Injuries to the Head and Spine

1

CHAPTER 29
Injuries to the Head and Spine
2

Anatomy Review
3

NervousSystem
4

Skull and Facial Bones
5

Contentsof the Skull
Bone Dura mater Arachnoid Pia mater
Subarachnoid space
Subdural space
Intracerebral
Dura mater
Arachnoid
Skull
Pia mater
6

Spinal Column
Division Corresponding Anatomy Number of Vertebrae
Cervical Neck 7
Thoracic Thorax, ribs, upper back 12
Lumbar Lower back 5
Sacral Back wall of pelvis 5
Coccyx Tailbone 4
7

Head Injuries
8

Head Injuries Overview

• Scalp injuries may bleed profusely.
• Injuries to the skull may cause damage to the
  brain and may have an open or closed wound.

9

Brain Injury Nontraumatic

• May occur due to clot or hemorrhage
• Can cause altered mental status
• Signs and symptoms similar to traumatic injury
  (but no trauma)

10

Signs Symptoms ofHead Injuries

• Altered or decreased mental status
• Irregular breathing patterns
• Mechanism of injury present
• Continued

11

Signs Symptoms ofHead Injuries

• Contusion, laceration, hematoma, or deformity to
  the skull
• Blood/fluid from ears or nose
• Bruising around eyes, behind ears
• Continued

12

Signs Symptoms ofHead Injuries

• Neurologic changes
• Nausea and/or vomiting
• Unequal pupil size
• Decreased heart rate and increased blood pressure
• Seizures

13
Emergency Care ofHead Injuries

• BSI.
• Maintain C-spine stabilization.
• Assess and treat ABCs.
• Perform initial assessment.
• Administer high-concentration oxygen.
• Continued

14

Emergency Care ofHead Injuries

• Complete assessment.
• Immobilize spine with cervical collar.
• Monitor airway, breathing, pulse, mental status
  closely.
• Continued

15

Emergency Care ofHead Injuries

• Control bleeding.
• Do not apply pressure to open or depressed skull
  injury.
• Transport immediately.
• Reassess vital signs every 5 min.

16

Spinal Injury
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Mechanisms of Spinal Injury

• Motor vehicle crashes
• Auto-pedestrian collisions
• Falls (especially 3 times patients height)
• Blunt or penetrating trauma
• Continued

18

Mechanisms of Spinal Injury

• Motorcycle crashes
• Hangings
• Diving accidents
• Unconscious trauma patients
• Continued

19

Mechanisms ofSpinal Injury
20
Whiplash

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Types of Spinal Injuries

• Compression
• Distraction (pulling apart)
• Lateral bending
• Flexion, rotation, extension

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Signs Symptoms of Spinal Injuries

• Paralysis of the extremities
• Pain with or without movement
• Tenderness along the spine
• Continued

23

Signs Symptoms of Spinal Injuries

• Loss of sensation
• Impaired breathing
• C3, 4, 5 keep the diaphragm alive
• Continued

24

Signs Symptoms of Spinal Injuries

• Deformity along spine (rare)
• Posturing
• Priapism
• Incontinence

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Assessing Spinal Injury

• Questions to ask
• What happened?
• Where does it hurt?
• Does your neck or back hurt?
• Continued

26

Assessing Spinal Injury

• Questions to ask
• Can you move your hands and feet?
• Can you feel me touching your fingers? Toes?

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Assess sensation in all extremities.
28

Assess motor function.
29

Assess strength feet.
30

Assess strength hands.
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Treating Spinal Injury

• Take BSI precautions.
• Instruct the patient not to move.
• Stabilize cervical spine ABCs.
• Evaluate mechanism of injury.
• Evaluate hand grip and foot strength.
• Continued

32

Treating Spinal Injury

• Assess pulse, movement, and sensation in
  extremities.
• Assess the neck and spine.
• Administer high-concentration oxygen.
• Continued

33

Treating Spinal Injury

• Apply properly sized cervical spine
  immobilization device.
• Apply and secure patient to appropriate
  immobilization device.
• Continued

34

Treating Spinal Injury

• If proper size collar is not available, use
  rolled towel and tape.
• Pad around child as necessary to maintain
  stabilization.

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SpinalImmobilization
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Applying aCervical SpineImmobilizationDevice
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Stabilize and measure.
38

Choose correct collar size.
39

Prepare collar.
40

Slide collar under chin.
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Secure collar maintain in-line position.
42

Use of ShortSpine Boards Seated Patient
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Short Spine Boards

• Vest type
• Rigid short spine board
• Stabilize head, neck, torso
• Used for noncritical, seated patient

44

Select immobilization device.
45

Manually stabilize patients head in neutral,
in-line position.
46

Assess distal pulse, motor function, and
sensation (PMS).
47
Apply the appropriately sized extrication collar.

48

Position the device behind patient.
49

Secure device to patients torso.
50

Evaluate and pad behind patients head as
necessary. Secure patients head to device.
51

Evaluate and adjust straps. As needed, secure
patients wrists and legs.
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Use of LongSpine Boards Supine Patient
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Long Spine Boards

• Stabilize head, neck, torso, pelvis, and
  extremities.
• May be applied in
• Lying, standing, and sitting positions
• Conjunction with short spine boards

54

Maintain stabilization apply collar.
55

Prepare and position device.
56

Move patient onto board. Apply padding to voids.
57

Secure the body, then the patients head.
58

Reassess PMS.
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Use of LongSpine Boards Standing Patient
60

Maintain stabilization apply collar.
61

Position boardand EMTBs.
62

Grasp the boardafter reaching under the
patientsshoulders.
63

Carefully lower patient then secure the board.
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Rapid Extrication
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Rapid Extrication
Indications

• Unsafe scene
• Unstable patient condition
• Patient blocks EMTBs access to an unstable
  patient

66

Manually stabilize apply collar.
67
After putting end of board next to patient,
position hands on legs/pelvis and chest/arms.

68

Rotate patient and reposition hands.
69

Lower patient to board.
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Move patient into position on board.
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Secure patient and transport.
72

Helmet Removal
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Indications to Leave Helmet in Place

• Good fit, little movement
• No current or expected airway problems
• Removal would cause further injury
• Continued

74

Indications to Leave Helmet in Place

• Proper immobilization is able to be performed
• No airway or breathing concerns
• Continued

75

Indications for Removing Helmet

• Inability to assess or treat airway and breathing
• Improper fit/movement within helmet
• Continued

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Indications for Removing Helmet

• Inability to immobilize spine
• Cardiac arrest

77

Stabilize head and helmet. Fingers should be on
patients mandible.
78

Second EMTB loosens strap.
79

Transfer stabilization to second EMTB.
80

Carefully remove the helmet.
81

Prevent head from falling once helmet is removed.
82

Begin routine stabilization and immobilization.
83

Review Questions
1. List the functions of the components of the
nervous system. 2. What are some mechanisms of
injury that could cause spinal injury?
84

Review Questions
3. List the signs and symptoms of a spinal
injury. 4. What questions should you ask if you
suspect a patient has a spinal injury?
85

Review Questions
5. Describe the emergency care steps for a
patient with a spinal injury. 6. Explain when
you would use a short spine board. A long spine
board.
86

Review Questions
7. What are the indications for rapid
extrication? 8. What are the indications for
leaving a helmet in place? For removing a helmet?
87

Review Questions
9. List the signs and symptoms of a head
injury. 10. Describe the emergency care steps
for a patient with a possible head injury.
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STREET SCENES

• What is your general impression of this patient?
• What immediate treatment should be provided?

89
STREET SCENES

• How should you monitor changing levels of
  responsiveness in a patient with a head injury?

90

Sample Documentation