Head, Spine, and Neurologic Trauma - NREMT AEMT Level

1. Identify the key spinal cord injury finding that indicates incomplete cord function.

   Presence of sensation or motor function below the injury. Sparing of some neural pathways allows partial preservation, contrasting with complete transection.

2. Which intracranial bleed is classically associated with a lucid interval after head injury?

   Epidural hematoma. Arterial bleeding leads to rapid hematoma formation, causing temporary recovery followed by deterioration.

3. What is neurogenic shock in the context of spinal cord injury?

   Hypotension with bradycardia from loss of sympathetic tone. Spinal cord disruption interrupts sympathetic pathways, leading to unopposed parasympathetic effects.

4. What is Cushing reflex (Cushing triad) in increased ICP?

   Hypertension, bradycardia, and irregular respirations. This compensatory response to increased ICP aims to maintain cerebral perfusion through elevated blood pressure and slowed heart rate.

5. Which intracranial bleed is most associated with bridging vein rupture and slower onset symptoms?

   Subdural hematoma. Venous bleeding accumulates gradually, resulting in delayed symptom presentation.

6. What is the Glasgow Coma Scale (GCS) total score range?

   Range $3$ to $15$. The scale quantifies neurologic function from minimal responsiveness to full alertness.

7. Which motor posturing indicates more severe brain injury: decorticate or decerebrate?

   Decerebrate posturing (extension) is more severe. It signifies deeper brainstem dysfunction compared to decorticate, which involves higher brain levels.

8. What is a basilar skull fracture sign involving periorbital bruising?

   Raccoon eyes (periorbital ecchymosis). Ecchymosis occurs due to blood leakage from fractured anterior skull base into orbital tissues.

9. Identify the GCS component scores for motor response (M).

   M6 obeys; M5 localizes; M4 withdraws; M3 flexion; M2 extension; M1 none. Scores assess purposeful movement, revealing brainstem and cortical integrity.

10. Which spinal region injury is most likely to cause diaphragmatic paralysis and apnea?

    High cervical injury (about $C^3$ to $C^5$). The phrenic nerve originates here, and injury disrupts diaphragmatic innervation essential for breathing.

11. What is the key prehospital airway and ventilation goal in suspected severe TBI?

    Prevent hypoxia and maintain adequate ventilation. Hypoxia exacerbates secondary brain injury, so ensuring oxygenation supports cerebral function.

12. Which maneuver should be used to open the airway in a trauma patient with possible spine injury?

    Jaw-thrust maneuver. This technique avoids neck extension, minimizing risk of exacerbating cervical spine damage.

13. What finding suggests a basilar skull fracture when fluid drains from the nose or ear?

    CSF leak (rhinorrhea or otorrhea). Fracture disrupts dural integrity, allowing cerebrospinal fluid to escape through nasal or ear passages.

14. What is the preferred initial airway adjunct for an unconscious head-injury patient with no gag reflex?

    Oropharyngeal airway (OPA). Absence of gag reflex allows safe insertion to maintain airway patency without triggering vomiting.

15. Identify the GCS component scores for eye opening (E).

    E4 spontaneous; E3 to voice; E2 to pain; E1 none. Scores reflect varying levels of responsiveness, contributing to overall assessment of consciousness.

16. What is a basilar skull fracture sign involving bruising behind the ear?

    Battle sign (mastoid ecchymosis). Bruising results from blood tracking along fascial planes from a fracture at the skull base.

17. What clinical finding helps differentiate neurogenic shock from hemorrhagic shock?

    Neurogenic shock often has bradycardia and warm, dry skin. Unlike hemorrhagic shock's compensatory tachycardia and vasoconstriction, neurogenic lacks these responses.

18. What is the target oxygen saturation for a patient with suspected head injury?

    Maintain $SpO_2 94\%$. Adequate oxygenation prevents secondary insults to the injured brain, aligning with trauma guidelines.

19. What GCS score threshold commonly defines severe traumatic brain injury (TBI)?

    GCS $\le 8$. Lower scores indicate profound impairment, guiding triage and intervention urgency in trauma care.

20. What is the most reliable early indicator of increased intracranial pressure (ICP) in head trauma?

    Decreasing level of consciousness (worsening mental status). This reflects deteriorating brain function due to pressure buildup, serving as an early warning before vital sign changes.

21. Identify the GCS component scores for verbal response (V).

    V5 oriented; V4 confused; V3 inappropriate; V2 incomprehensible; V1 none. Scores evaluate communication ability, indicating cognitive function in neurologic evaluation.

22. What pupil finding suggests possible uncal herniation from increased ICP?

    Unilateral fixed, dilated pupil (ipsilateral mydriasis). Compression of the oculomotor nerve from herniating temporal lobe causes pupil dilation on the same side.

23. What is spinal shock following spinal cord injury?

    Temporary loss of reflexes and flaccid paralysis below injury. Initial cord edema causes transient functional loss, distinguishing it from permanent damage.

24. What is the appropriate action when a helmeted patient has airway compromise in trauma?

    Remove the helmet with spinal motion restriction to manage airway. Airway priority supersedes helmet retention when compromise exists, using techniques to limit spinal movement.

25. What is the correct prehospital management for a suspected CSF leak from ear or nose?

    Do not pack; cover loosely with sterile dressing. This approach prevents infection risk while allowing fluid drainage without obstruction.

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