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Ch. 27 Head and Spinal Injuries
Terms in this set (69)
The complex network of spinal nerves that controls the lower extremities is called the:
Following a severe closed head injury, a 23-year-old female develops cardiac dysrhythmias and an irregular pattern of breathing. The area of her brain MOST likely injured is the:
When assessing an unresponsive 20-year-old male with a traumatic brain injury, you note that his left pupil is fully dilated and non-reactive. This indicates injury
to the left cerebral hemisphere
A 40-year-old man was struck in the head with a steel pipe. He opens his eyes when you ask him a question, but cannot recall the date or events prior to the injury. When you ask him if he is injured anywhere else, he tells you no. You should assign him a Glasgow Coma Scale (GCS) score of:
Manual C-spine stabilization should continue until:
the patient is fully secured to a long backboard
If a person places his or her hand on a hot stove:
the sensory nerve will bypass the brain and send a message directly to the motor nerve
Which of the following head-injured patients should be hyperventilated at a rate of 20 breaths/min with a bag-mask device and 100% oxygen?
Unresponsive 21-year-old male with slow, irregular breathing, fixed and dilated pupils, and extensor posturing
Following blunt head trauma, a 44-year-old male presents with clear, watery fluid draining from his nose. You should suspect:
damage to all of the meningeal layers
A 38-year-old male committed suicide by hanging himself. This mechanism of injury MOST likely resulted in
distraction of the upper cervical spine
The presence of posturing following severe head trauma is a sign of:
Of the following clinical findings, which one would you MOST likely encounter during the early phase following a fracture of the basilar skull?
Altered mental status
What physiologic response may occur when a head-injured patient is hyperventilated with a bag-mask device and 100% oxygen?
Vasoconstriction and decreased cerebral perfusion
Which of the following signs or symptoms would you MOST likely encounter in a patient who was struck in the back of the head
Which portion of the central nervous system is afforded the BEST protection by the cranium?
The MOST significant complication associated with a severe closed head injury is:
increased intracranial pressure
A 48-year-old male fell approximately 20' from his roof. As you approach him, you note that his eyes are closed and that he is not moving. His respirations are gurgling and you see blood draining from his mouth. You should
take proper standard precautions
You are transporting a semiconscious 30-year-old female with an isolated head injury to a local trauma center. When you reassess her, you note that her BP is 78/56 mm Hg and her radial pulses are no longer palpable. You should
infuse 20 mL/kg of normal saline as needed to maintain her BP at 90 mm Hg
A linear skull fracture:
usually does not present with deformity of the skull
The 31 pairs of spinal nerves serve all of the following functions EXCEPT:
transmitting sensations directly to and from the brain
A 23-year-old male was involved in a motor-vehicle crash and has an obviously depressed skull fracture. His pulse is rapid and weak, his skin is cool and clammy, and his blood pressure is low. You should:
suspect that he has internal bleeding and administer crystalloid fluid boluses
Two of the meningeal layers that protect the central nervous system are the arachnoid and pia mater which:
produce cerebrospinal fluid
Of the following, which is the LEAST common sign or symptom of a head injury?
A cardiac rhythm disturbance
A 37-year-old male was struck on the driver side of his vehicle by another car traveling at 45 mph. Your primary assessment reveals that the patient is semiconscious and in respiratory distress. When extricating this patient from his car, you should:
apply a C-collar and rapidly remove him on a long backboard
Cerebral edema is aggravated by:
low O2 levels in the blood
A patient with neurogenic shock would be expected to present with:
bradycardia and hypothermia
The two MOST common causes of secondary brain injury are:
cerebral hypoxia and hypotension
Which of the following clinical presentations is MOST indicative of a subdural hematoma?
A.. Progressive deterioration of mental status and other neurologic functions 2 days following a head injury.
B. No loss of consciousness immediately following a head injury and a frontal headache that is increasing in intensity.
While assessing a patient with blunt head trauma, you note an unstable segment of the skull and a large laceration to the scalp. You should control active bleeding, administer 100% oxygen, and:
be alert for increased intracranial pressure
A person would MOST likely experience a compression injury of the lumbar spine when he or she:
falls and lands on his or her feet
Which of the following MOST accurately describes the position of the cerebellum within the skull?
A. Inferoposterior to the cerebrum
B. Inferolateral to the brain stem
A subdural hematoma is an accumulation of blood:
beneath the dura mater but outside the brain
Decerebrate posturing is characterized by:
A. flexion of the arms and flexion of the legs.
B. extension of the arms and extension of the legs.
You are caring for an 11-month-old male who fell from a second-story window and landed on his head. While assessing him, it is important to remember that:
he could develop hypovolemic shock from intracranial bleeding
Mastoid bruising is also referred to as:
A young female was involved in a motor-vehicle crash and complains of neck pain. When assessing her, you should NOT:
determine cervical range of motion
An appropriately sized cervical collar should:
A. rest on the shoulder and provide support under the mandible.
B. fit loosely underneath the chin to minimize patient discomfort.
A middle-aged male is found unconscious at the base of the steps to his house. There is no evidence of trauma and there were no witnesses to the event. You should:
stabilize his head and open his airway with the jaw-thrust maneuver
Which of the following sets of vital signs is MOST indicative of Cushing's triad?
BP, 190/100 mm Hg; pulse, 68 beats/min; respirations, 30 breaths/min and irregular
A young male has experienced a possible neck injury. When you attempt to place his head in a neutral in-line position, he complains of a severe spasm in his neck. You should
immobilize him in the position in which you found him
Which of the following situations dictates removal of a football or motorcycle helmet?
Respirations of 24 breaths/min and reduced tidal volume
Following a minor head injury, which of the following occurs more commonly in children than adults?
Hypotension in an adult patient with an isolated brain injury and no external bleeding is MOST likely the result of:
A. dilation of the cerebral vessels. .
B. decreased cerebral perfusion.
An intracerebral hematoma is the result of bleeding:
A. above the surface of the cerebrum.
B. within the brain tissue itself.
The physiologic response that occurs when a person is exposed to a stressful stimulus is initiated by the:
A. involuntary nervous system.
B. sympathetic nervous system.
The central nervous system (CNS) is:
composed of the cerebrum, cerebellum, brainstem, and spinal cord
A 57-year-old male was struck in the head by a falling object. He opens his eyes when you pinch his trapezius muscle, is using inappropriate words, and withdraws from painful stimuli. His Glasgow Coma Scale (GCS) score is:
During your assessment of a 29-year-old female with a severe head injury, you note that her left pupil is dilated and unreactive to light. This suggests pressure on the
Following a traumatic brain injury, a patient presents with Cushing's triad, which consists of:
hypertension, bradycardia, and irregular respirations
Which of the following statements regarding scalp lacerations is correct?
Scalp lacerations may contribute to hypovolemic shock in adult patients
A 19-year-old male was struck by a baseball in the occipital region of the skull. Witnesses report that the patient was briefly unconscious following the incident. He is now conscious and alert, but cannot remember the events immediately following the injury. He is breathing without difficulty and his vital signs are stable. This patient's clinical presentation is MOST consistent with a/an:
Which of the following statements regarding cerebral perfusion pressure (CPP) is correct
CPP is the difference between mean arterial pressure and intracranial pressure
In contrast to a cerebral concussion, diffuse axonal injury (DAI):
A. involves stretching, shearing, or tearing of cerebral nerve fibers.
B. is generally associated with better clinical outcomes.
You are dispatched to a construction site, where a 30-year-old male fell approximately 30 feet and landed on his head. He is unresponsive, has respirations of 38 breaths/min and irregular, and decerebrate posturing. Further assessment reveals that his pupils are fixed and dilated and his blood pressure is 190/120 mm Hg. In addition to spinal immobilization, the MOST appropriate treatment for this patient includes:
A. assisted ventilations at a rate of 10 breaths/min with a bag-mask device and 100% oxygen, followed by insertion of a King LT airway.
B. hyperventilation at a rate of 20 breaths/min with a bag-mask device and 100% oxygen, followed by insertion of an advanced airway device.
When stabilizing a patient's cervical spine, you should:
align the patient's nose with the navel
What portion of the nervous system controls the functions of many of the body's vital organs, over which the brain has no voluntary control?
A 39-year-old female struck a tree while traveling approximately 40 mph. When you arrive at the scene, the patient is out of her vehicle and walking around. You should:
immobilize her in a standing position to a long backboard
The function of the 12 pairs of cranial nerves is to:
allow transmission of sensations directly to and from the brain
You are transporting a 37-year-old male with a head injury to a local trauma center. When performing your reassessment, which of the following clinical findings would be the earliest indicator of increasing intracranial pressure?
A decreasing level of consciousness
Which of the following patients should be assigned a Glasgow Coma Scale (GCS) score of 8
19-year-old male who does not open his eyes, is making mumbling sounds, and pulls his arm away when you are palpating it
When immobilizing a patient onto a long backboard, it is important to:
secure the torso prior to securing the head
A football player sustained a possible spinal injury when he was tackled. He is conscious and alert, complains of pain to the mid-cervical spine region, and has stable vital signs. You should
immobilize him with his helmet on unless it is not tight-fitting
Subluxation of the spine occurs when:
You are caring for a young female who experienced blunt head trauma and is unresponsive. You have inserted a King LT airway and are providing mild hyperventilation because she has signs of brain herniation. In doing this, you should:
A. utilize capnography and ensure that her end-tidal CO2 does not fall below 30 mm Hg.
B. continue to hyperventilate her, even if her clinical status begins to improve.
You are transporting a 40-year-old male who experienced blunt trauma to the side of his head. At the scene, he was conscious and alert and refused oxygen; however, you note that his mental status has deteriorated and his respirations have become irregular and shallow. You should:
A. start a large-bore IV and deliver a 20 mL/kg fluid bolus.
B. assist his ventilations with a bag-mask device.
C. insert an advanced airway device immediately.
D. apply a nonrebreathing mask set at 15 L/min.
B. assist his ventilations with a bag-mask device
The largest portion of the brain, which controls a wide variety of functions, is the:
During a motor-vehicle crash, a 3-year-old female, who was properly restrained in her car seat, is crying and asking for her mommy. There is no obvious injury to the child and she is breathing without difficulty. You should
B. immobilize her in the car seat and apply padding as needed
A 40-year-old female is semiconscious following blunt head trauma. Your assessment reveals that her respirations are slow and shallow, her pulse is slow, and her blood pressure is elevated. Her pupils are bilaterally dilated and sluggishly reactive. Appropriate management for this patient includes:
assisted ventilation at a rate of 10 breaths/min
A patient with closed head trauma would MOST likely deteriorate rapidly following a/an:
The ability to consciously flex a muscle in an extremity is a function of the:
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