Presentation on theme: "Injuries to the Head and Spine"— Presentation transcript:
1Injuries to the Head and Spine Chapter 29Injuries to the Head and Spine
2Case HistoryYou 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.
10Nerve 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 nerveThe period of time over which it is applied
14Lateral Bending Distraction Pulling apart of the spine Example: Hanging
15High Index of Suspicion for Spinal Injury Motor vehicle crashesPedestrian vs. vehicle collisionsFallsBlunt trauma
16High Index of Suspicion for Spinal Injury Penetrating trauma to head, neck, or torsoMotorcycle crashesHangingsDiving accidentsUnconscious trauma victims
17Spinal Injuries – Signs and Symptoms Tenderness in the area of injuryPain associated with movingDo 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.
18Spinal Injuries – Signs and Symptoms Pain independent of movement or palpationAlong spinal columnLower legsMay be intermittentObvious deformity of the spine on palpationSoft tissue injuries associated with traumaFrom head and neck to cervical spineShoulders, back, or abdomen (thoracic, lumbar region)Lower extremities (lumbar, sacral region)
21Loss of Sensation and Function Below Level of Injury Loss of sensation and paralysisC4: claviclesT4: nipple lineT10: navelL1: groinLevel of injury – respiratory paralysisAbove C3, complete paralysis/respiratory arrestBelow C5, intercostals and abdominals, diaphragmatic breathing onlyUpper or lower extremitiesIncontinence
22Assessment of Spine-Injured Responsive Patient Mechanism of injuryQuestions to askDoes 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?
23Assessment of Spine-Injured Unresponsive Patient Mechanism of injuryInitial assessmentInspect forContusionsDeformitiesLacerationsPunctures/penetrationsSwelling
24Assessment of Spine-Injured Unresponsive Patient Palpate for areas of tenderness or deformity.Obtain information from others.Mechanism of injuryMental status
33Secondary Complications of Brain Injury HypoxiaHypotensionHypoglycemiaInfectionsIncreased intracranial pressure
34Significance of Secondary Complications Occur with direct brain injuryAggravate brain functionManagement is important to overall care.Treatment prevents further injury to the brain.
35Injuries to the Brain and Skull Most common cause of traumatic deathMay be immediateMay occur over timeRapid recognition and management is key.Access to surgical intervention is critical.Immobilization, airway, and ventilationKey to prehospital care
36Injuries to the Brain and Skull ScalpSkull fractureConcussionIncreased intracranial pressureEpidural hematomaSubdural hematoma
37Related Nontraumatic Conditions Clots or hemorrhageNontraumatic brain injuriesCan be a cause of altered mental statusSigns and symptoms parallel those of traumatic injuriesNo evidence of traumaLack of mechanism of injury
38Skull Injury – Signs and Symptoms Mechanism of traumaScalp injuriesContusionsLacerationsHematomasDeformity to the skull
39Skull Injury – Signs and Symptoms Blood or fluid leakage from the ears or noseBruising around the eyesBruising behind the ears (mastoid process)
40Concussion Transient loss of consciousness or neurologic function Many degrees of injuryLeast severeMomentary loss of function immediately after injuryShort period of confusion
41Concussion – More Severe Brain contusionVision lossParalysisSensory deficits
42Signs of Increased Intracranial Pressure Conscious patientsHeadachesNauseaVomiting (sometimes projectile)Alterations in consciousness may occurSleepyResponds to verbal stimuliResponds to painful stimuliUnresponsive
43Signs of Increased Intracranial Pressure in Children Drowsiness, nausea, vomitingEven after minor head injuryWorsening may be due toHypoxiaHypotensionOther causes
44Eye and Motor Findings Unilaterally dilated pupil May not constrict with lightEyelid may droopUnilateral 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
47Pulse and Blood Pressure Late sign of increased intracranial pressurePulse slows.Blood pressure increases.
48Epidural HematomaRequires rapid recognition and early surgical interventionUsually presents with short period of unconsciousness after blunt trauma to head, followed by lucid interval, then decrease in LOCBlown pupil on side of injuryWeakness and sensory impairment on opposite side of bodyAbnormal respiratory patternAbnormal posturingPossible high blood pressure and slow pulseIf left untreated, death occurs.
51Brain Injury – Signs and Symptoms Altered or decreasing mental statusConfusion, disorientation, or repetitive questioningBest indicator of a brain injuryUnresponsiveIrregular breathing patternConsideration of mechanism of injuryDeformity of windshieldDeformity of helmet
52Brain Injury – Signs and Symptoms Contusions, lacerations, hematomas to scalpDeformity to skullBlood or fluid leakage from ears and noseBruising around eyesBruising behind ears (mastoid process)Neurologic disabilityNausea and/or vomitingUnequal pupil size with altered mental statusSeizure activity may be seen
53Open Head Injury – Signs and Symptoms Bruising around eyesBruising behind ears (mastoid process)Nausea and/or vomitingBrain injuryPossible signs and symptoms of a closed head injury
54Glasgow Coma Scale Objective assessment of mental status Three parametersEye openingVerbal responseMotor ability
55Eye Opening Scores 4 – Open spontaneously (no stimuli) 3 – Open to verbal stimuli2 – Open to painful stimuli1 – Do not open
56Verbal Response Scores 5 – Alert and oriented 4 – Confused (attention can be maintained)3 – Inappropriate (attention cannot be maintained)2 – Incomprehensible sounds1 – No response
57Motor 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
58Emergency 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.
59Emergency Medical Care MonitorAirway, breathing, pulse, and mental statusControl bleeding.Do not apply pressure to open or depressed skullDress and bandage open wound.
60Emergency Medical Care Nontraumatic injuryPlace patient on the left side.Be prepared for changes in patient’s condition.Transport immediately.
61Cervical Spine Immobilization Devices – Indications Any suspected injury to the spine, based onMechanism of injuryHistorySigns and symptomsUsed in conjunction with short and long backboards.
62Cervical 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.
63Long BackboardsSeveral 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 positionUse in conjunction with short backboards.
64Rapid Extrication Unsafe scene Unstable patient condition Patient blocking access to a seriously injured patientBased onTimePatient conditionNot the EMT’s preference
65Rapid Extrication Apply C-collar before move. Perform smoothly. Coordination from lead person is key.Secure to long spine board after removal.
66Helmet Removal – Special Assessment Needs Ability to gain access to airway and breathingFit of the helmetMay prevent proper spinal immobilizationPatient movement within the helmet
67Indications 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.
68Indications for Helmet Removal Inability to assess and/or reassess airway and breathingRestriction of adequate airway or breathing managementImproperly fitted helmetInability to perform proper spinal immobilization because of helmetCardiac arrest
69Types of Helmets Sports Motorcycle Typically open anteriorly Easier access to airwayMotorcycleFull face guardShieldOther
70General Rules – Helmet Removal Technique depends on type of helmet.Remove patient’s eyeglasses before removing the helmet.
71Infants and ChildrenRequire same attention to spinal immobilization as adultsPad spine boards from the shoulders to the heelsAccounts for larger head in proportion to rest of bodyIf C-collar does not fit properly, use rolled towel and tape.Transport in car seat if assessment, treatment, and immobilization can be accomplished.