3ObjectivesDescribe how the patient is immobilized on the backboard.The following slides list noncurriculum objectives.
4Cognitive Objectives (1 of 5) State the components of the nervous system.List the functions of the central nervous system.Define the structure of the skeletal system as it relates to the nervous system.Relate mechanism of injury to potential injuries of the head and spine.Describe the implications of not properly caring for potential spinal injuries.
5Cognitive Objectives (2 of 5) 6. State the signs and symptoms of a potential spinal injury.7. Describe the method of determining if a responsive patient may have a spinal injury.8. Relate the airway emergency medical care techniques to the patient with a suspected spinal injury.9. Describe how to stabilize the cervical spine.10. Discuss indications for sizing and using a cervical spine immobilization device.
6Cognitive Objectives (3 of 5) 11. Establish the relationship between airway management and the patient with head and spinal injuries.12. Describe a method for sizing a cervical spine immobilization device.13. Describe how to log roll a patient with a suspected spinal injury.14. Describe how to secure a patient to a long spine board.15. List instances when a short spine board should be used.
7Cognitive Objectives (4 of 5) 16. Describe how to immobilize a patient using a short spine board.17. Describe the indications for the use of rapid extrication.18. State the circumstance when a helmet should be left on the patient.19. Discuss the circumstances when a helmet should be removed.20. Identify different types of helmets.
8Cognitive Objectives (5 of 5) 21. Describe the unique characteristics of sports helmets.22. Explain the preferred methods to remove a helmet.23. Discuss alternative methods for removal of a helmet.24. Describe how the patient’s head is stabilized to remove the helmet.25. Differentiate how the head is stabilized with a helmet compared to without a helmet.
9Affective Objectives (1 of 2) 26. Explain the rationale for immobilization of the entire spine when a cervical spine injury is suspected.27. Explain the rationale for utilizing immobilization methods apart from the straps on the cots.28. Explain the rationale for utilizing a short spine immobilization device when moving a patient from the sitting to the supine position.
10Affective Objectives (2 of 2) 29. Explain the rationale for utilizing rapid extrication approaches only when they indeed will make the difference between life and death.30. Defend the reasons for leaving a helmet in place for transport of a patient.31. Defend the reasons for removal of a helmet prior to transport of a patient.
11Anatomy and Physiology of the Nervous System (1 of 2) Insert Fig. 17-1
12Anatomy and Physiology of the Nervous System (2 of 2) Divided into the central nervous system and the peripheral nervous systemCentral nervous system consists of parts of the nervous system that are covered and protected by bones.Peripheral nervous system is made up of cables of nerve fibers that link the nerve cells to the body’s organs.
14Central Nervous System (2 of 2) Composed of the brain and spinal cord.The brain controls the body.Divided into three partsCerebrumCerebellumBrain stemThe spinal cord carries messages between the brain and the body.
17Peripheral Nervous System (2 of 3) Anatomic parts31 pairs of spinal nervesConduct sensory impulses from the skin and other organs to the spinal cordConduct motor impulses from the spinal cord to the muscles12 pairs of cranial nervesTransmit sensations to and from the brain
18Peripheral Nervous System (3 of 3) Types of peripheral nervesSensory nerves carry information from the body to the brain via the spinal cord.Motor nerves carry information from the CNS to the muscles.Connecting nerves connect sensory and motor nerves with short fibers.
19How the Nervous System Works Controls the body’s activitiesVoluntary activities: somatic nervous systemInvoluntary activities: autonomic nervous systemSympathetic nervous system: fight-or-flightParasympathetic nervous system: relax
20Anatomy and Physiology of the Skeletal System The skull has two layers of bone.Divided into two large structures: cranium and faceThe spinal column supports the body.Has 33 bones or vertebraeDivided into five sections: cervical, thoracic, lumbar, sacral, and coccygeal
22Injuries of the Spine Compression Overextension Flexion Rotation Lateral bendingFractures and neurologic defectsDistraction
23Assessment of Spinal Injuries (1 of 3) Mechanisms of InjuryMotor vehicle crashesPedestrian-motor vehicle collisionsFallsBlunt or penetrating traumaMotorcycle crashesHangingsDriving accidentsRecreational accidents
24Assessment of Spinal Injuries (2 of 3) Questions 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? Your toes?
25Assessment of Spinal Injuries (3 of 3) Signs and symptomsPain or tenderness of spineDeformity of spineTingling in the extremitiesLoss of sensation or paralysisIncontinenceInjuries to the head
26Emergency Medical Care Follow BSI precautions.Manage the airway.Perform the jaw-thrust maneuver to open the airway.Consider inserting an oropharyngeal airway.Administer oxygen.Stabilize the cervical spine.
27Stabilization of the Cervical Spine (1 of 2) Hold head firmly with both hands.Support the lower jaw.Move to eyes-forward position.Maintain the position until patient is secured to a backboard.
28Stabilization of the Cervical Spine (2 of 2) Do not force the head into a neutral, in-line position if any of the following exist:Muscle spasmsPain increases with movementNumbness, tingling, or weaknessCompromised airway or breathing
29Preparation for Transport: Supine Patients (1 of 2) Maintain in-line stabilization.Assess pulse, motor, and sensory function.Apply appropriately sized cervical collar.Have the other team members position the immobilization device.
30Preparation for Transport: Supine Patients (2 of 2) Log roll patient.Ensure that patient is centered on board.Secure patient to backboard.Reassess pulse, motor, and sensory function in each extremity, and continue to do so periodically.
31Preparation for Transport: Sitting Patients Maintain manual in-line stabilization.Assess pulse, motor, and sensory function.Apply a cervical collar.Place a short board behind patient.Position device around patient.Turn patient and lower to long backboard.Secure short and long backboards together.Reassess the pulse, motor, and sensory function.
32Preparation for Transport: Standing Patients Stabilize the head and neck and apply a cervical collar.Position board behind patient.Carefully lower the patient to the ground.
33Head Injuries Scalp lacerations Skull fractures Brain injuries Medical conditionsComplications of head injuries
34Scalp Lacerations Scalp has a rich blood supply. There may be more serious, deeper injuries.Fold skin flaps back down onto scalp.Control bleeding by direct pressure.
35Skull Fracture Indicates significant force Signs Obvious deformity Visible crack in the skullRaccoon eyesBattle’s sign
36Brain Injuries (1 of 3) Concussion Temporary loss or alteration in brain functionMay result in unconsciousness, confusion, or amnesia
37Brain Injuries (2 of 3) Contusion Brain can sustain bruise when skull is struck.There will be bleeding and swelling.Bleeding will increase the pressure within the skull.
38Brain Injuries (3 of 3) Intracranial bleeding Laceration or rupture of blood vessel in brainSubduralIntracerebralEpidural
39Other 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.
40Complications of Head Injury Cerebral edemaConvulsions and seizuresVomitingLeakage of cerebrospinal fluid
41Assessing Head Injuries Common causesMotor vehicle crashesDirect blowsFalls from heightsAssaultSports InjuriesEvaluate and monitor level of consciousness
42Types of Head Injuries Closed Associated with trauma Open Caused by penetrating object
43Signs and Symptoms (1 of 3) Lacerations, contusions, hematomas to scalpSoft areas or depression upon palpationVisible skull fractures or deformitiesEcchymosis around eyes or behind the earClear or pink CSF leakage
44Signs and Symptoms (2 of 3) Failure of pupils to respond to lightUnequal pupilsLoss of sensation and/or motor functionPeriod of unconsciousnessAmnesiaSeizures
45Signs and Symptoms (3 of 3) Numbness or tingling in the extremitiesIrregular respirationsDizzinessVisual complaintsCombative or abnormal behaviorNausea or vomiting
46Level of Consciousness Change in level of consciousness is the single most important observation.Use the AVPU scale or Glasgow Coma Scale (depending on local protocols).ReassessEvery 15 minutes if patient is stable.Every 5 minutes if patient is unstable.
47Changes in Pupil SizeUnequal pupil size may indicate increased pressure on one side of the brain.
48Emergency Medical Care Establish an adequate airway.Control bleeding and provide adequate circulation.Start large bore IV.Assess the patient’s baseline level of consciousness.
49Managing the Airway Establish a patent airway. Perform jaw-thrust maneuver to open airway.Apply cervical collar.Suction as needed.Assess ventilatory status.Provide supplemental oxygen.Check oxygen saturation.
50Circulation Start CPR if patient is in full arrest. Control bleeding. Apply cervical collar.Treat for shock.Consider IV bolus.
51Immobilization Devices: Cervical Collars One EMT-I provides continuous manual in-line support of the head.Measure the proper size of the collar.Place the chin support snugly under the chin.Wrap the collar around the neck.Ensure that the collar fits.
52Immobilization Devices: Short Backboards Used on patients found in a sitting position
53Immobilization Devices: Long Backboards Provide full-body immobilization
54Helmet Removal (1 of 6)Is the airway clear and is the patient breathing adequately?Can airway be maintained and ventilations assisted with helmet in place?How well does the helmet fit?Can the patient’s head move within the helmet?Can the spine be immobilized in a neutral position with the helmet on?
55Helmet Removal (2 of 6)A helmet that fits well prevents the head from moving and should be left on, as long as the following conditions apply: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.
57Helmet Removal (4 of 6)Slide helmet off while partner supports head.
58Helmet Removal (5 of 6) • Preferred method Partner supports head. Kneel at patient’s head.Open the face shield.Stabilize the helmet.Loosen the strap.Gently slip halfway off.Partner supports head.Remove helmet.Apply cervical collar.Pad shoulders if necessary.
59Helmet Removal (6 of 6) Alternative method Used with football helmets. Remove chin strap.Remove face mask.Remove pads.Continue in the same manner as the preferred method.
60Pediatric Needs Immobilize a child in the car seat, if possible. Children may need extra padding to maintain immobilization.