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Questions and Answers

The Glasgow Coma Scale evaluates all of the following areas, EXCEPT:

Verbal response

Motor response

Eye response

Circulatory response (correct)

Which of the following is accurate regarding a basilar skull fracture?

It involves only the frontal bone

It does not cause bleeding

It is commonly associated with no symptoms

It often begins as a linear temporal fracture (correct)

What should you do if a patient becomes unconscious during transport after being struck in the head?

Assure a patent airway, continue the administration of oxygen, and divert to a level 1 trauma center.

Ecchymosis around the eyes and behind the ears is associated with:

Basilar skull fracture. Signup and view all the answers

A sudden drop in blood pressure during the assessment of a head trauma patient could indicate:

Brainstem failure. Signup and view all the answers

Always assume that a patient with a head injury also has:

Spinal injury. Signup and view all the answers

What do raccoon signs indicate?

Bruising under the eyes. Signup and view all the answers

What is Cushing reflex?

Increased systolic blood pressure, decreased heart rate, and possible changes in the respiratory pattern. Signup and view all the answers

When pressure increases inside the skull due to swelling of brain tissue, what happens?

The brain is starved for oxygen and carbon dioxide increases, causing even more swelling. Signup and view all the answers

Which area is commonly the site of fractures due to trauma?

Basilar skull. Signup and view all the answers

If a patient exhibits altered mental status after a motorcycle accident and was not wearing a helmet, what should be suspected?

Head injury. Signup and view all the answers

What fluid bathes and protects the brain and spinal cord?

Cerebral spinal fluid. Signup and view all the answers

What does low blood pressure in a head-injured patient indicate?

Bleeding elsewhere. Signup and view all the answers

Which can mimic skull deformity?

Blood trapped under intact scalp. Signup and view all the answers

What might indicate that a patient is developing a hematoma inside the brain?

Confusion. Signup and view all the answers

What does a patient flexing his arms across his chest and extending his legs indicate?

Decorticate posturing. Signup and view all the answers

What is the name of the paired bones located at the superior-lateral regions of the skull?

Parietal bones. Signup and view all the answers

What does bruising behind the ear indicate?

Battle sign associated with skull fracture. Signup and view all the answers

What finding may indicate a brain injury in a patient who fell from a roof?

Altered mental status. Signup and view all the answers

Scalp injuries often bleed heavily because:

There is a rich supply of vessels in the scalp. Signup and view all the answers

What type of injury to the head can result in blood accumulation between the dura mater and the skull?

Epidural hematoma. Signup and view all the answers

What vital sign changes should be expected in a patient with suspected brain injury?

Blood pressure and heart rate abnormalities. Signup and view all the answers

What finding indicates that a patient who received a blow to the head may be experiencing something more serious than a simple concussion?

Unequal pupils. Signup and view all the answers

What is the purpose of determining a Glasgow Coma Scale score in a head injury patient?

To assess if the patient's mental status is improving or deteriorating. Signup and view all the answers

What is the greatest threat associated with a head injury when no bleeding is seen?

Damage to the brain. Signup and view all the answers

What immediate action should be taken for a patient with unresponsiveness and snoring respirations?

Perform the jaw-thrust maneuver. Signup and view all the answers

What finding is most consistent with a basilar skull fracture?

Bruising behind the ear. Signup and view all the answers

A patient who is experiencing garbled speech following a fall should have which assessment performed next?

Perform a secondary exam. Signup and view all the answers

What indicates increasing pressure within the skull?

Blood pressure of 192/106 mmHg. Signup and view all the answers

What should be suspected in a patient with significant deformity to the head following a high-speed accident?

Brain injury. Signup and view all the answers

What is indicated by a patient responding to painful stimuli with purposeful motion?

Potential brain injury assessment. Signup and view all the answers

When assessing pupils, which finding suggests a closed head injury?

Left pupil constricts to light but the right pupil does not. Signup and view all the answers

What is the rate of positive pressure ventilation needed?

12 breaths per minute Signup and view all the answers

What is an epidural hematoma?

A pocket of arterial blood collected between the skull and dura mater Signup and view all the answers

What is the technique used when hyperventilating a patient with a head injury showing signs of brain herniation?

Provide 1 ventilation every 3 seconds Signup and view all the answers

What should be the EMT's priority action for a young female patient involved in a motor vehicle collision with shallow breathing?

Start positive pressure ventilation at 20 breaths/min Signup and view all the answers

What immediate care should be performed on a combative patient who has a head injury?

Take manual cervical spine motion restriction Signup and view all the answers

What could happen when the brain shifts back and forth within the skull after an impact?

The ridges of the basilar skull can damage the brain as it moves back and forth Signup and view all the answers

What finding during reassessment indicates that a patient has experienced a concussion?

Improving memory Signup and view all the answers

How does the body respond as brain herniation occurs?

Increasing systolic blood pressure in an attempt to maintain perfusion to the brain Signup and view all the answers

What finding should raise concern for an EMT when a patient states he takes a blood thinner?

A headache resulting from a fall Signup and view all the answers

What question is crucial to ask a patient's mother if the young female was thrown from a horse?

Did she lose consciousness? Signup and view all the answers

What instruction should be given regarding care for a patient with a skull injury and draining clear fluid from the ear?

Will someone administer supplemental oxygen to the patient? Signup and view all the answers

How should a skull injury be documented on the PCR?

Obvious deformity and instability to the right side of the skull with a laceration to the overlying scalp Signup and view all the answers

What should the EMT do first for a combative patient who has fallen from a height?

Begin administering supplemental oxygen Signup and view all the answers

What type of injury should an EMT suspect when a soccer player has dazed responses after being struck in the head?

Concussion Signup and view all the answers

Given the patient's findings and history, what type of injury should the EMT suspect in a 68-year-old mother with confusion?

Subdural hematoma Signup and view all the answers

What should be done when assessing a young male patient who has a gunshot wound to the head?

Performing a jaw-thrust maneuver Signup and view all the answers

What pathophysiology is a patient with Cushing reflex most likely experiencing?

Brain herniation Signup and view all the answers

What critical information should be relayed to the physician for a patient who fell and hit their head?

Known history of alcoholism Signup and view all the answers

What should be the EMT's greatest concern when a deformity is found on a patient's head?

Possible brain injury Signup and view all the answers

What area of the brain controls reflexes and assists in maintaining body posture?

Cerebellum Signup and view all the answers

What is a cerebral contusion?

Bruising and swelling of the brain tissue Signup and view all the answers

The Glasgow Coma Scale indicates that the higher the score, the better the patient's neurologic status.

True Signup and view all the answers

What should follow after providing manual spine motion restriction for a patient with head injuries and shallow breathing?

Perform the jaw-thrust maneuver Signup and view all the answers

What type of injury does a large scalp avulsion with obvious skull depression indicate?

Open head injury Signup and view all the answers

How can the EMT assess sensory function in the hands?

Can you tell me which finger I am touching? Signup and view all the answers

What sign would indicate the loss of cerebrospinal fluid in a patient with head trauma?

Clear fluid coming from the nose Signup and view all the answers

When assessing for a possible basilar skull fracture, what finding would be significant?

Clear fluid coming from the right ear and the left nostril Signup and view all the answers

Linear skull fractures can typically be identified with palpation.

False Signup and view all the answers

What does retrograde amnesia involve?

Cannot remember falling and hitting her head Signup and view all the answers

Which patient has the most serious isolated brain injury?

21-year-old male wearing a deformed motorcycle helmet who does not respond to verbal or painful stimuli after crashing Signup and view all the answers

What portion of the central nervous system is likely damaged in a patient who died after a self-inflicted gunshot wound to the head?

Brainstem Signup and view all the answers

What action should an EMT take for a patient in custody after a car crash who exhibits slurred speech and a smell of alcohol?

Contact medical direction with assessment findings Signup and view all the answers

What care should be provided for a patient struck in the head with a large laceration and skull instability?

A loose dressing over the top of the laceration Signup and view all the answers

What should be noted for a young female pedestrian who sustained deep depression to her head after being struck by a car?

Note the injury and continue assessing the patient Signup and view all the answers

What provides the strongest evidence that the meningeal layers have been breached for a patient shot with a nail gun?

Cerebrospinal fluid oozing from the puncture wound Signup and view all the answers

Study Notes

Glasgow Coma Scale and Head Injuries

The Glasgow Coma Scale does not evaluate circulatory response.
Cushing reflex indicates increased systolic blood pressure, decreased heart rate, and possible respiratory changes.
Regular pupil assessment during head trauma reassessment is crucial, as dilated pupils can indicate drug overdose rather than brain injury.

Skull Fractures

Basilar skull fractures often start as linear temporal fractures and can be identified by signs such as raccoon eyes and bruising behind the ears (Battle sign).
The basilar skull is prone to fractures due to its numerous openings.

Blunt Force Trauma and Head Injuries

Always suspect a spinal injury in patients with head trauma.
Significant head trauma can lead to brainstem failure, indicated by sudden drops in blood pressure.
Altered mental status in a motorcycle wreck without a helmet suggests a head injury.

Hematomas and Intracranial Bleeding

Subdural hematomas develop slowly and can be indicated by a history of minor head trauma followed by symptoms like severe headaches and dizziness.
Epidural hematomas present acutely and involve blood between the dura mater and skull.
A cerebral contusion refers to bruising of brain tissue.

Evaluation and Assessment

Monitor vital signs closely since low blood pressure in head-injured patients can signify internal bleeding elsewhere.
A confused patient unresponsive to stimuli may indicate severe intracranial injury.
Head injuries can result in significant bleeding from scalp lacerations due to rich vascular supply, despite minor trauma.

Neurological Signs

Altered mental status and confusion are key indicators of brain injury, often accompanied by abnormal pupillary responses.
Decorticate posturing involves flexing arms across the chest with extended legs.
Severe diffuse axonal injury is characterized by shearing and tearing of nerve fibers in the brain.

Specific Conditions and Findings

Spinal motion restriction should be maintained in cases of severe head trauma.
Raccoon eyes, bruising behind the ears, and altered pupils indicate potential basilar skull fractures.
Findings indicating intracranial pressure elevation include high blood pressure, irregular respirations, and unresponsive states.

Treatment and Interventions

In suspected herniation cases, hyperventilation should be approached with care, suggesting one breath every three seconds to manage pressure.
Positive pressure ventilation may be necessary in patients with irregular or insufficient breathing patterns.
The appearance of a significant head deformity, especially with unresponsiveness, necessitates immediate intervention for airway management.

Key Anatomy

The three meningeal layers include the dura mater (outermost layer), which protects the brain and contains cerebral spinal fluid (CSF).
Parietal bones are located at the superior-lateral regions of the skull, while temporal bones are found on the sides of the head.

Post-Injury Symptoms

Symptoms such as weakness, unusual pupil dilation, and hypertension following head injuries suggest serious underlying conditions requiring immediate medical evaluation.
Blood accumulation under intact scalp skin can mimic skull deformity, complicating assessment and treatment.

Potential Complications

Severe brain injuries increase the risk of herniation and necessitate careful monitoring for neurological deficits.
Patients experiencing seizures, severe headaches, or prolonged confusion post-injury require prompt diagnosis and intervention.### Cervical Spine and Motion Restriction
Manual cervical spine motion restriction is crucial for immobilizing patients with potential spinal injuries.

Skull and Brain Injury

The basilar skull has ridges that can inflict damage to the brain during rapid back-and-forth movements post-impact.
Concussions are indicated by an improvement in memory after an injury, signaling recovery.
During brain herniation, the body compensates by increasing systolic blood pressure to ensure brain perfusion.

Cerebellum and Coordination

Damage to the cerebellum results in poor muscle coordination, affecting tasks like writing.

Head Injuries and Patient Evaluation

Patients on blood thinners have a higher risk of complications from head injuries.
Inquire about loss of consciousness following a head injury as it is critical for assessing consciousness levels.
Clear fluid drainage from the ear may indicate a serious skull injury requiring immediate attention.

Vital Signs and Interventions

A patient with an open skull injury should have proper documentation emphasizing deformities and scalp injuries.
In case of confusion and potentially low oxygen saturation after a fall, administering supplemental oxygen should be prioritized.

Types of Head Injuries

Concussions often manifest as dazed mental states and repeated questioning.
Subdural hematomas can develop from previous head trauma, particularly if there are presenting headaches and confusion.
Open head injuries are indicated by skull deformities and bleeding.

Brain Physiology and Emergencies

Cushing reflex suggests the patient is experiencing brain herniation, indicating severe pathophysiology.
The brain’s reflex actions and posture are controlled by the cerebellum.

Glasgow Coma Scale and Awareness

The Glasgow Coma Scale reflects the patient’s neurologic status—higher scores indicate better states of consciousness.

Respiratory Management

In patients with compromised airway status, such as low responsiveness and snoring respirations, performing the jaw-thrust maneuver is critical.

Additional Injury Insights

Symptoms like clear fluid draining from the nose can signal a loss of cerebrospinal fluid.
Linear skull fractures typically cannot be detected through physical palpation.
Retrograde amnesia in patients suggests a lapse in memory regarding the injury event.

Severe Brain Injuries

Unresponsive patients with heavy head trauma may indicate serious brainstem damage, necessitating rapid medical intervention.

Alcohol Influence and Responsiveness

Consider alcohol intoxication in patients with head injuries and altered consciousness, as it complicates assessment.

Wound Treatment

Large lacerations on the head should be treated with loose dressings to prevent further injury and manage bleeding.

Assessment Continuation

Noteworthy head depressions should be documented and continuously assessed.

Penetrating Injuries

Cerebrospinal fluid from a wound is a strong indicator of penetration through the meningeal layers and requires urgent care.

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