30: Head and Spine Injuries

1. 30: Head and Spine Injuries

2. Cognitive Objectives(1 of 5) 5-4.1 State the components of the nervous system. 5-4.2 List the functions of the central nervous system. 5-4.3 Define the structure of the skeletal system as it relates to the nervous system. 5-4.4 Relate mechanism of injury to potential injuries of the head and spine. 5-4.5 Describe the implications of not properly caring for potential spine injuries. 5-4.6 State the signs and symptoms of a potential spine injury.

3. Cognitive Objectives(2 of 5) 5-4.7 Describe the method of determining if a responsive patient may have a spine injury. 5-4.8 Relate the airway emergency medical care techniques to the patient with a suspected spine injury. 5-4.9 Describe how to stabilize the cervical spine. 5-4.10 Discuss indications for sizing and using a cervical spine immobilization device. 5-4.11 Establish the relationship between airway management and the patient with head and spine injuries.

4. Cognitive Objectives(3 of 5) 5-4.12 Describe a method for sizing a cervical spine immobilization device. 5-4.13 Describe how to log roll a patient with a suspected spine injury. 5-4.14 Describe how to secure a patient to a long spine board. 5-4.15 List instances when a short spine board should be used. 5-4.16 Describe how to immobilize a patient using a short spine board.

5. Cognitive Objectives(4 of 5) 5-4.17 Describe the indications for the use of rapid extrication. 5-4.18 List the steps in performing rapid extrication. 5-4.19 State the circumstance when a helmet should be left on the patient. 5-4.20 Discuss the circumstances when a helmet should be removed. 5-4.21 Identify different types of helmets. 5-4.22 Describe the unique characteristics of sports helmets.

6. Cognitive Objectives(5 of 5) 5-4.23 Explain the preferred methods to remove a helmet. 5-4.24 Discuss alternative methods for removal of a helmet. 5-4.25 Describe how the patient’s head is stabilized to remove the helmet. 5-4.26 Differentiate how the head is stabilized with a helmet compared to without a helmet.

7. Affective Objectives(1 of 2) 5-4.27 Explain the rationale for immobilization of the entire spine when a cervical spine injury is suspected. 5-4.28 Explain the rationale for utilizing immobilization methods apart from the straps on the cots. 5-4.29 Explain the rationale for utilizing a short spine immobilization device when moving a patient from the sitting to the supine position.

8. Affective Objectives(2 of 2) 5-4.30 Explain the rationale for utilizing rapid extrication approaches only when they indeed will make the difference between life and death. 5-4.31 Defend the reasons for leaving a helmet in place for transport of a patient. 5-4.32 Defend the reasons for removal of a helmet prior to transport of a patient.

9. Psychomotor Objectives(1 of 3) 5-4.33 Demonstrate opening the airway in a patient with a suspected spinal cord injury. 5-4.34 Demonstrate evaluating a responsive patient with a suspected spinal cord injury. 5-4.35 Demonstrate stabilization of the cervical spine. 5-4.36 Demonstrate the four-person log roll for a patient with a suspected spinal cord injury. 5-4.37 Demonstrate how to log roll a patient with a suspected spinal cord injury using two people.

10. Psychomotor Objectives(2 of 3) 5-4.38 Demonstrate securing a patient to a long spine board. 5-4.39 Demonstrate using the short board immobilization technique. 5-4.40 Demonstrate the procedure for rapid extrication. 5-4.41 Demonstrate preferred methods for stabilization of a helmet. 5-4.42 Demonstrate helmet removal techniques.

11. Psychomotor Objectives(3 of 3) 5-4.43 Demonstrate alternative methods for stabilization of a helmet. 5-4.44 Demonstrate completing a prehospital care report for patients with head and spinal injuries.

12. Anatomy and Physiologyof the Nervous System

13. Central Nervous System

14. Sensory and Connecting Nerves • The connecting nerves in the spinal cord form a reflex arc. • If a sensory nerve in this arc detects an irritating stimulus, it will bypass the brain and send a direct message to a motor nerve.

15. How the Nervous System Works • The nervous system controls virtually all of our body activities including reflex, voluntary and involuntary activities • Voluntary activities are action that we consciously perform (ie, passing a dish) • Involuntary activities are actions that are not under our control (ie, body functions) • Body functions are controlled by the autonomic nervous system

16. Autonomic Nervous System • Two components • Sympathetic nervous system • Reacts to stress with a flight or fright response. • Some common responses are dilated pupils, increased pulse rate, or rising BP. • Parasympathetic nervous system • Causes the opposite effect of the sympathetic nervous system

17. Spinal Column

18. Anatomy and Physiologyof the Skeletal System • Two layers of bone protect the brain. • Skull is divided into cranium and face. • Injury to the vertebrae can cause paralysis. • Vertebrae are connected by intervertebral disks.

19. Head Injuries • Scalp lacerations • Skull fractures • Brain injuries • Medical conditions • Complications of head injuries

20. Scalp Lacerations • Scalp has a rich blood supply. • There may be more serious, deeper injuries.

21. Skull Fracture • Indicates significant force • Signs • Obvious deformity • Visible crack in the skull • Raccoon eyes • Battle’s sign

22. Concussion (1 of 2) • Brain injury • Temporary loss or alteration in brain function • May result in unconsciousness, confusion, or amnesia

23. Concussion (2 of 2) • Brain can sustain bruise when skull is struck. • There will be bleeding and swelling. • Bleeding will increase the pressure within the skull.

24. Intracranial Bleeding • Laceration or rupture of blood vessel in brain • Subdural • Intracerebral • Epidural

25. Other Brain Injuries • Brain injuries are not always caused by trauma. • Medical conditions may cause spontaneous bleeding in the brain. • Signs and symptoms of nontraumatic injuries are the same as those of traumatic injuries. • There is no mechanism of injury.

26. Complications of Head Injury • Cerebral edema • Convulsions and seizures • Vomiting • Leakage of cerebrospinal fluid

27. Signs and Symptoms (1 of 3) • Lacerations, contusions, hematomas to scalp • Soft areas or depression upon palpation • Visible skull fractures or deformities • Ecchymosis around eyes and behind the ear • Clear or pink CSF leakage

28. Signs and Symptoms (2 of 3) • Failure of pupils to respond to light • Unequal pupils • Loss of sensation and/or motor function • Period of unconsciousness • Amnesia • Seizures

29. Signs and Symptoms (3 of 3) • Numbness or tingling in the extremities • Irregular respirations • Dizziness • Visual complaints • Combative or abnormal behavior • Nausea or vomiting

30. Spine Injuries • Compression injuries occur from a fall. • Motor vehicle crashes or other types of trauma can overextend, flex, or rotate the spine. • Distraction: When spine is pulled along its length; causes injuries. • Hangings are an example.

31. Significant Mechanisms of Injury • Motor vehicle crashes • Pedestrian-motor vehicle collisions • Falls • Blunt or penetrating trauma • Motorcycle crashes • Hangings • Driving accidents • Recreational accidents

32. You are the provider • Your unit is on standby at the All American College during a gymnastic tournament. • A bystander comes to you and states a 19-year-old female gymnast has fallen head first from a balance beam. • You find the patient prone on a rubber mat awake and breathing normal. No threats to life are observed.

33. You are the provider continued • What is the mechanism of injury? • What injuries do you suspect? • What is the next step in the assessment process?

34. Scene Size-up • Observe scene for hazards; take BSI precautions. • Anticipate problems with ABCs. • Pay attention for changes in level of consciousness. • Call for ALS backup as soon as possible when serious MOI is present. • Look for a deformed helmet or deformed windshield.

35. You are the provider continued (1 of 2) • You manually stabilize the spine and log roll the patient. • You assess the ABCs and place the patient on oxygen via nonrebreathing mask. • She said she felt pain in her neck right away and has tingling in her arms and legs. You begin a rapid trauma assessment.

36. You are the provider continued (2 of 2) • Why did you do a rapid trauma assessment? • What steps comes next?

37. Initial Assessment • Ask the patient: • What happened? • Where does it hurt? • Does your neck or back hurt? • Can you move your hands and feet? • Did you hit your head? • Confused or slurred speech, repetitive questioning, or amnesia indicate head injury. • Ask when patient lost consciousness. • Stabilize the spine.

38. ABCs • Use jaw-thrust maneuver to open airway. • Vomiting may occur. Suction immediately. • Move patient as little as possible. Do not remove c-collar. • Consider providing positive pressure ventilations. • A pulse that is too slow can indicate a serious condition. • Assess and treat for shock.

39. Transport Decision • If patient has problems with ABCs, provide rapid transport.

40. You are the provider continued (1 of 3) • You check for an absence of a distal pulse. Pulse is normal. Bleeding is not noted. • You determine that this patient is a low-priority transport.

41. You are the provider continued (2 of 3) • What do you need to be sure to ask during the SAMPLE history? • Describe the rest of your emergency care.

42. You are the provider continued (3 of 3) • You quickly inspect and palpate the chest for DCAP-BTLS. This was unremarkable. • You start the patient on high-flow oxygen. • You apply a cervical collar and immobilize her to a long board. • The patient could vomit. Be ready to reposition the long board and suction.

43. Focused History and Physical Exam • The absence of pain does not rule out a potential spinal injury. • Do not ask patients with possible spinal injuries to move their neck.

44. Rapid Physical Exam for Significant Trauma (1 of 2) • Quickly use DCAP-BTLS. • Decreased level of consciousness is the most reliable sign of head injury. • Expect irregular respirations. • Look for blood or CSF leaking from ears, nose, or mouth.

45. Rapid Physical Exam forSignificant Trauma (2 of 2) • Look for bruising around eyes, behind ears. • Evaluate pupils. • Do not probe scalp lacerations. Do not remove an impaled object.

46. Focused Physical Examfor Nonsignificant Trauma • Watch for change in level of consciousness. • Use Glasgow Coma Scale. • Pain, tenderness, weakness, numbness, and tingling are signs of spinal injury. • May lose sensation or become paralyzed • May become incontinent

47. Baseline Vital Signs/SAMPLE History • Complete set of baseline vital signs is essential. • Assess pupil size and reactivity to light; continue to monitor. • Gather as much history as possible while preparing for transport.

48. Interventions (1 of 2) • Control bleeding. • Fold torn skin flaps back down onto the skin bed. • Do not apply excessive pressure. • If dressing becomes soaked, place a second dressing over it.

49. Interventions (2 of 2) • Once bleeding has been controlled, secure with a soft self-adhering roller bandage. • Monitor and treat for shock. • Protect airway from vomiting. • Provide immediate transport.

50. Detailed Physical Exam • Perform if time permits. • Can help identify subtle or covert injuries