Chapter 29 Workbook Flashcards by Tom Bowl

The temporary loss of the brain’s ability to function without actual physical damage

Concussion

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Swelling of the brain

Cerebral edema

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An inability to remember events after an injury

Anterograde amnesia

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An accumulation of blood between the skull and dura mater

Epidural hematoma

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Increased blood pressure, decreased pulse, and irregular respirations

Cushing’s triad

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The three distinct layers of tissue that surround and protect the brain and spinal cord

Meninges

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An inability to remember events leading up to a head injury

Retrograde amnesia

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An accumulation of blood beneath the dura mater but outside the brain

Subdural hematoma

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Located in the brain and spinal cord, these connect the motor and sensory nerves within the skull and spinal canal

Connecting nerves

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A cushion that lies between the vertebrae

Intervertebral disk

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Which of the following is NOT part of the central nervous system?
A. The brain
B. The spinal cord
C. Cerebrospinal fluid
D. Cranial nerves

D. Cranial nerves

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The nervous system is divided into the central nervous system and the:
A. autonomic nervous system
B. peripheral nervous system
C. sympathetic nervous system
D. somatic nervous system

B. peripheral nervous system

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The brain is divided into the cerebrum, the cerebellum, and the:
A. foramen magnum
B. meninges
C. brainstem
D. spinal column

C. brainstem

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Injury to the head and neck may indicate injury to the:
A. thoracic spine
B. lumbar spine
C. cervical spine
D. sacral spine

C. cervical spine

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The ________ is composed of three layers of tissue that suspend the brain and spinal cord within the skull and spinal canal.
A. meninges
B. dura mater
C. pia mater
D. arachnoid space

A. meninges

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The skull is divided into the cranium and the:
A. occipital
B. face
C. parietal
D. foramen magnum

B. face

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Peripheral nerves include all of the following EXCEPT:
A. connecting nerves
B. sensory nerves
C. motor nerves
D. the spinal cord

D. the spinal cord

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Which of the following is NOT a function of cerebrospinal fluid?
A. Acts as a shock absorber
B. Bathes the brain and spinal cord
C. Buffers the brain and spinal cord from injury
D. Provides continuous oxygen to the brain

D. Provides continuous oxygen to the brain

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The autonomic nervous system is composed of the sympathetic nervous system and the:
A. peripheral nervous system
B. central nervous system
C. parasympathetic nervous system
D. somatic nervous system

C. parasympathetic nervous system

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The most prominent and the most easily palpable spinous process is at the ________ cervical vertebra at the base of the neck.
A. 7th
B. 6th
C. 5th
D. 4th

A. 7th

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You respond to a 14-year-old boy who fell out of a tree at a local park. He is unresponsive. His airway is open, and respirations are 16 breaths/min and regular. His pulse is strong and regular. Distal pulses are present. You manage the cervical spine. Whom should you NOT ask for help in determining how the injury happened?
A. First responders
B. Family members
C. Bystanders
D. Curious passersby who did not witness the accident

D. Curious passersby who did not witness the accident

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Emergency medical care of a patient with a possible spinal injury begins with:
A. opening the airway
B. assessing level of consciousness
C. summoning law enforcement
D. standard precautions

D. standard precautions

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The ________ is a tunnel running the length of the spine, which encloses and protects the spinal cord.
A. foramen magnum
B. spinal canal
C. foramen foramina
D. meninges

B. spinal canal

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Once the head and neck are manually stabilized, you should assess for:
A. pulse
B. motor function
C. sensation
D. All of the above

D. All of the above

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You are called to a motor vehicle collision where a 27-year-old woman has a bump on her head. You immediately begin manual stabilization of the head. Her airway is open, and respirations are within normal limits. Her pulse is a little fast but strong and regular. Distal pulses are present. You can release manual stabilization when: A. the patient’s head and torso are in line B. the patient is secured to a backboard with the head immobilized C. the rigid cervical collar is in place D. the patient arrives at the hospital

B. the patient is secured to a backboard with the head immobilized

One procedure for moving a patient from the ground to the backboard is the: A. four-person log roll B. lateral slide C. four-person lift D. push-and-pull maneuver

A. four-person log roll

You respond to a motor vehicle collision with a 29-year-old woman who struck the rearview mirror and has serious bleeding from the scalp. Her airway is open, and respirations are normal. The pulse is a little rapid but strong and regular. Distal pulses are present, and there is no deformity to the skull. Most bleeding from the scalp can be controlled by: A. direct pressure B. elevation C. pressure point D. tourniquet

A. direct pressure

Exceptions to using a short spinal extrication device include all of the following EXCEPT: A. you or the patient is in danger B. the patient is conscious and complaining of lumbar pain C. you need to gain immediate access to other patients D. the patient’s injuries justify immediate removal

B. the patient is conscious and complaining of lumbar pain

Neck rigidity, bloody cerebrospinal fluid, and headache are associated with what kind of bleeding in the brain? A. Epidural hematoma B. Subdural hematoma C. Intracerebral hematoma D. Subarachnoid hemorrhage

D. Subarachnoid hemorrhage

A ________ is a temporary loss or alteration of a part or all of the brain’s ability to function without actual physical damage to the brain. A. contusion B. concussion C. hematoma D. subdural hematoma

B. concussion

Which of the following is NOT a symptom of a concussion? A. Dizziness B. Weakness C. Muscle tremors D. Visual changes

C. Muscle tremors

Intracranial bleeding outside of the dura mater and under the skull is known as a(n): A. concussion B. intracerebral hemorrhage C. subdural hematoma D. epidural hematoma

D. epidural hematoma

The first step in securing a patient to a short backboard is to: A. assess pulse, motor function, and sensation B. assess the cervical area C. provide manual stabilization of the cervical spine D. apply an appropriately sized cervical collar

C. provide manual stabilization of the cervical spine

________ is the most reliable sign of a head injury. A. Vomiting B. Decreased level of consciousness C. Seizures D. Numbness and tingling in extremities

B. Decreased level of consciousness

Hyperventilation should be used with caution in head injury patients and only be attempted when ________ is/are available. A. pulse oximetry B. capnography C. air medical services D. noninvasive blood pressure monitoring

B. capnography

Common causes of head injuries include all of the following EXCEPT: A. falls B. motor vehicle collisions C. seizure activity D. sports injuries

C. seizure activity

Assessment of mental status is accomplished through the use of the mnemonic: A. SAMPLE B. OPQRST C. AVPU D. AEIOU-TIPS

C. AVPU

You respond to a 38-year-old man who fell while rock climbing. He is unconscious, with an open airway. The respiration and pulse rates are within normal limits. His distal pulses are intact. You check his pupils and find that they are unequal. You know this could be a sign of: A. brain injury B. hypoxia C. seizure activity D. chronic hypertension

A. brain injury

Which of the following is NOT part of Cushing’s triad? A. Increased blood pressure B. Decreased pulse rate C. Decreased pulse oximetry D. Irregular respirations

C. Decreased pulse oximetry

A cervical collar should be applied to a patient with a possible spinal injury based on: A. the mechanism of injury B. the history C. signs and symptoms D. All of the above

D. All of the above

Helmets must be removed in all of the following cases EXCEPT: A. cardiac arrest B. when the helmet allows for excessive movement C. when there are no impending airway or breathing problems D. when a shield cannot be removed for access to the airway

C. when there are no impending airway or breathing problems

A vacuum mattress molds to the specific contours of the patient’s body and: A. reduces pressure-point tenderness B. provides better comfort C. provides thermal insulation D. All of the above

D. All of the above

True/False An intracerebral hematoma involves bleeding outside the brain tissue.

False

True/False If a sensory nerve in the reflex arc detects an irritating stimulus, it will bypass the brain and send a message directly to the motor nerve.

True

True/False Voluntary activities are those actions we perform unconsciously.

False

True/False The autonomic nervous system is composed of the sympathetic nervous system and the parasympathetic nervous system.

True

True/False The parasympathetic nervous system reacts to stress with the fight-or-flight response whenever it is confronted with a threatening situation.

False

True/False All patients with suspected head and/or spine injuries should have their heads realigned to an in-line, neutral position when you begin assessing them.

False

True/False When assessing a patient for possible spinal injury, you should begin with a full-body scan.

False

True/False One procedure for moving a patient from the ground to a backboard is the four-person log roll.

True

True/False You should not try to put a patient on a short backboard if the patient is in danger.

True

True/False To properly measure a cervical collar, use the manufacturer’s specifications.

True

The __________ nerves carry information to the muscles.

motor

The dura mater, arachnoid, and pia mater are layers of __________ within the skull and spinal canal.

meninges

The brain and spinal cord are part of the __________ nervous system.

central

The peripheral nervous system has __________ pairs of spinal nerves.

The __________ nerves are the 12 pairs of nerves that emerge from the brainstem and transmit information directly to or from the brain.

cranial

Vertebrae are separated by cushions called ___________ ___________.

intervertebral disk

The skull is composed of two groups of bones, the ____________ and the ____________ bones.

cranium, facial

The ____________ and the __________ __________ are the inner two layers of the meninges and are much thinner than the dura mater.

arachnoid, pia mater

The ____________ nervous system reacts to stress.

sympathetic

The ____________ nervous system causes the body to relax.

parasympathetic

A(n) __________ __________ involves bleeding within the brain tissue itself.

intracerebral hematoma

A(n) ____________ is far more serious than a concussion because it involves physical injury to the brain tissue.

contusion

When immobilizing a small child, ____________ may need to be added to maintain an in-line, neutral position.

padding

On completion of spinal immobilization, reassessment of ____________, ____________, and ____________ function in each extremity is necessary.

pulse, motor, sensory

In a patient with a suspected head injury, you should use the __________-__________ method for opening the airway.

jaw-thrust

Brain A. Cerebrum B. Parietal lobe C. Frontal lobe D. Occipital lobe E. Temporal lobe F. Brainstem G. Cerebellum H. Spinal cord I. Foramen magnum

Connecting Nerves in the Spinal Cord A. Motor nerve B. Sensory nerve C. Connecting nerve cell D. Spinal cord

Spinal Column A. Cervical (7) B. Thoracic (12) C. Lumbar (5) D. Sacrum (5) E. Coccyx (4)

Short Answer List the 10 mechanisms of injury where you are likely to encounter a head injury.

1. Motor vehicle collision (including motorcycles, snowmobiles, and all-terrain vehicles) 2. Pedestrian–motor vehicle collision 3. Falls >20 feet (>6 m) (adult) 4. Falls >10 feet (>3 m) (pediatric) 5. Blunt trauma 6. Penetrating trauma to the head, neck, back, or torso 7. Rapid deceleration injuries 8. Hangings 9. Axial loading injuries 10. Diving accidents

Short Answer List the reasons for not placing the head and/or spine injury patient’s head into a neutral in-line position.

* Muscle spasms in the neck * Substantial increased pain * Numbness, tingling, or weakness in the arms or legs * Compromised airway or ventilations

Short Answer What is the difference between a primary brain injury and a secondary brain injury?

Primary brain injury is injury to the brain and its associated structures that results instantaneously from impact to the head. Secondary brain injury refers to a multitude of processes that increase the severity of a primary brain injury and therefore negatively affect the outcome. Secondary brain injuries result from cerebral edema, intracranial hemorrhage, increased intracranial pressure, cerebral ischemia, and infection. Hypoxia and hypotension are the two most common causes of secondary brain injuries.

Short Answer List at least 10 signs and symptoms of a head injury.

* Lacerations, contusions, or hematomas to the scalp * Soft area or depression on palpation * Visible fractures or deformities of the skull * Decreased mentation, irregular breathing pattern, widening pulse pressure, slow pulse rate * Ecchymosis about the eyes or behind the ear over the mastoid process * Clear or pink cerebrospinal fluid leakage from a scalp wound, the nose, or the ear * Failure of the pupils to respond to light * Unequal pupil size * Loss of sensation and/or motor function * A period of unconsciousness * Amnesia * Seizures * Numbness or tingling in the extremities * Irregular respirations * Dizziness * Visual complaints * Combative or other abnormal behavior * Nausea or vomiting * Posturing (decorticate or decerebrate)

Short Answer List the three general principles for treating a head injury.

1. Establish an adequate airway. 2. Control bleeding. 3. Assess the patient’s baseline level of consciousness.

Short Answer List the seven questions to ask yourself when deciding whether to remove a helmet.

1. Is the patient’s airway clear? 2. Is the patient breathing adequately? 3. Can you maintain the airway and assist ventilations if the helmet remains in place? 4. Can the face guard be easily removed to allow access to the airway without removing the helmet? 5. How well does the helmet fit? 6. Can the patient move within the helmet? 7. Can the spine be immobilized in a neutral position with the helmet on?

Ambulance Calls You are dispatched to a bicycle-versus-car collision. The driver of the car is uninjured, but the bicyclist is reported as “severely injured.” You arrive to find the patient lying unconscious in the street and with an apparent head injury. The patient was not wearing a helmet when she was struck by the car. Witnesses say that she was launched into the windshield and then landed in the road. How would you best manage this patient?

This incident involves a significant mechanism of injury. The impact with the car, the lack of a helmet, the obvious head trauma, and the patient’s decreased level of consciousness all indicate significant life threatening injuries. You must quickly apply full spinal precautions and manage her airway. Provide prompt transport and high flow oxygen, and perform reassessment while en route to the nearest appropriate medical facility.

Ambulance Calls You are dispatched to assist a “young child fallen.” You arrive to find a frantic parent who tells you that her daughter was playing on the family’s trampoline in the backyard. She was bouncing very high and accidentally launched herself off the trampoline, landing facedown on a concrete pad in the neighbor’s yard. She responds to painful stimuli and has snoring respirations. How would you best manage this patient?

This child landed facedown on a concrete surface, with significant force. She is now unconscious, with a partially obstructed airway. You must move her to a supine position to manage her airway. Take note of any apparent injuries to her back as you reposition her. Ideally, you will have the appropriate equipment and adequate staffing to quickly and safely move her to a long backboard immediately. However, do not delay appropriately moving her to a supine position because you must do this to assess and manage her airway. This may be difficult because she likely has facial fractures and possibly broken teeth, blood, and secretions in her airway. Be prepared to suction her airway and apply positive pressure ventilations (this may be especially challenging in the presence of significant facial fractures). Use high flow oxygen and promptly transport her to the nearest appropriate facility according to your local protocols.

Ambulance Calls You are dispatched to a motor vehicle collision with major damage to the patient compartment. Your patient, an 18 month old boy, is still in his car seat in the center of the back seat. He responds appropriately, and there is no damage to his seat. He has no visible injuries, but a front seat passenger was killed. How would you best manage this patient?

Leave the patient in his car seat. Pad appropriately to immobilize the patient. Use blow by oxygen if the patient will tolerate it. Monitor vital signs. Continue assessment. Provide rapid transport due to mechanism of injury and death in the vehicle.

You respond to a patient who was assaulted and is unconscious. On reaching his side, you check his airway, and it is open. Breathing is at 18 breaths/min and regular. Pulse is strong and regular, with distal pulses present. You want to administer oxygen with a nonrebreather mask. At what flow rate would you give it? A. 2 L/min B. 6 L/min C. 10 L/min D. 15 L/min

D. 15 L/min

You and your partner have determined that you need to put the patient from Question 1 in full immobilization. When can your partner release manual stabilization of the head? A. When the cervical collar is applied B. When the torso is secured to the backboard C. When the patient is completely secured to the backboard D. When you arrive at the hospital

C. When the patient is completely secured to the backboard

You decide to put the patient on a long backboard and use the log-roll technique to accomplish the task. When do you check the patient’s back? A. After securing the patient to the backboard B. As the patient is rolled onto his side C. Before any movement is attempted D. When you move the patient to the hospital bed

B. As the patient is rolled onto his side

If you respond to a patient who is in a sitting position and stable, how would you immobilize him or her? A. Lay the patient down and perform the log-roll technique. B. Use a scoop stretcher. C. Use a short backboard. D. Have the patient lie down on your backboard.

C. Use a short backboard.

You respond to a motorcycle accident. You decide that you need to remove the rider’s helmet. What is the minimum number of people required to remove the helmet? A. Two B. Three C. Four D. Five

A. Two

Chapter 29 Workbook Flashcards

(84 cards)