Depressed Skull Fracture

High energy direct trauma to smalls surface area of head
-frontal and parietal most succeptible
-bony fragments may displace, causing more injury

50

Basilar Skull Fracture

CSF drainage, raccoon eyes, and battle signs
May show up 24 hours after injury

51

Open Skull Fracture

Tissue may be exposed

52

TBI

Traumatic Brain Injury
-classified into primary and secondary
Primary: injury instantaneously from Impact
Secondary: after injuries such as edema, ICP, cerebral ischemia

53

ICP

Blood or CSF, Edema accumulating inside cranial vault
Normal ICP Ranges : 0-15mmHg
Cerebral Perfusion Pressure=MAP-ICP

54

Critical Minimum Threshold

Minimum CPP to adequately perfuse brain is 60mmHg in adults
Less will lead to cerebral ischemia

55

Autoregulation

When body responds to a decrease in CPP by increasing the MAP, resulting in cerebral dialate on and increased cerebral blood flow.

56

Herniation

Brain is forced through the foramen magnum or the tentorium

57

Uncal Herniation

When temporal lobe is displaced resulting in compression of cranial Nerve 3, the midbrain, and posterior cerebral artery (decelerate)

58

Tonsillar Herniation

When cerebellum is displaced through foramen magnum
(Decorticate)

59

Cushing Triad

Hypertension( widening pulse pressure )
Bradycardia
Irregular Respirations
and Blown Pupils

60

Diffuse Brain Injury

Injury that affects entire brain

61

Cerebral Concussion

When Brain is jarred around in cranial vault

62

Retrograde Amnesia

Loss of memory of events before injury

63

Anterograde Amnesia

Loss of memory of events after injury

64

Diffuse Axonal Injury DAI

Similar to concussion
-involves stretching, shearing or tearing of nerve fibers with axonal damage
-from high speed collision forces

65

Focal Brain Injury

Observable brain injury on CT scan

66

Cerebral Contusion

Brain tissue bruised or damaged in a local area
-commonly frontal lobe and caused just like concussion with coup counter coup injuries

67

Epidural Hematoma

Accumulation of blood between skull and dura mater
-from blow to head and produces linear fracture of thin temporal bone
-brisk arterial bleeding common
-LOC from injury, wakes up, then passes back out

68

Subdural Hematoma

Accumulation of blood beneath dura matter but outsid of brain
-associated with skull fracture
-associated with venous bleeding, typically takes more time to develop Signs and symptoms
-slurred speech and fluctuation of symptoms

69

Intracerebral Hematoma

Bleeding within brain tissue
-once symptoms present, patient declines quickly
-high mortality rate

70

Subarachnoid Hematoma

Subarachnoid space where CSF is bleeding occurs
-common from aneurysm or atriovenous malformation
-sudden severe headache
-signs of ICP as it progresses
-survival usually means permanent damage

71

Subgaleal Hemorrhage

Bleeding between peritoneum of skull and galea aponeurosis
-body mass that is palpated And able to move around skull

72

Thermal Management

Do not allow patient to be overheated
-patients with head injury can develop high temperatures (hyperpyrexia)
-do not cover with blankets if room temp is 70F

73

Brain Tissue exposes

Cover moist sterile dressings

74

Reduce ICP

Lasix, osmitrol
-seizures must be immediately controlled because they further increase ICP

75

Scalp Lacerations

More serious in children and can cause hypovolemia

76

SCI

Spinal Cord Injuries
Most devastation but only limited care prehospital

77

FlexioN Injuries

Forward movement of neck
-can involve C1-2
-can result in anterior wedge fractures
-injuries to ligaments around spinal column

78

Partial Dislocation of spinal Coumn

Subluxation

79

Rotation with Flexion

Can produce stable dislocation of spine
-typically cause Fracture rather than dislocation

80

Vertical Compression

Forces transmitted up spine through feet or head vertically comprssing the spine
-can cause Herniation of disks

81

Hyperextension

Fractures of ligamentous injuries
-hangmans fracture: C2 results from hyperextension from rapid deceleration
-

82

Primary SCI

Injury at moment of impact

83

Spinal Cord Concussion

Temporary dysfunction that lasts 24-48 hours

84

Secondary SCI

edema, blood resulting after injury cause injury

85

Complete SCI

Complete disruption of spinal cord with permananet loss of all cord mediated functions beneath injury
-high thoracic injury results in paraplegia

86

Incomplete SCI

Retains some Cord mediated function

87

Anterior Cord Syndrome

Displacement of bony fragments into anterior portion of spinal cord due to flexion injuries or fractures
-disruption in flow in anterior spinal artery
-paralysis below injury with loss of sensation to touch, temperature and pain

88

Central Cord Syndrome

Hyperextension injuries to cervical area present with edema or blood to cervical areas
-risk with cervical spondylosis and arthritic changes in elderly
-motor and efferent fibers disturbed
- loss in upper extremities than lower
-many have good outcomes

89

Posterior Cord Syndrome

Extension injuries
-dorsal columns effected presenting as decreased sensation to light touch, proprioception, and vibration

90

Cauda Equina Syndrome

Compression of bundle of Nerve roots that resembles horses tail at the end of the spinal column
-lower back pain, paresthesia, acute bladder or Bowel dysfunction

91

Brown-Sequard Syndrome

Penetrating trauma and depicts functional hemisection of the cord and complete damage to all spinal tracts on involved side

92

Spinal shock

Refers to temporary local neurogenic condition that occurs immediately after spinal trauma
Swelling of the cord

93

Neurogenic Shock

Temporary loss of autonomic function
-hypotension, blood pools, decreased cardiac output
-warm skin, Hypotensive, bradycardia

94

C Spine

Hold head and jaw with fingers

95

Unnatural Head Position

If head is crooked and presents with pain or abnormality, splint and do not move or attempt to realign

96

Supine

Decrease chances of cord hypoxia

97

KED

Hold c spine, secure torso and hips then head last with void padding

98

Rapid Extrication

Hold c spine and operate in one full motion as best as possible quickly

99

Stnding

Hold c spine with collar and lower to the ground in neutral position

100

Helmets removal

Remove if chin strap and helmet fail to hold head properly
Prevents immobilization for transport
Can not be removed after attempts
Prevent adequate airway control

101

Water Board

Completely board and strap patient in water before moving to land

102

Strain

Tear

103

Sprain

Pulled muscle