2. Chapter 17 Head and Spine Injuries

3. Objectives
Describe how the patient is immobilized on the backboard.
The following slides list noncurriculum objectives.

4. Cognitive 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.

5. Cognitive 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.

6. Cognitive 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.

7. Cognitive 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.

8. Cognitive 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.

9. Affective 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.

10. Affective 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.

11. Anatomy and Physiology of the Nervous System (1 of 2)
Insert Fig. 17-1

12. Anatomy and Physiology of the Nervous System (2 of 2)
Divided into the central nervous system and the peripheral nervous system
Central 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.

13. Central Nervous System (1 of 2)

14. Central Nervous System (2 of 2)
Composed of the brain and spinal cord.
The brain controls the body.
Divided into three parts
Cerebrum
Cerebellum
Brain stem
The spinal cord carries messages between the brain and the body.

15. Protective Coverings
Bony structures
Meninges
Cerebrospinal fluid

16. Peripheral Nervous System (1 of 3)

17. Peripheral Nervous System (2 of 3)
Anatomic parts
31 pairs of spinal nerves
Conduct sensory impulses from the skin and other organs to the spinal cord
Conduct motor impulses from the spinal cord to the muscles
12 pairs of cranial nerves
Transmit sensations to and from the brain

18. Peripheral Nervous System (3 of 3)
Types of peripheral nerves
Sensory 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.

19. How the Nervous System Works
Controls the body’s activities
Voluntary activities: somatic nervous system
Involuntary activities: autonomic nervous system
Sympathetic nervous system: fight-or-flight
Parasympathetic nervous system: relax

20. Anatomy and Physiology of the Skeletal System
The skull has two layers of bone.
Divided into two large structures: cranium and face
The spinal column supports the body.
Has 33 bones or vertebrae
Divided into five sections: cervical, thoracic, lumbar, sacral, and coccygeal

21. Spinal Column

22. Injuries of the Spine Compression Overextension Flexion Rotation
Lateral bending
Fractures and neurologic defects
Distraction

23. Assessment of Spinal Injuries (1 of 3)
Mechanisms of Injury
Motor vehicle crashes
Pedestrian-motor vehicle collisions
Falls
Blunt or penetrating trauma
Motorcycle crashes
Hangings
Driving accidents
Recreational accidents

24. Assessment of Spinal Injuries (2 of 3)
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? Your toes?

25. Assessment of Spinal Injuries (3 of 3)
Signs and symptoms
Pain or tenderness of spine
Deformity of spine
Tingling in the extremities
Loss of sensation or paralysis
Incontinence
Injuries to the head

26. Emergency 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.

27. Stabilization 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.

28. Stabilization 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 spasms
Pain increases with movement
Numbness, tingling, or weakness
Compromised airway or breathing

29. Preparation 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.

30. Preparation 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.

31. Preparation 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.

32. Preparation 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.

33. Head Injuries Scalp lacerations Skull fractures Brain injuries
Medical conditions
Complications of head injuries

34. Scalp 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.

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

36. Brain Injuries (1 of 3) Concussion
Temporary loss or alteration in brain function
May result in unconsciousness, confusion, or amnesia

37. Brain 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.

38. Brain Injuries (3 of 3) Intracranial bleeding
Laceration or rupture of blood vessel in brain
Subdural
Intracerebral
Epidural

39. 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.

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

41. Assessing Head Injuries
Common causes
Motor vehicle crashes
Direct blows
Falls from heights
Assault
Sports Injuries
Evaluate and monitor level of consciousness

42. Types of Head Injuries Closed Associated with trauma Open
Caused by penetrating object

43. Signs and Symptoms (1 of 3)
Lacerations, contusions, hematomas to scalp
Soft areas or depression upon palpation
Visible skull fractures or deformities
Ecchymosis around eyes or behind the ear
Clear or pink CSF leakage

44. Signs and Symptoms (2 of 3)
Failure of pupils to respond to light
Unequal pupils
Loss of sensation and/or motor function
Period of unconsciousness
Amnesia
Seizures

45. Signs and Symptoms (3 of 3)
Numbness or tingling in the extremities
Irregular respirations
Dizziness
Visual complaints
Combative or abnormal behavior
Nausea or vomiting

46. Level 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).
Reassess
Every 15 minutes if patient is stable.
Every 5 minutes if patient is unstable.

47. Changes in Pupil Size
Unequal pupil size may indicate increased pressure on one side of the brain.

48. Emergency Medical Care
Establish an adequate airway.
Control bleeding and provide adequate circulation.
Start large bore IV.
Assess the patient’s baseline level of consciousness.

49. Managing 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.

50. Circulation Start CPR if patient is in full arrest. Control bleeding.
Apply cervical collar.
Treat for shock.
Consider IV bolus.

51. Immobilization 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.

52. Immobilization Devices: Short Backboards
Used on patients found in a sitting position

53. Immobilization Devices: Long Backboards
Provide full-body immobilization

54. Helmet 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?

55. Helmet 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.

56. Helmet Removal (3 of 6)
Prevent head movement.

57. Helmet Removal (4 of 6)
Slide helmet off while partner supports head.

58. Helmet 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.

59. Helmet 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.

60. Pediatric Needs Immobilize a child in the car seat, if possible.
Children may need extra padding to maintain immobilization.