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Comprehensive Neurological Injury Management Guide

Learn the anatomy and physiology of nervous system injuries, identification and assessment methods, prevention techniques, and urgent interventions for spine-related issues. Understand the signs and symptoms of traumatic brain injuries and spinal cord disorders. Enhance your knowledge on various types of neuro injuries to improve patient care.

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Comprehensive Neurological Injury Management Guide

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  1. Neurological Injury Management

  2. Objectives • Review the anatomy and physiology of the nervous system and spinal column • Identify the types and mechanisms of head and spine injuries, and describe their features • Describe the assessment of head and spine injuries

  3. Neurological Injuries • Responsible for one half of the deaths that occur secondary to trauma • The major cause of long-term disability • Caused most frequently by falls and MVA’s • Can be prevented in part by helmets

  4. Anatomy 101 • Neuron: nerve cell • Peripheral neurons (nerves outside of the brain and spinal cord) are sheathed with a protective fatty coating called myelin • Nerve impulses are transmitted across synapses (junctions)

  5. Anatomy 101 • Central Nervous System: Brain Spinal Cord

  6. Anatomy 101 • Peripheral Nervous System: spinal nerves and their branches

  7. Anatomy 201 • Meninges: protective triple layer cover • Dura mater = outer layer • Arachnoid= middle layer • Pia mater= inner layer • Cerebral spinal fluid circulates within the Arachnoid

  8. Anatomy 201 • Brain: Cerebrum Cerebellum Brainstem

  9. Anatomy 201 • Cranial Nerves: originate at base of the brain • Provide sensory/motor supply to the head & face

  10. Anatomy 201 • Motor nerves - brain to muscle units • Sensory nerves - skin back to brain

  11. Anatomy 301 • Somatic Nervous System: Voluntary

  12. Anatomy 301 • Autonomic Nervous System:Involuntary

  13. Traumatic Brain Injury • Severity depends on the amount of primary and secondary brain injury • Primary Injury:THE INITIAL TRAUMA • Main cause of secondary injury: HYPOXIA

  14. Traumatic BrainInjuries • Categories: Open or Closed Open Closed

  15. Traumatic Brain Injuries • Forces: Shearing and Compressive Shearing Compressive

  16. Types of Traumatic Brain Injury • Concussion:Temporary loss or alteration of part or all of the brain’s abilities to function, without apparent physical damage to the brain

  17. Types of Traumatic Brain Injury • Cerebral Contusion:Bruised Brain • Far more serious than a concussion! • Involves physical injury to the brain • May be long-lasting or permanent

  18. Types of Traumatic Brain Injury • Cerebral Hematoma or Bleed • Subdural • Intracerebral • Epidural

  19. Traumatic Brain InjuryGeneral Signs & Symptoms • Headache • Dizziness • Nausea/vomiting • Amnesia

  20. Traumatic Brain Injury General Signs & Symptoms • Decreasing level of responsiveness • Confusion • Combativeness • Loss of responsiveness

  21. Assessing Traumatic Brain Injuries Level of Responsiveness (LOR) • LOR usually corresponds to the extent of loss of brain function • Progressive deterioration usually indicates serious brain injury

  22. AVPU SCALE A=Alert V=Verbal P= Pain U=Unresponsive Obtain Baseline Monitor Frequently(q. 5-15 minutes) Assessing Traumatic Brain InjuriesLevel of Responsiveness (LOR)

  23. The Progressive Downward Spiral Brain Swelling  Increased Intracranial Pressure (ICP) Hypoxia Further Secondary Injury More Swelling Increased ICP

  24. Signs Of Increasing Intracranial PressureThe General Signs of Head Injury Described PreviouslyPLUS • Change in pupilsize and reactivity to light • Slowing pulse • Rising BP.

  25. Signs Of Increasing Intracranial PressureThe General Signs of Head Injury Described PreviouslyPLUS • Change in respiration • Unilateral weakness • Incontinence • Seizures

  26. Urgent Interventions • Presume C-Spine injury: immobilize neck • Open airway, administer oxygen • Do not hyperventilate • Treat bleeding and shock

  27. Urgent Interventions • Prevent aspiration of vomit/secretions • Transport immediately • Elevate head 6”, Transport head uphill

  28. The Spine • 33 vertebra – 7 cervical 12 thoracic 5 lumber 5 sacral 4 coccygeal

  29. The Spine Typical Vertebra

  30. Bony Spine InjurySigns & Symptoms • Usually produced by compression or bending trauma • Pain at injury site • Localized acute tenderness • Self-splinting or guarding • Deformity – usually not obvious

  31. Bony Spine InjurySigns & Symptoms Compression-Cervical 4

  32. Bony Spine Injury Signs & Symptoms Bending (Flexion) Trauma Cervical 5 on Cervical 6 Vertebra

  33. Spinal Cord Injury • Significance of spine injury depends whether spinal cord injured • Spinal Cord damage more common with neck injury than mid/lower back injury

  34. Spinal Cord Injury • Mechanism: axial compression, hyperextension, hyperflexion, rotation • The higher the cord injury, the more nerve fibers damaged Cervical 5 Thoracic 5

  35. Types of Spinal Cord Injuries • Paraplegia - paralysis of both legs • Quadriplegia - paralysis of both arms and both legs • Hemiplegia - paralysis of an arm and leg on the same side

  36. Spinal Cord Injury Signs and Symptoms • Abnormal sensation • Loss of sensation • Muscle weakness or paralysis

  37. Spinal Cord Injury Signs and Symptoms • Signs of neurogenic shock • Difficulty breathing • Incontinence • Priapism

  38. Emergency Care - Spine • Urgent interventions for obstructed airway, abnormal breathing, bleeding • Stabilize head and neck manually • Care for other injuries

  39. Emergency Care - Spine • Transfer to spine board with proper technique to minimize movement • Immobilize on long spine board with CID; apply cervical collar

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