← back to chapter

Referencing the content of EMT-Basic training and emergency patient care

EMT Basic · Chapter 29

Head and Spine Injuries

Learning objectives (15)

  1. Define traumatic brain injury (TBI) — Knowledge/skills objective (printed page 1039); confirm wording in your course copy.
  2. Demonstrate how to perform a jaw-thrust maneuver on a patient with a suspected spinal injury — Knowledge/skills objective (printed page 1040); confirm wording in your course copy.
  3. Describe the anatomy and physiology of the nervous system, including its divisions into the central nervous system (CNS) and peripheral nervous system (PNS) and the structures and — Knowledge/skills objective (printed page 1039); confirm wording in your course copy.
  4. Describe the different types of brain injuries and their corresponding signs and symptoms, including increased intracranial pressure (ICP), concussion, contusion, and injuries caus — Knowledge/skills objective (printed page 1039); confirm wording in your course copy.
  5. Describe the different types of injuries that may damage the cervical, thoracic, or lumbar spine; include examples of possible MOIs that may cause each one — Knowledge/skills objective (printed page 1039); confirm wording in your course copy.
  6. Discuss age-related variations that are required when providing emergency care to a pediatric patient who has a suspected head or spine injury — Knowledge/skills objective (printed page 1040); confirm wording in your course copy.
  7. Explain emergency medical care of a patient with a head injury; include the three general principles designed to protect and maintain the critical functions of the CNS and ways to — Knowledge/skills objective (printed page 1040); confirm wording in your course copy.
  8. Explain the difference between a primary (direct) injury and a secondary (indirect) injury; include examples of possible MOIs that may cause each one — Knowledge/skills objective (printed page 1039); confirm wording in your course copy.
  9. Explain the different circumstances in which a helmet should be left on or taken off a patient with a possible head or spinal injury — Knowledge/skills objective (printed page 1040); confirm wording in your course copy.
  10. Explain the different types of head injuries, their potential mechanism of injury (MOI), and general signs and symptoms of a head injury that EMTs should consider when performing a — Knowledge/skills objective (printed page 1039); confirm wording in your course copy.
  11. Explain the functions of the somatic and autonomic nervous systems — Knowledge/skills objective (printed page 1039); confirm wording in your course copy.
  12. Explain the steps in the patient assessment process for a person who has a suspected head or spine injury; include specific variations that may be required as related to the type o — Knowledge/skills objective (printed page 1039); confirm wording in your course copy.
  13. List the MOIs that cause a high index of suspicion for the possibility of a head or spinal injury — Knowledge/skills objective (printed page 1040); confirm wording in your course copy.
  14. List the major bones of the skull and spinal column and their related structures; include their functions as they relate to the nervous system — Knowledge/skills objective (printed page 1039); confirm wording in your course copy.
  15. List the steps EMTs must follow to remove a helmet, including the removal of a football helmet — Knowledge/skills objective (printed page 1040); confirm wording in your course copy.

Vocabulary (14)

Traumatic brain injury (TBI)
An injury to the brain caused by external force — ranging from mild concussion to severe brain damage.
Concussion
A mild TBI marked by transient neurologic symptoms — confusion, headache, brief loss of consciousness — without structural brain injury on imaging.
Contusion (cerebral)
Bruising of brain tissue from blunt impact, with localized bleeding and swelling.
Coup-contrecoup injury
Brain injury occurring both at the site of impact (coup) and on the opposite side from rebound (contrecoup).
Epidural hematoma
Bleeding between the skull and dura mater, often arterial, classically with a lucid interval followed by rapid deterioration.
Subdural hematoma
Bleeding between the dura and brain, typically venous; can develop acutely or chronically, especially in older adults on anticoagulants.
Intracerebral hemorrhage
Bleeding directly into brain tissue from a ruptured vessel.
Intracranial pressure (ICP)
The pressure inside the skull; sustained elevation reduces brain perfusion and worsens brain injury.
Cushing's triad
A late sign of increased intracranial pressure — rising blood pressure, falling pulse, and irregular respirations.
Spinal motion restriction (SMR)
Keeping the spine in neutral alignment when injury is suspected; selectively applied per current evidence.
Neurogenic shock
Distributive shock from loss of sympathetic tone below a spinal cord injury, producing hypotension with bradycardia and warm skin.
Spinal shock
A transient loss of reflex activity below a spinal cord injury that typically resolves over hours to weeks.
Decorticate posturing
Abnormal posture with arms flexed, fists clenched, and legs extended — indicates injury at or above the upper brainstem.
Decerebrate posturing
Abnormal posture with arms extended and rotated outward — indicates more severe brainstem injury and worse prognosis than decorticate.

Sequence practice (2 puzzles on Quiz Me)

Spinal motion restriction in a suspected spine-injured patient

Order the EMT actions for spinal motion restriction.

  1. Assess and document neurologic status (motor, sensation, pulses) in all extremities
  2. Manually stabilize the head in neutral alignment
  3. Apply an appropriately sized cervical collar
  4. Move the patient as a unit (log roll or scoop) to the transport device
  5. Secure the torso, then the head, with padding to maintain neutral alignment
  6. Reassess neurologic status before transport
Cushing's triad as ICP rises

Order the three components of Cushing's triad as intracranial pressure becomes critical.

  1. Rising systolic blood pressure (widening pulse pressure)
  2. Falling pulse (bradycardia)
  3. Irregular respirations

Quick fire sample (14 of 14 on Quiz Me)

An injury to the brain caused by external force — ranging from mild concussion to severe brain damage.
  1. Traumatic brain injury (TBI)
  2. Intracranial pressure (ICP)
  3. Epidural hematoma
  4. Coup-contrecoup injury
A mild TBI marked by transient neurologic symptoms — confusion, headache, brief loss of consciousness — without structural brain injury on imaging.
  1. Intracerebral hemorrhage
  2. Spinal motion restriction (SMR)
  3. Decerebrate posturing
  4. Concussion
Bruising of brain tissue from blunt impact, with localized bleeding and swelling.
  1. Decerebrate posturing
  2. Contusion (cerebral)
  3. Spinal motion restriction (SMR)
  4. Traumatic brain injury (TBI)
Brain injury occurring both at the site of impact (coup) and on the opposite side from rebound (contrecoup).
  1. Intracranial pressure (ICP)
  2. Coup-contrecoup injury
  3. Spinal motion restriction (SMR)
  4. Decorticate posturing
Bleeding between the skull and dura mater, often arterial, classically with a lucid interval followed by rapid deterioration.
  1. Traumatic brain injury (TBI)
  2. Intracerebral hemorrhage
  3. Decerebrate posturing
  4. Epidural hematoma
Bleeding between the dura and brain, typically venous; can develop acutely or chronically, especially in older adults on anticoagulants.
  1. Intracerebral hemorrhage
  2. Neurogenic shock
  3. Subdural hematoma
  4. Concussion
Bleeding directly into brain tissue from a ruptured vessel.
  1. Spinal motion restriction (SMR)
  2. Epidural hematoma
  3. Subdural hematoma
  4. Intracerebral hemorrhage
The pressure inside the skull; sustained elevation reduces brain perfusion and worsens brain injury.
  1. Intracranial pressure (ICP)
  2. Subdural hematoma
  3. Decerebrate posturing
  4. Intracerebral hemorrhage
A late sign of increased intracranial pressure — rising blood pressure, falling pulse, and irregular respirations.
  1. Intracerebral hemorrhage
  2. Contusion (cerebral)
  3. Cushing's triad
  4. Decerebrate posturing
Keeping the spine in neutral alignment when injury is suspected; selectively applied per current evidence.
  1. Traumatic brain injury (TBI)
  2. Coup-contrecoup injury
  3. Subdural hematoma
  4. Spinal motion restriction (SMR)
Distributive shock from loss of sympathetic tone below a spinal cord injury, producing hypotension with bradycardia and warm skin.
  1. Concussion
  2. Traumatic brain injury (TBI)
  3. Intracranial pressure (ICP)
  4. Neurogenic shock
A transient loss of reflex activity below a spinal cord injury that typically resolves over hours to weeks.
  1. Traumatic brain injury (TBI)
  2. Spinal shock
  3. Contusion (cerebral)
  4. Intracerebral hemorrhage
Abnormal posture with arms flexed, fists clenched, and legs extended — indicates injury at or above the upper brainstem.
  1. Traumatic brain injury (TBI)
  2. Intracranial pressure (ICP)
  3. Spinal shock
  4. Decorticate posturing
Abnormal posture with arms extended and rotated outward — indicates more severe brainstem injury and worse prognosis than decorticate.
  1. Spinal shock
  2. Concussion
  3. Decerebrate posturing
  4. Intracerebral hemorrhage

Some topics in this course differ across field references. See when sources disagree on Quiz Me before you teach from this sheet alone.

Full scored drills are on Quiz Me at /courses/nm-emt-b/chapters/29/print/. Answers are not marked on this sheet.