Head and Spine Injuries

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Head and Spine Injuries

• Chapter 13

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Head and Spine Anatomy

• Brain
• Enclosed in the skull
• Swelling within the skull increases pressure on
  the brain
• Unrelieved pressure can cause death
• Spinal cord
• Enclosed in hollow column of vertebrae
• Half of all spinal injuries occur in the neck
• Causes MVA, diving, falls

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Scalp Injuries

• Suffers same injuries as other soft tissue
• Scalp injuries bleed freely
• Torn fascia mimics depressed skull fracture
• Control bleeding
• Elevate head and shoulders
• Gentle pressure
• Do not stop bleeding if you suspect fracture!
• Never elevate the feet!

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Brain and Skull Injuries

• Most caused by trauma
• Direct force
• Coup-contrecoup
• Also secondary to other body system injury,
  clots, or hemorrhage (CVA)

• Skull fractures may or may not injure the brain
• Depressed
• Linear
• Comminuted
• Basal
• Closed skull is NOT exposed (scalp may be
  injured)
• Open skull and/or brain tissue is exposed

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Head Injury continued

• Brains physiologic response to injury
• Blood vessels dilate
• Fluid leaks into the area and dilutes the brain
• Swelling results
• CSF production down
• Fluid absorption up
• Blood flow to brain down
• Swelling compresses the brain stem

• Assessment
• Obtain a history
• Primary survey
• Secondary survey
• Immobilizemaintain in-line stabilization
• Never probe or palpate a wound
• Never remove impaled objects
• Check extremities for paralysis and/or loss of
  sensation

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Signs and symptoms

• May not appear immediately
• Altered responsiveness
• Erratic behavior
• Nausea
• Unequal pupils
• Visual disturbances
• Headache
• Disorientation or confusion
• Seizures

• Significant trauma to the head
• Soft tissue injuries to the scalp
• Skull deformity
• Blood or CSF leaking from orifices
• Raccoon eyes
• Battles signs
• Visible brain tissue
• Pain, tenderness, swelling

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Emergency Care

• Activate EMS immediately
• Stabilize head and neck
• Assess level of consciousness
• Assume spinal injury
• Monitor ABCs
• Airway is 1 priority
• Be wary for worsening condition
• Anticipate vomiting
• Treat for shock
• Control bleeding with gentle pressure
• Slightly elevate head and shoulders
• Place on left side if not contraindicated
• DO NOT RAISE THE LEGS!

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Spine Injuries

• Mechanism of Injury
• Compression
• Excessive ROM
• Distraction
• Cord can be injured by bone and disc fragments
• Complications
• Inadequate breathing effort
• Paralysis
• Assessment is limited by YOUR training

• When to suspect spine injury
• MVA, pedestrian-vehicle accidents
• Falls, hangings, diving accidents
• Violent injuries, assaults
• Sports injuries with helmet damage
• Any unconscious victim

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Signs and Symptoms of Spinal Injury

• Serious injury to any other body part
• Lack of paralysis/anesthesia does NOT indicate no
  injury
• Wounds or tenderness
• Pain with movement
• NEVER move a victim or ask them to move
• Pain independent of movement
• Obvious deformity
• Numbness, weakness, or tingling
• Loss of sensation or paralysis
• Urinary or fecal incontinence
• Impaired breathing

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Emergency Care for Spinal Injury

• Maintain in-line stabilization
• EMS will spineboard
• Dont remove helmets unless
• You need to reach the airway (remove facemask)
• It interferes with spinal immobilization
  (motorcycle)
• Monitor ABCs

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Lifting and Moving Victims

• Chapter 29

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General Principles of Moving

• Move prone patient only after assessing ABCs and
  there is a need to give care
• Do not move if it will make the injuries worse
• Splint all fractures before moving
• Move only if there is immediate danger

• Examples of when to move a patient
• Uncontrolled traffic
• Physically unstable surroundings
• Exposure to hazardous materials
• Fire
• Hostile crowds
• Need to give emergency care
• Need to access another victim
• Weather conditions

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One-rescuer techniques
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Two- and three-rescuer techniques
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Equipment