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Slide 1 Injuries to the Head and Spine Chapter 29.

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Presentation on theme: "Slide 1 Injuries to the Head and Spine Chapter 29."— Presentation transcript:

1 Slide 1 Injuries to the Head and Spine Chapter 29

2 Slide 2 Case History You respond to a 60-year-old man who fell while riding a motorcycle without a helmet. He has a contusion on the left side of his forehead and fluid leaking from his nose, mouth, and ears. He is verbally combative but cannot move his upper and lower extremities. You respond to a 60-year-old man who fell while riding a motorcycle without a helmet. He has a contusion on the left side of his forehead and fluid leaking from his nose, mouth, and ears. He is verbally combative but cannot move his upper and lower extremities.

3 Slide 3 Central and Peripheral Nervous System

4 Slide 4 Brain

5 Slide 5 Layers of the Brain

6 Slide 6 Blood Supply to the Brain

7 Slide 7 Skeletal System  Provides structure and support  Protects vital organs  Allows movement, in conjunction with muscles

8 Slide 8 Skull

9 Slide 9 Base of the Skull

10 Slide 10 Nerve Cells and Pressure  Nerve cells are very sensitive to pressure.  When pressure is applied to nerve cells, function becomes compromised.  Determinants of injury from pressure:  The amount of pressure applied on nerve  The period of time over which it is applied

11 Slide 11 Mechanism of Injury – Compression Forces

12 Slide 12 Mechanism of Injury – Hyperflexion

13 Slide 13 Mechanism of Injury – Hyperextension

14 Slide 14 Lateral Bending  Distraction  Pulling apart of the spine  Example: Hanging

15 Slide 15 High Index of Suspicion for Spinal Injury  Motor vehicle crashes  Pedestrian vs. vehicle collisions  Falls  Blunt trauma

16 Slide 16 High Index of Suspicion for Spinal Injury  Penetrating trauma to head, neck, or torso  Motorcycle crashes  Hangings  Diving accidents  Unconscious trauma victims

17 Slide 17 Spinal Injuries – Signs and Symptoms  Tenderness in the area of injury  Pain associated with moving  Do not ask the patient to move to try to elicit a pain response.  Do not move the patient to test for a pain response.  Tell the patient not to move while you are asking questions.  Normal function does not rule out spinal injury.

18 Slide 18 Spinal Injuries – Signs and Symptoms  Pain independent of movement or palpation  Along spinal column  Lower legs  May be intermittent  Obvious deformity of the spine on palpation  Soft tissue injuries associated with trauma  From head and neck to cervical spine  Shoulders, back, or abdomen (thoracic, lumbar region)  Lower extremities (lumbar, sacral region)

19 Slide 19 Motor and Sensory Function – Upper Extremities

20 Slide 20 Motor and Sensory Function – Lower Extremities

21 Slide 21 Loss of Sensation and Function Below Level of Injury  Loss of sensation and paralysis  C4: clavicles  T4: nipple line  T10: navel  L1: groin  Level of injury – respiratory paralysis  Above C3, complete paralysis/respiratory arrest  Below C5, intercostals and abdominals, diaphragmatic breathing only  Upper or lower extremities  Incontinence

22 Slide 22 Assessment of Spine-Injured Responsive Patient  Mechanism of injury  Questions to ask  Does your neck or back hurt?  What happened?  Where does it hurt?  Can you move your hands and feet?  Can you feel me touching your fingers?  Can you feel me touching your toes?

23 Slide 23 Assessment of Spine-Injured Unresponsive Patient  Mechanism of injury  Initial assessment  Inspect for  Contusions  Deformities  Lacerations  Punctures/penetrations  Swelling

24 Slide 24 Assessment of Spine-Injured Unresponsive Patient  Palpate for areas of tenderness or deformity.  Obtain information from others.  Mechanism of injury  Mental status

25 Slide 25 Complications  Inadequate breathing effort  Prepare for positive- pressure ventilation.  Maintain manual inline stabilization.  Paralysis

26 Slide 26 Emergency Medical Care  Body substance isolation  Determined by presenting problem Goggles Goggles Gloves Gloves Mask Mask Gown Gown

27 Slide 27 Critically Injured Patient  Perform a rapid extrication.  Bring body into alignment.  Transfer to long board without short spine board.  Transport immediately.

28 Slide 28 Injuries to the Head – Structural Specific sections of the brain are injured.  Brain lacerations  Brain contusions  Blockage of vessels (stroke)  Injuries can be traumatic or nontraumatic.

29 Slide 29 Structural Injuries – Signs and Symptoms  Result in localized findings (unilateral)  Unequal pupils  One-sided paralysis  One-sided sensory loss

30 Slide 30 Metabolic Injuries  Interruption of energy needed for cell life  Poisoning  Hypoxia  Low blood sugar

31 Slide 31 Metabolic Injuries – Signs and Symptoms  Symmetrical findings  General signs of CNS dysfunction

32 Slide 32 Structural vs. Metabolic Findings

33 Slide 33 Secondary Complications of Brain Injury  Hypoxia  Hypotension  Hypoglycemia  Infections  Increased intracranial pressure

34 Slide 34 Significance of Secondary Complications  Occur with direct brain injury  Aggravate brain function  Management is important to overall care.  Treatment prevents further injury to the brain.

35 Slide 35 Injuries to the Brain and Skull  Most common cause of traumatic death  May be immediate  May occur over time  Rapid recognition and management is key.  Access to surgical intervention is critical.  Immobilization, airway, and ventilation  Key to prehospital care

36 Slide 36 Injuries to the Brain and Skull  Scalp  Skull fracture  Concussion  Increased intracranial pressure  Epidural hematoma  Subdural hematoma

37 Slide 37 Related Nontraumatic Conditions  Clots or hemorrhage  Nontraumatic brain injuries  Can be a cause of altered mental status  Signs and symptoms parallel those of traumatic injuries  No evidence of trauma  Lack of mechanism of injury

38 Slide 38 Skull Injury – Signs and Symptoms  Mechanism of trauma  Scalp injuries  Contusions  Lacerations  Hematomas  Deformity to the skull

39 Slide 39 Skull Injury – Signs and Symptoms  Blood or fluid leakage from the ears or nose  Bruising around the eyes  Bruising behind the ears (mastoid process)

40 Slide 40 Concussion  Transient loss of consciousness or neurologic function  Many degrees of injury  Least severe Momentary loss of function immediately after injury Momentary loss of function immediately after injury Short period of confusion Short period of confusion

41 Slide 41 Concussion – More Severe  Brain contusion  Vision loss  Paralysis  Sensory deficits

42 Slide 42 Signs of Increased Intracranial Pressure  Conscious patients  Headaches  Nausea  Vomiting (sometimes projectile)  Alterations in consciousness may occur  Sleepy  Responds to verbal stimuli  Responds to painful stimuli  Unresponsive

43 Slide 43 Signs of Increased Intracranial Pressure in Children  Drowsiness, nausea, vomiting  Even after minor head injury  Worsening may be due to  Hypoxia  Hypotension  Other causes

44 Slide 44 Eye and Motor Findings  Unilaterally dilated pupil  May not constrict with light  Eyelid may droop  Unilateral weakness, paralysis, sensory loss, or a combination may be seen.  As pressure increases, motor and sensory findings may affect both sides.  With further deterioration, abnormal postures or positions may be seen.  Eventual flaccidity

45 Slide 45 Abnormal Posturing

46 Slide 46 Respirations  Abnormal respiratory patterns

47 Slide 47 Pulse and Blood Pressure  Late sign of increased intracranial pressure  Pulse slows.  Blood pressure increases.

48 Slide 48 Epidural Hematoma  Requires rapid recognition and early surgical intervention  Usually presents with short period of unconsciousness after blunt trauma to head, followed by lucid interval, then decrease in LOC  Blown pupil on side of injury  Weakness and sensory impairment on opposite side of body  Abnormal respiratory pattern  Abnormal posturing  Possible high blood pressure and slow pulse  If left untreated, death occurs.

49 Slide 49 Epidural Hematoma

50 Slide 50 Subdural Hematoma

51 Slide 51 Brain Injury – Signs and Symptoms  Altered or decreasing mental status  Confusion, disorientation, or repetitive questioning  Best indicator of a brain injury  Unresponsive  Irregular breathing pattern  Consideration of mechanism of injury  Deformity of windshield  Deformity of helmet

52 Slide 52 Brain Injury – Signs and Symptoms  Contusions, lacerations, hematomas to scalp  Deformity to skull  Blood or fluid leakage from ears and nose  Bruising around eyes  Bruising behind ears (mastoid process)  Neurologic disability  Nausea and/or vomiting  Unequal pupil size with altered mental status  Seizure activity may be seen

53 Slide 53 Open Head Injury – Signs and Symptoms  Bruising around eyes  Bruising behind ears (mastoid process)  Nausea and/or vomiting  Brain injury  Possible signs and symptoms of a closed head injury

54 Slide 54 Glasgow Coma Scale  Objective assessment of mental status  Three parameters  Eye opening  Verbal response  Motor ability

55 Slide 55 Eye Opening  Scores  4 – Open spontaneously (no stimuli)  3 – Open to verbal stimuli  2 – Open to painful stimuli  1 – Do not open

56 Slide 56 Verbal Response  Scores  5 – Alert and oriented  4 – Confused (attention can be maintained)  3 – Inappropriate (attention cannot be maintained)  2 – Incomprehensible sounds  1 – No response

57 Slide 57 Motor Ability  Scores  6 – Obeys verbal commands  5 – Localized to pain (reaches to source of pain)  4 – Withdraws (rolls or moves from pain)  3 – Flexion (flexes arms to pain)  2 – Extension (extends arms to pain)  1 – No response to pain

58 Slide 58 Emergency Medical Care  Use personal protection measures.  Suspect spinal injury; immobilize spine.  Maintain airway/artificial ventilation/oxygenation.  Perform initial assessment.  Immobilization spine.  Complete detailed physical examination en route.

59 Slide 59 Emergency Medical Care  Monitor  Airway, breathing, pulse, and mental status  Control bleeding.  Do not apply pressure to open or depressed skull  Dress and bandage open wound.

60 Slide 60 Emergency Medical Care  Nontraumatic injury  Place patient on the left side.  Be prepared for changes in patient’s condition.  Transport immediately.

61 Slide 61 Cervical Spine Immobilization Devices – Indications  Any suspected injury to the spine, based on  Mechanism of injury  History  Signs and symptoms  Used in conjunction with short and long backboards.

62 Slide 62 Cervical Spine Immobilization Devices – Precaution  Cervical immobilization devices alone do not provide adequate inline immobilization. Maintain manual immobilization until the head is secured to the board.

63 Slide 63 Long Backboards  Several different types of long board immobilization devices exist.  Provide stabilization and immobilization to the head, neck and torso, pelvis, and extremities.  Use to immobilize patients found in a lying, standing, or sitting position  Use in conjunction with short backboards.

64 Slide 64 Rapid Extrication  Unsafe scene  Unstable patient condition  Patient blocking access to a seriously injured patient  Based on  Time  Patient condition  Not the EMT’s preference

65 Slide 65 Rapid Extrication  Apply C-collar before move.  Perform smoothly.  Coordination from lead person is key.  Secure to long spine board after removal.

66 Slide 66 Helmet Removal – Special Assessment Needs  Ability to gain access to airway and breathing  Fit of the helmet  May prevent proper spinal immobilization  Patient movement within the helmet

67 Slide 67 Indications for Leaving Helmet in Place  Fit of helmet is good with little or no movement of head.  Helmet does not impede airway or cause breathing problems.  Removal would cause further injury to the patient.  Proper spinal immobilization could be performed with helmet in place.  Helmet does not interfere with the ability to assess and reassess airway and breathing.

68 Slide 68 Indications for Helmet Removal  Inability to assess and/or reassess airway and breathing  Restriction of adequate airway or breathing management  Improperly fitted helmet  Inability to perform proper spinal immobilization because of helmet  Cardiac arrest

69 Slide 69 Types of Helmets  Sports  Typically open anteriorly  Easier access to airway  Motorcycle  Full face guard  Shield  Other

70 Slide 70 General Rules – Helmet Removal  Technique depends on type of helmet.  Remove patient’s eyeglasses before removing the helmet.

71 Slide 71 Infants and Children  Require same attention to spinal immobilization as adults  Pad spine boards from the shoulders to the heels  Accounts for larger head in proportion to rest of body  If C-collar does not fit properly, use rolled towel and tape.  Transport in car seat if assessment, treatment, and immobilization can be accomplished.


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