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Chapter 34
Trauma: Head and Spine Trauma
100
Medical
Not Applicable
10/24/2016
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Term
Cerebrospinal fluid is manufactured in the __________ of the brain and serves to ______________.
 Definition
ventricles, cushion and protect the brain
Term
Upon arriving at the scene of a motor vehicle crash, you find the driver of the car still seated in her two-door vehicle. The passenger side of the vehicle has sustained severe damage and is inaccessible. The driver is conscious and alert and complains only of lower back pain. The backseat passenger, a young child who was unrestrained, is bleeding from the head and appears to be unconscious. You should:
 Definition
rapidly extricate the driver so you can gain quick access to the child in the backseat.
Term
A 39-year-old man crashed his vehicle into a wooded area and was not found for approximately 8 hours. When you arrive at the scene and assess him, you note that he is conscious but anxious. He is unable to feel or move below his mid-thoracic area and complains of a severe headache. His blood pressure is 210/130 mm Hg, heart rate is 44 beats/min, and respirations are 22 breaths/min. This patient's clinical presentation is MOST consistent with:
 Definition
autonomic dysreflexia
Term
Cerebrospinal fluid drainage from the ears is MOST indicative of:
 Definition
a skull fracture
Term
Death following a head injury is MOST often the result of:
 Definition
trauma to the brain
Term
Most head injuries are the result of:
 Definition
motor vehicle crashes
Term
Which of the following statements regarding a closed head injury is correct?
 Definition
In a closed head injury, the dura mater remains intact.
Term
Bleeding from a scalp laceration with an underlying skull deformity:
 Definition
may contribute to hypovolemia in adults.
Term
Which of the following types of skull fracture would be the LEAST likely to present with gross physical signs?
 Definition
linear fracture
Term
A scalp laceration that occurs in conjunction with a nondisplaced skull fracture:
 Definition
is considered to be an open skull fracture.
Term
What type of skull fracture is MOST common following high-energy direct trauma to a small surface area of the head with a blunt object?
 Definition
depressed fracture
Term
Which of the following signs of a basilar skull fracture would MOST likely be observed in the prehospital setting?
 Definition
cerebrospinal fluid drainage from the ear
Term
The brain connects to the spinal cord through a large opening at the base of the skull called the:
 Definition
foramen magnum
Term
Open fractures of the cranial vault:
 Definition
are associated with a high risk of bacterial meningitis.
Term
Secondary brain injuries include all of the following, EXCEPT:
 Definition
axonal injury
Term
When an unrestrained passenger's head strikes the windshield of a motor vehicle following rapid deceleration:
 Definition
compression injuries occur to the anterior portion of the brain, and stretching or tearing injuries occur to the posterior portion of the brain.
Term
Following a traumatic brain injury, initial swelling of the brain occurs due to:
 Definition
cerebral vasodilation
Term
Autoregulation is defined as:
 Definition
an increase in mean arterial pressure to maintain cerebral blood flow.
Term
Prehospital treatment of the patient with a traumatic brain injury must focus primarily on:
 Definition
maintaining cerebral perfusion pressure.
Term
Early signs and symptoms of increased intracranial pressure include:
 Definition
headache and vomiting.
Term
Which of the following statements regarding a cerebral concussion is correct?
 Definition
Concussions are usually not associated with structural brain injury.
Term
A diffuse axonal injury:
 Definition
involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body.
Term
Unlike a cerebral concussion, a cerebral contusion is:
 Definition
associated with physical brain damage and more pronounced neurologic deficits.
Term
At what age do the sutures of the skull solidify and the fontanelles close?
 Definition
18 months
Term
A moderate diffuse axonal injury:
 Definition
produces an immediate loss of consciousness and residual neurologic deficits when the patient wakes up.
Term
Common clinical findings associated with a subdural hematoma include all of the following, EXCEPT:
 Definition
rapidly increasing intracranial pressure
Term
A subdural hematoma is classified as acute if clinical signs and symptoms develop:
 Definition
within 24 hours following the injury.
Term
Chronic subdural hematomas are MOST commonly seen in patients who:
 Definition
have alcoholism
Term
What type of intracranial hemorrhage would MOST likely be caused by a penetrating head injury?
 Definition
Intracerebral hematoma
Term
When assessing the severity of a traumatic brain injury, the MOST important assessment parameter is the patient's:
 Definition
level of consciousness
Term
Pupils that are slow (sluggish) to react to light:
 Definition
are a sign of cerebral hypoxia.
Term
A 19-year-old woman fell from a second story window and landed on her head. She is unconscious with a blood pressure of 148/94 mm Hg, heart rate of 58 beats/min, and irregular respirations of 8 breaths/min. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the MOST appropriate treatment for this patient involves:
 Definition
intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments.
Term
The MOST effective method for decreasing morbidity and mortality associated with spinal cord injury is:
 Definition
public education and prevention strategies.
Term
According to the National Spinal Cord Injury Database, MOST spinal cord injuries are caused by:
 Definition
motor vehicle crashes
Term
The cone-shaped section of bone located at the base of each temporal bone is called the:
 Definition
mastoid process.
Term
The LEAST common cause of death in spinal cord injury patients who are discharged from the hospital is:
 Definition
muscular atrophy.
Term
The spine:
 Definition
is the major structural component of the axial skeleton.
Term
The anterior weight-bearing structure of the vertebra is the:
 Definition
vertebral body.
Term
The cervical spine:
 Definition
supports the weight of the head and permits a high degree of mobility in multiple planes.
Term
In addition to the supporting muscles and ligaments found in the vertebral column, the thoracic spine is further stabilized by the:
 Definition
rib attachments.
Term
Because of its weight-bearing capacity, the ________ spine is especially susceptible to injury.
 Definition
lumbar
Term
Although extremely painful, injuries to the ________ spine are typically neurologically insignificant.
 Definition
coccygeal
Term
As the body ages, the intervertebral discs:
 Definition
lose water content and become thinner.
Term
Herniation of an intervertebral disc occurs when:
 Definition
stress on the vertebral column forces a disc into the spinal canal.
Term
Which of the following statements regarding the brainstem is correct?
 Definition
The brainstem connects the spinal cord to the brain.
Term
The occipital condyles are the:
 Definition
points of articulation between the skull and vertebral column.
Term
The innermost meningeal layer that rests directly on the brain and spinal cord is the:
 Definition
pia mater
Term
The upper thoracic spinal nerves:
 Definition
innervate the muscles of the chest that help in breathing and coughing
Term
The phrenic nerve arises from the _________ plexus and innervates the _______.
 Definition
cervical, diaphragm
Term
The afferent and efferent nerves:
are responsible for the somatic functions of the
 Definition
spinal cord
Term
Beta receptor stimulation results in all of the following effects, EXCEPT:
 Definition
vascular smooth muscle contraction.
Term
Flexion injuries to the spine would MOST likely result from:
 Definition
rapid deceleration forces.
Term
The only area of the spine that allows for significant rotation is:
 Definition
C1-C2
Term
A compression or burst fracture of the cervical spine would MOST likely occur following:
 Definition
a significant fall in which the patient lands head first.
Term
Which of the following statements regarding the hangman's fracture is correct?
 Definition
It is a fracture of C2 that is secondary to significant distraction of the neck
Term
In contrast to secondary spinal cord injury, primary spinal cord injury occurs:
 Definition
at the moment of impact
Term
Which of the following statements regarding the brain is correct?
 Definition
The brain uses 45 to 50 L/min of oxygen.
Term
Which of the following factors would be the LEAST likely to result in secondary spinal cord injury?
 Definition
Hyperglycemia
Term
The MOST effective way for the paramedic to minimize further injury in a patient with a spinal injury is:
 Definition
spinal motion restriction and prevention of heat loss
Term
A complete spinal cord injury to the upper cervical spine:
 Definition
will result in permanent loss of all cord-mediated functions below the level of the injury.
Term
What spinal cord injury is characterized by motor loss on the same side as the injury, but below the lesion?
 Definition
Brown-Séquard syndrome
Term
Spinal shock is a condition that:
 Definition
is usually temporary and results from swelling of the spinal cord.
Term
Signs of neurogenic shock include all of the following, EXCEPT:
 Definition
diaphoresis
Term
Hypotension that is associated with neurogenic shock is the result of:
 Definition
loss of alpha receptor stimulation.
Term
Patients with evidence of trauma above the _________ should be considered at risk for an associated spine injury.
 Definition
clavicles
Term
In which of the following situations would spinal motion restriction precautions likely NOT be necessary?
 Definition
Syncopal episode in which the patient was already seated or supine
Term
Modification of your physical examination of a patient with a suspected spinal cord injury following a two-car motor vehicle crash is based on all of the following factors, EXCEPT:
 Definition
injuries to patients in the other vehicle.
Term
Paralysis of the extremities would MOST likely result from injury to the:
 Definition
cerebral cortex
Term
Which of the following conditions that can cause an airway obstruction is unique to patients with an injury to the upper cervical spine?
 Definition
Retropharyngeal hematoma
Term
Following a spinal injury, a patient presents with abdominal breathing and use of the accessory muscles in the neck. This suggests injury at or above:
 Definition
C3-C4.
Term
Prior to immobilizing an anxious patient with a suspected spinal injury on a backboard, it is important to:
 Definition
make note of any neurologic deficits or gross injuries up to that point.
Term
The main disadvantage of using a scoop stretcher to transfer a patient to a long backboard is:
 Definition
inability to conduct a visual exam of the back for injuries.
Term
The MOST significant complication associated with prolonged immobilization of a patient on a long backboard is:
 Definition
pressure lesion development
Term
A full-body exam for a trauma patient with a significant mechanism of injury and signs of a spinal cord injury:
 Definition
should be performed en route to the hospital.
Term
If the mechanism of injury indicates that your patient may have sustained a spinal cord injury:
 Definition
assume that a spine injury exists, regardless of the neurologic findings.
Term
The FIRST step in any neurologic assessment involves:
 Definition
determining the patient's level of consciousness.
Term
When performing a cranial nerve assessment of a patient with a suspected spinal injury, you note that the patient's pupil is constricted and the upper eyelid droops. This indicates an injury to:
 Definition
C3
Term
Inability to feel or move below the level of the nipple line indicates injury to which spinal nerve root?
 Definition
T4
Term
Which of the following statements regarding the hypothalamus is correct?
 Definition
The hypothalamus is the most inferior portion of the diencephalon and controls functions such as hunger, sleep, and vomiting.
Term
Hyperacute pain to touch is called:
 Definition
hyperesthesia
Term
A positive Babinski reflex is observed when the:
 Definition
toes move upward in response to stimulation of the sole of the foot.
Term
Spinal cord injuries that cause neurogenic shock generally produce:
 Definition
flaccid paralysis and complete loss of sensation distal to the injury.
Term
When moving an injured patient from the ground onto a long backboard, it is preferred that you:
 Definition
use the four-person log roll technique.
Term
When immobilizing a patient to a long backboard, you should take standard precautions and then:
 Definition
ensure that the patient's head is stabilized manually.
Term
An injured patient's head should be secured to the long backboard only after:
 Definition
his or her torso has been secured adequately.
Term
Spinal cord injury without radiographic abnormalities (SCIWORA. can occur in children because:
 Definition
their vertebrae lie flatter on top of each other.
Term
In which of the following situations would it be MOST appropriate to apply a vest-type extrication device or a short backboard to a patient who is seated in his or her crashed motor vehicle?
 Definition
Conscious with neck pain and stable vital signs
Term
When immobilizing a sitting patient with a vest-type extrication device or short backboard, you should manually stabilize his or her head and then:
 Definition
assess distal pulse and sensory and motor functions.
Term
When applying a vest-type extrication device or short backboard to a seated patient, his or her head should be secured to the device:
 Definition
only after the torso is fastened securely.
Term
The cerebellum is located in the ____________ part of the brain and is responsible for _______________.
 Definition
inferoposterior, posture and equilibrium
Term
If a trauma patient cannot be assessed properly in his or her vehicle, you should:
 Definition
maintain manual stabilization of the head, apply a cervical collar, and move the patient from the vehicle onto a long backboard
Term
You would MOST likely have to place several blankets or pillows under a patient's upper back prior to immobilization if he or she has:
 Definition
kyphosis
Term
Regardless of the method of spinal immobilization used, you must:
 Definition
keep the head, neck, and trunk in alignment.
Term
You are dispatched to a senior citizen's center where an elderly woman fainted. When you arrive, you find the patient sitting in a chair. An employee of the center tells you that he caught the patient before she fell to the ground. Your primary assessment reveals that the patient is conscious and alert and is breathing adequately. You should:
 Definition
obtain vital signs and assess her blood glucose level
Term
A 45-year-old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions should include:
 Definition
manually stabilizing his head and opening his airway with the jaw-thrust maneuver.
Term
You have intubated an unresponsive, apneic patient with a suspected spinal injury. After confirming proper ET tube placement and securing the tube, you should:
 Definition
ventilate at 10 to 12 breaths/min and monitor end-tidal CO2
Term
You are assessing a patient who sustained blunt trauma to the center of his back. He is conscious, but is unable to feel or move his lower extremities. His blood pressure is 80/50 mm Hg, pulse is 40 beats/min and weak, and respirations are 24 breaths/min and shallow. If IV fluids do not adequately improve perfusion, you should:
 Definition
give 0.5 mg of atropine and consider a dopamine infusion.
Term
A skier wiped out while skiing down a large hill. He is conscious and alert and complains of being very cold; he also complains of neck stiffness and numbness and tingling in all of his extremities. A quick assessment reveals that his airway is patent and his breathing is adequate. You should:
 Definition
immobilize his spine and quickly move him to a warmer environment.
Term
Following a traumatic injury, a 19-year-old woman presents with confusion, tachycardia, and significant hypotension. Her skin is cool, clammy, and pale. Further assessment reveals abdominal rigidity and deformity with severe pain over her thoracic vertebrae. In addition to administering high-flow oxygen and immobilizing her spine, you should:
 Definition
start at least one large-bore IV line and give crystalloid boluses as needed to maintain adequate perfusion.
Term
A 21-year-old woman was thrown from a horse and landed on her head. Upon arrival at the scene, you find the patient lying supine. She is conscious and has her head turned to the side. As you attempt to move her head to a neutral in-line position, she screams in pain. You should:
 Definition
maintain her head in the position found and continue with your assessment.
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