Head and Spine Injury

1. Head and Spine Injury Chapter 30

2. Anatomy and Physiology of the Nervous System

3. Central Nervous System

4. 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

5. 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

6. 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

7. Anatomy and Physiology of 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 intervertebraldisks

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

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

10. Concussion • Brain injury • Temporary loss or alteration in brain function • May result in unconsciousness, confusion, or amnesia • Brain can sustain bruise when skull is struck. • There will be bleeding and swelling. • Bleeding will increase the pressure within the skull

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

12. 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.

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

14. Signs and Symptoms • 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 • Failure of pupils to respond to light • Unequal pupils • Numbness or tingling in the extremities • Irregular respirations • Dizziness • Visual complaints • Combative or abnormal behavior • Nausea or vomiting • Loss of sensation and/or motor function • Period of unconsciousness • Amnesia • Seizures

15. 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

16. 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

17. 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.

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

19. Rapid Physical Exam for Significant Trauma • 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 • Look for bruising around eyes, behind ears • Evaluate pupils

20. Interventions • 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 • Once bleeding has been controlled, secure with a soft self-adhering roller bandage

21. Stabilization of the Cervical Spine • Always stabilize the head in a neutral, in-line position unless: • Muscles spasm • Pain increases • Numbness, tingling, or weakness develop • There is a compromised airway or breathing problems

22. Helmet Removal • A helmet that fits well prevents the head from moving and should be left on, as long as: • There are no impending airway or breathing problems • It does not interfere with assessment and treatment of the airway • You can properly immobilize the spine

23. Helmet Removal • If you must remove the helmet: • Open the face shield • Prevent head movement • Partner places hands • Gently slip helmet off halfway • Partner slides hands from occiput to back of head • Remove helmet • Stabilize spine • Apply cervical collar • Pad as needed

24. Car Seat • Immobilize a child in the car seat, if possible

25. Pediatric Needs • Children may need extra padding to maintain immobilization (especially under the Shoulders)