Anki Flashcards
What is the atrium?
This is the upper chamber of the heart that receives incoming blood.
What is the ventricle?
This is the lower chamber of the heart, and pumps out the outgoing blood.
What is the aorta?
This is the body's main artery, and it receives the blood ejected from the left ventricle and delivers it to all the other arteries.
What does the right side of the heart do?
This side of the heart receives deoxygenated blood from the veins of the body, through the vena cava. After contraction of the ventricle on this side, blood flows into the pulmonary artery where the blood is oxygenated.
How does the oxygenated blood return to the heart?
This returns to the heart through the pulmonary veins to the left side of the heart.
Why is the left side of the heart more muscular than the right?
This side is more muscular because it has to pump blood into the aorta and all other arteries of the body.
What is automaticity?
This is a special characteristic found in cardiac muscle cells. It allows a cardiac muscle cell to contract spontaneously without stimulus from a nerve-source.
What is the autonomic nervous system?
This is the part of the brain that controls the functions of the body that do not require conscious thought, such as the heartbeat, respirations, dilation and constriction of blood vessels, and digestion of food. It has two parts: The sympathetic nervous system and the parasympathetic nervous system.
What does the sympathetic nervous system do?
This speeds up the heart rate, increases respiratory rate and depth, dilates blood vessels in the muscle, and constricts blood vessels in the digestive system.
What does the parasympathetic nervous system do?
This directly opposes the other system, it slows the heart and respiratory rates, constricts blood vessels in the muscles, and dilates blood vessels in the digestive system.
What is the mycardium?
This is heart muscle, and must have a continuous supple of oxygen and nutrients.
What is stroke volume?
This is the volume of blood ejected with each ventricular contraction.
What are coronary arteries?
These are blood vessels that supply blood to the heart muscle, starting at aortic valve
what does atherosclerosis lead to?
- can cause complete occlusion, or blockage, of coronary artery- evnetually, as people age, the smooth and elastic artery wall becomes brittle and rough with atherosclerotic plaques
What is lumen?
- This is the inside diameter of the artery. It narrows as a person ages as more fatty material- like cholesterol and calcium- is deposited
Where can the posterior tibial pulse be felt?
This can be felt on the inside of the ankle.
Where can the dorsalis pedis pulse be felt?
This can be felt at the top of the foot.
Where can the brachial pulse be felt?
This can be felt on the inside of the upper arm.
What is a thromboembolism?
This is a blood clot that is floating through blood vessels until it reaches an area too narrow for it to pass, causing it to block blood flow. These tissue will become hypoxic, and may die without correct treatment
What is an acute myocardial infarction (AMI)?
- This is a blockage that occurs in a coronary artery, from thromboembolism, and is also known as a heart attack- infarction means death of tissue- must treat quick bc dead cells can't be relieved
What is cardiac arrest?
- This is the complete stopage of the heart, caused by infarction, or death of heart tissue. - It is determined by the absence of a palpable pulse at the carotid artery.- heart unable to pump or stop completely: no palpable pulse
What is acute coronary syndrome (ACS)?
- This describes a group of symptoms caused by myocardial ischemia, or a decrease blood flow to the heart, which leads to chest pain.- May be temporary angina pectoris or more serious AMI
What is angina pectoris?
- This is when, for a brief time, heart tissues are not getting enough oxygen. It is often a symptom of atherosclerotic coronary artery disease.- low O2 levels usually during stress
Why is fast action so critical in treating an A.M.I. (A.K.A. a heart attack)?
Fast action is critical in treating this because once dead, heart muscle tissue cannot be revived. Instead, they turn into scar tissue and become a burden to the beating heart.
What is the timeline for an AMI?
During this, 30 minutes after blood flow is cut off, some cells begin to die. After 2 hours, as many as half. After 4-6, more than 90%.
What are the signs and symptoms of AMI?
Signs and symptoms of this include:- Sudden onset fo weakness, nausea, and sweating without an obvious cause.- Chest pain, discomfort, or pressure that is often crushing or squeezing and that does not change with each breath.- Pain, discomfort, or pressure in the lower jaw, arms, back, abdomen, or neck.- Irregular heartbeat and syncope.- Shortness of breath, or dyspnea- Pink, frothy sputum- Sudden death- Some pts like women, elderly, and diabetics, may not experience pain- or mild discomfort- so look out for other symptoms
How is the pain of an AMI different from the pain of angina?
It is different from angina in three ways:- It can occur during exercise OR when a person is sitting quietly or even sleeping.- It does not resolve in a few minutes; rather, it can last between 30 minutes and several hours.- It may or may not be relieved by rest or nitroglycerin.
What are the physical findings of AMI?
These are:- Nausea, vomiting, sweating, pale skin, possible cyanosis- irregular or even a slowing of the pulse, bradycardia- dec blood pressure. Most of the time may have normal or elevated blood pressure- normal unless pt has CHS â rapid and labored w frothy sputum- impending sense of doom
What is an arrhythmia?
This is an abnormality of heart rhythm, whereby the heart is using up energy without pumping any blood. It is also known as ventricular fibrillation.
What is tachycardia?
This is rapid beating of the heart, 100 BPM or higher.
What is bradycardia?
This is unusually slow beating of the heart, 60 BPM or less.
What is ventricular tachycardia?
This occurs when electrical activity starts in the ventricle instead of the atrium, causing a rapid heart rate of 150-200 BPM. Blood pressure falls, pulse drops, and may deteriorate into ventricular defibrillation.
What is congestive heart failure (CHF)?
- When the ventricular heart muscle is so damaged that it can no longer keep up with the return flow of blood from the atria. - can occur any time after MI or bc of high blood pressure or days after heart attack- Blood backs up in the pulmonary veins, increasing pressure in the capillaries of the lungs and forcing water into the alveoli, causing pulmonary, or dependent, edema.
What is dependent edema?
This is the collection of fluid in the part of the body that is closest to the ground.
What is a hypertensive emergency?
This is when the systolic pressure is greater than 160 mm Hg.
What is an aortic aneurysm? cause?
- This is a weakness in the wall of the aorta, making it susceptible to rupture- cause: uncontrolled hypertension
What is a dissecting aneurysm?
This occurs when the inner layers of the aorta become separated, allowing blood to flow between the layers.
What is special consideration for atheltic patients?
These patients tend to have slower heart rates at rest.
What is the difference between AMI and dissecting aneurysm regarding the onset of pain?
The difference between the two is:AMI: Gradual, with additional symptoms.Dissecting Aneurysm: Abrupt, without additional sympoms.
What is the difference between AMI and dissecting aneurysm regarding the quality of pain?
The difference is:AMI: Tightness or pressureDissecting aneurysm: Sharp or Tearing
What is the difference between AMI and dissecting aneurysm regarding the severity of pain?
The difference is:AMI: Increases with timeDissecting aneurysm: Maximal from the outset
What is the difference between AMI and dissecting aneurysm regarding the timing of pain?
The difference is:AMI: May wax and waneDissecting Aneurysm: Does not abate once it has started
What is the difference between AMI and dissecting aneurysm regarding the region/radiation of pain?
The difference is:AMI: Substernal; back rarely involvedDissecting Aneurysm: Back possibly involved, between the shoulder blades
What is the difference between AMI and dissecting aneurysm regarding clinical signs?
The difference is:AMI: Peripheral pulses equalDissecting Aneurysm: Blood pressure discrepancy between arms or decrease in femoral or carotid pulse.
What is the cerebrum?
It contains about 75% of the brain's total volume, and controls a wide variety of activities, including most voluntary motor functions and conscious thought.
What is the brain stem?
It controls virtually all the functions that are necessary for life, including the cardiac and respiratory systems and nerve function transmissions. It is deep inside the cranium and is the best-protected part of the CNS.
What is grey matter composed of?
This is composed of neural cell bodies and synapses, which are connections between nerve cells.
What does white matter consist of?
This consists of fiber pathways.
What is the skull covered by?
It is covered by layers of muscle, superficial fascia, and thick skin.
What protects the CNS?
It is protected by the meninges, three distinct laters of tissue that suspend the brain and the spinal cord within the skull and the spinal canal..
What is the outer layer of the meninges?
It is the dura mater, a tough fibrous layer that closely resembles leather.
What are the two inner layers of the meninges?
They are the arachnoid and the pia mater. They contain the blood vessels that nourish the brain and spinal cord.
Where is CSF (Cerebral Spinal Fluid) produced?
This is produced inside a chamber in the brain, called the third ventricle.
Where is cerebral spinal fluid, A.K.A. CSF, located?
This is located in the subarachnoid space below the arachnoid.
What is the primary purpose of CSF?
The primary purpose of this is to act as a shock absorber for the brain.
How many anatomic parts does the peripheral nervous system have?
It has two parts: 31 pairs of spinal nerves and 12 pairs of cranial nerves.
What do the spinal nerves do?
They conduct sensory impulses from the skin and other organs to the spinal cord.
What does the brachial plexus control?
This controls the arms.
What does the lumbosacral plexus control?
This controls the legs.
What are cranial nerves?
These emerge from the brain stem and transmit information directly to or from the brain. For the most part, they perform special functions in the head and face, including sight, smell, taste, hearing, and facial expressions.
What are the two major types of peripheral nerves?
They are the sensory nerves and motor nerves.
What do the sensory nerves do?
These carry information from the body to the brain via the spinal cord.
What do the motor nerves do?
These carry information from the CNS to the muscles.
What are connecting nerves?
These, found only in the brain and spinal cord, connect the sensory and motor nerves with short fibers, which allow the cells on either end to exchange simple messages.
What are voluntary activities?
These are actions which are consciously perform, in which sensory input determines the specific muscular activity.
What are involuntary activities?
These are actions that are not under a person's conscious control, such as breathing.
What are the intercostal muscles?
These muscles extend between the ribs, and are innervated from the spinal nerves originating in the cervical region C6 and C7, and allow the chest to expand on contraction and allow for the active portion of ventilation to occur.
What is belly breathing?
This occurs when a patient is breathing entirely with their diaphragm, and is considered a clinical or positive diagnostic finding that indicates cord damage at or above the C6 or C7 level.
What is a closed chest injury?
This is an injury in which the skin is not broken, and is generally caused by blunt trauma. These types of injuries often cause significant contusions in both the cardiac muscle and lung tissues (pulmonary contusions), impairing the function of these organs.
What is an open chest injury?
This is when some object penetrates the chest wall itself.
What are the signs and symptoms of chest injury?
Signs and symptoms of these are:Pain at the site of injury;Pain localized at the site of injury that is aggravated by or increasing with breathing;Bruising to the chest wall;Crepitus with palpation of the chest;Any penetrating injury to the chest;Dyspnea;Hemoptysis (coughing up blood);Failure of one or both sides of the chest to expand normally with inspiration;Rapid, weak pulse and low blood pressure;Cyanosis around the lips or fingernails
What kind of breathing do chest trauma patients often have?
Patients with this injury often have tachypnea and shallow respirations, as it hurts to take a breath.
What is pleuritic pain or pleurisy?
This is irritation of or damage to the pleural surfaces, which causes a characteristic sharp or sticking pain with each breath when these normally smooth surfaces slide on one another.
In a patient with chest trauma, what does dyspnea indicate?
This indicates many things, including airway obstruction, damage to the chest wall, improper chest expansion because of the loss of normal control of breathing, or lung compression because of accumulated blood or air in the chest cavity.
What does hemoptysis in a chest trauma patient indicate?
This indicates that the lung itself or the air passages have been damaged.
What is paradoxical motion?
This is an abnormality associated with multiple fractured ribs, in which one segment (often referred to as a flail segment) of the chest wall moves opposite the remainder of the chest; that is, out with expiration and in with inspiration.
What is occlusive dressing?
This is a dressing made of Vaseline-impregnated gauze, aluminum foil, or plastic that protects a wound from air and bacteria.
What should you remember when treating a chest trauma patient with positive-pressure ventilation?
In this situation, it is important to remember that you are overcoming normal physiologic functions, and if your patient has pneumothorax, you can easily exacerbate the injury.
What are the Deadly Dozen Chest Injuries that must be detected and managed during primary assessment?
These are:1. Airway obstruction2. Bronchial disruption3. Diaphragmatic tear4. Esophageal injury5. Open pneumothorax6. Tension pneumothorax7. Massive hemothorax8. Flail chest9. Cardiac tamponade[SECONDARY ASSESSMENT]10. Thoracic aortic dissection11. Myocardial contusion12. Pulmonary contusion
What should you always be alert for in elderly trauma patient?
With these patients, reduced bone density may cause a number of fractures to the rib cage.
What is the difference between hypoxia and hypoxemia?
The first is a decrease in available oxygen; the second is a decreased number of red blood cells that can carry oxygen.
What is an open pneumothorax?
This is an open or penetrating wound to the chest that is also called a sucking chest wound. You can actually hear a sucking sound as the patient inhales and a rushing sound as they exhale.
What is a flutter valve?
This is a one-way valve that allows air to leave the chest cavity but not return. Careful obervation is required after the placement of this dressing.
What should you do if signs of a tension pneumothorax develop?
If this develops, it is suggested that the occlusive dressing be partially removed to allow the chest to vent.
What is the weakened area of the lung called?
This area is called a bleb.
What is spontaneous pneumothorax?
This event is not related to any major injury but simply happens with normal breathing or may occur during times of strenous physical activity such as exercise or coughing forcefully.
What is a tension pneumothorax?
This conditions occurs when there is significant ongoing air accumulation in the pleural space. This air gradually increases the pressure in the chest, first causing the complete collapse of the affected lung and then pushing the mediastinum (the central part of the chest containing the heart and great vessels) into opposite pleural cavity. This prevents blood from returning through the venae cavae to the heart, ultimately leading to shock and death.
What are common signs and symptoms of tension pneumothorax?
Common signs and symptoms of this are: increasing respiratory distress, altered level of consciousness, distended neck veins, deviation of the trachea to the side of the chest opposite, and decreased breath sounds on the side of the injury.
What is hemothorax?
This is a condition in which blood collects in the pleural space of the thorax.
What is hemopneumothorax?
This condition is the presence of air and blood in the pleural space of the thorax.
What is cardiac tamponade (pericardial tamponade)?
This condition occurs more commonly in the presence of penetrating chest trauma, when the protective membrane around the heart (pericardial sac) fills with blood or fluid (pus from an infection). As the fluid amount increases, the heart is less able to fill with blood during relaxation, so the heart cannont pump an adequate amount of blood.
What are the signs and symptoms of cardiac tamponade (pericardial tamponade)?
The signs and symptoms of this are referred to as Beck's triad, and include: distended or engorged jugular veins seen on both sides of the trachea, a narrowing pulse pressure (difference between systolic and diasystolic), and muffled heart sounds.
What is the Frank-Starling mechanism?
This is the mechanism that streches the heart to create a good contraction to pump blood out of the heart's ventricles.
What does crepitus (subcutaneous emphysema) indicate in a chest trauma patient?
This condition indicates that air escaping from a lacerated lung is leaking into the chest wall.
What is flail chest?
This condition is when three or more ribs are fractured in two or more places, or if the sternum is fractured along with several ribs, and a segment of the chest wall may detach from the rest of the thoracic cage. This seriously interferes with the body's normal ventilation mechanics and must be addressed quickly.
How should you treat a patient with a flail chest?
In this situation, you should maintain the airway, provide respiratory support if necessay, give supplemental oxygen, and perform ongoing assessments for possible pneumothorax or other respiratory complications. Treatment may also include positive-pressure ventilations with a bag-mask device. You can also immobilize the patient with a pillow that the patient can hold against the chest wall.
What is a pulmonary contusion?
This the injuring or bruising of lung tissue that results in hemorrhage.
When should you suspect pulmonary contusion, and what should you provide?
You should always suspect this in patients with flail chest, and should provide respiratory support and supplemental oxygen to ensure adequate ventilation.
What is traumatic asphyxia?
This is result of a sudden, severe compression of the chest, which produces a sudden increase in intrathoracic pressure, and results in a characteristic appearance, including distended neck veins, cyanosis in the face and neck, and hemorrhage into the sclera of the eyes.
How should you treat traumatic asphyxia?
This condition is severe and you should provide ventilatory support with supplemental oxygen and monitor the patient's vital signs as you provide IMMEDIATE transport.
What is myocardial contusion?
This is the bruising of the heart muscle. Provide supplemental oxygen and transport immediately.
What is commotio cordis?
This is a blunt chest injury caused by a sudden, direct blow to the chest over the heart that occurs during the critical portion of a heartbeat, possibly resulting in immediate cardiac arrest. The blunt force causes a lethal abnormal heart rhythm called ventricular fibrillation.
How should you treat commotio cordis?
In this situation, the ventricular fibrillation that occurs from this injury responds well to early defibrillation if provided in the first 2 minutes after injury.
What are the large blood vessels in the chest?
These are the superior vena cava, the inferior vena cava, the pulmonary arteries, four main pulmonary veins, and the aorta.
What are the five sections of the spinal column, and how many vertebrae in each?
They are the cervical (7), thoracic (12), lumbar (5), sacral (5), and coccygeal (4).
What connects and separates the vertebrae?
They are connected by ligaments and separated by cushions known as intervertebral disks.
What are the general signs and symptoms of a head injury?
The general signs and symptoms of this are: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 heart rate;Ecchymosis about the eyes or behind the ear over the mastoid process;Clear or pink CSF 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)
Where is a skull fracture diagnosis usually made?
This is usually made in a hospital with a computed tomographic, or CT, scan.
What are some signs of a skull fracture?
Some signs of this are ecchymosis (bruising) that develops under the eyes (aka raccoon eyes) or behind one ear over the mastoid process (aka battle's sign).
What causes compressed skull fractures?
These result from high-energy direct trauma to the head with a blunt object (such as a baseball bat to the head).
What are basilar skull fractures?
These are associated with high-energy trauma, and usually occur following diffuse impact to the head (e.g. falls, motor crashes). These injuries generally result from extension of a linear fracture to the base of the skull and can be difficult to diagnose with radiography (X-ray).
What are the signs of a basilar skull fracture?
Signs of this include CSF drainage from the ears (a risk for bacterial meningitis), which indicates rupture of the tympanic membrane in the ear. Other signs include raccoon eyes or battle's sign.
What is a traumatic brain injury (TBI)?
These are defined as "a traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes" (from the National Head Injury Foundation).
What are the two broad catagories of TBI?
These are primary (direct) injuries and secondary (indirect) injuries.
What are primary (direct) injuries?
These are injury to the brain and its associated structures that results instantaneously from impact to the head.
What are secondary (indirect) brain injuries?
These refer to a multitude of processes that increase the severity of a primary brain injury and therefore, negatively impact the outcome.
What are the two most common causes of secondary injuries to the brain?
The two most common causes of this are hypoxia and hypotension.
What are some causes of secondary injuries to the brain? 7 + defs
These may be caused by cerebral edema, intracranial hemorrhage (bleeding from ruptured vessel), increased intracranial pressure, cerebral ischemia (insufficient blood flow to brain), infection, and hypoxia and hypotension (the two most common causes).
How long after a TBI can secondary brain injuries occur?
They can occur anywhere from a few minuters to several days following the injury.
What is coup-contrecoup injury?
This is when the brain strikes the front and back of the skull due to rapid deceleration.
What is cerebral edema?
This is swelling of the brain, and may not develop until several hours after the initial injury due to fluids
What aggravates and improves cerebral edema?
This is aggravated by low oxygen levels in the blood, and improved by high ones. This is especially true if the patient is unconscious.
Why is it not uncommon for a patient with a head injury to have a seizure?
This is not uncommon for a patient with a head injury as a result of excessive excitability of the brain, caused by direct injury or the accumulation of fluid within the brain (edema).
What can lead to a rapid increase in intracranial pressure?
This can be caused by an accumulation of blood within the skull or swelling of the brain.
What are the signs and symptoms of a mild elevation of intracranial pressure?
The signs and symptoms of this are:Increased blood pressure and decreased pulse rate;Pupils that are still reactive;Cheyne-Strokes respirations (respirations that are fast and then become slow, with intervening periods of apnea);Patient initially attempts to localize and remove painful stimuli, followed by withdrawal and extension;[EFFECTS ARE REVERSIBLE WITH PROMPT TREATMENT]
What are the signs and symptoms of moderate elevation in intracranial pressure?
The signs and symptoms of this are:Widened pulse pressure and bradycardia;Pupils that are sluggish or nonreactive;Central neurogenic hyperventilation (deep, rapid respirations);Decerebrate posturing;[SURVIVAL IS POSSIBLE BUT NOT WITHOUT PERMANENT NEUROLOGIC DEFICIT]
What are the signs and symptoms of marked elevation in intracranial pressure?
The signs and symptoms of this are:Unilateral fixed and dilated pupils;Ataxic respirations (characterized by irregular rate, pattern, and volume of breathing with intermittent periods of apnea), or absent respirations;Flaccid response to painful stimuli;Irregular pulse rate;Diminished blood pressure;NB: This level of ICP indicates that the lower portion of the brain stem is involved[MOST PATIENTS DO NOT SURVIVE THIS LEVEL OF INTRACRANIAL PRESSURE]
What is an intracerebral hematoma?
This involves bleeding within the brain tissue itself. They have a high mortality rate.
What is a subarachnoid hemorrhage?
This is when bleeding occurs into the subarachnoid space, where the CSF circulates.
What are common causes of subarachnoid hematoma?
The common causes of this condition include trauma or rupture of an aneurysm.
What is a common symptom of a subarachnoid hematoma?
A common symptom of this is a sudden, severe headache. Mortality rates are high, and permanent neurologic impairment is common.
What is a concussion?
This is a mild TBI caused by a blow to the head or face. It is in general a closed injury with a temporary loss of alteration of part or all of the brain's abilities to function without demonstrable physical damage to the brain.
What is retrograde amneisa?
This is when the patient can remember everything but the events leading up to the injury.
What is anterograde (posttraumatic) amnesia?
This is when a patient is unable to remember events after the injury.
What are some additional signs and symptoms you may see in concussion patients?
With these patients, you may see nausea or vomiting, ringing in the ears, slurred speech, and an inability to focus.
What should you always assume with patients with symptoms of a concussion?
You should always assume that these patients have a more serious injury.
What is a brain contusion?
A contusion involves physical injury to the brain tissue, and is therefore more serious than a concussion.
What often causes spinal compression injuries?
These can occur as a result of a fall, regardless of whether the patient landed on his or her feet, coccyx, or on top of the head.
What is a distraction?
This is when the spine is pulled along its length.
What is subluxation?
This is an incomplete dislocation of a joint.
What is the best way to protect a patient with a spinal injury's airway?
The best way to do this is to use advanced airway techniques employed by AEMT and paramedics.
What does the absence of pain and/or the ability to move and feel extremities tell you about spinal injuries?
This does NOT rule out spinal injuries.
What does a gradual and progressive deterioration in the patient's response to stimuli indicate?
This usually indicates serious brain injury that may need surgical treatment; physicians at the hospital will need to know when a loss of consciousness occurs.
What is another name for Cushing's triad?
Another name for this is herniation syndrome.
What are the signs of Cushing's triad?
The signs of this are: hypertension, bradycardia, irregular respirations (for example Cheyne-Stokes respirations), central neurogenic hyperventilation, and Biot respirations (irregular rate, pattern, and depth of breathing).
What is Cushing's triad / herniation syndrome?
This is when the intracranial pressure is so great that it forces the brain stem and the midbrain through the foramen magnum (large circular opening in occipitol lobe through skull)
What is the prime concern for the patient when you perform the four-person log roll?
The prime concern in this situation is to ensure that the head, torso, and pelvis move as a unit, with your teammates controlling the movement of the body.
What should you do with a patient wandering around after an accident whom you suspect of having a skull or spinal injuries?
In this situation, you should NOT have them lie down; immobilize them with a long backboard in the upright position.
When should a helmet be left on an injured trauma patient?
This should always be left on provided: There are no impending airway or breathing problems; it does not interfere with assessment and treatment of airway or ventilation problems; and you can properly immobilize the spine.
When should a helmet be removed?
This should be removed from a trauma patient if: 1) It makes assessing or managing airway problems difficult and removing of the face guard is not possible. 2) It prevents you from properly immobilizing the spine. Or 3) It allows excessive head movement. Remember to always remove in the event of cardiac arrest, and, most importantly:ALWAYS CONSULT WITH MEDICAL CONTROL IF YOU DECIDE TO REMOVE THIS.
What is an additional consideration for children with helmets and skull or spinal injuries?
In this situation, they may require additional padding to maintain the in-line neutral position due to their smaller airways and larger heads.