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1 Head & Spine Injuries Hamburg High School EMT Program.

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Presentation on theme: "1 Head & Spine Injuries Hamburg High School EMT Program."— Presentation transcript:

1 1 Head & Spine Injuries Hamburg High School EMT Program

2 2 Nervous System Components  Central Nervous System Brain Spinal Cord  Peripheral Nervous System Motor nerves Sensory nerves

3 3 Brain  Body’s controlling organ  Weighs 3 lbs.  Responsible for organizing functions of other body organ systems  Meninges – 3 thin tough membranes covering the brain/spinal cord

4 4 Brain  Functions localized to specific areas Cerebrum Cerebellum Brainstem

5 5 Cerebrum  Frontal lobe Foresight, planning, judgment Movement  Parietal lobe Sensation from body surface  Temporal lobe Hearing Speech  Occipital lobe Vision Center for conscious perception, thoughts, personality, feeling – “You”

6 6 Cerebrum Left side of cerebrum Right side of cerebrum Sensory, motor functions of body’s left side Sensory, motor functions of body’s right side

7 7 Cerebellum  Posture  Balance  Equilibrium  Fine motor skills

8 8 Pons – “Bridge”  Connects cerebrum, cerebellum and medulla  Coordinate communication between brain and spinal cord

9 9 Brain Stem  Automatic functions below level of consciousness Heart rate Respirations Blood pressure Body temperature

10 10 Medulla Oblongata  Top of the cord – controls heart rate, respirations, blood pressure

11 11 Cerebrospinal Fluid (CSF)  Surrounds brain, spinal cord in space between arachnoid and pia mater (subarachnoid space)  High in glucose to provide nourishment for the brain  Acts as a shock absorber  Protects brain from jolts, shocks

12 12 Spinal Cord  Connects brain with body through a long tract of nerves  Surrounded and protected by spinal column  Damage cuts brain off from body structures distal to injury site

13 Spinal Regions  Cervical – neck C1 – C7  Thoracic – (chest) T1 – T12  Lumbar – (lower back) L1 – L5  Sacral – (sacrum) 5 fused vertebrae  Coccyx – (tail bone) 4 fused vertebrae  Spinal regions most vulnerable to injury are the cervical and lumbar 13

14 14 Peripheral Nerves Brain Sensory Nerves Motor Nerves Spinal Cord

15 Nerves  Sensory Nerves Send information to the brain on what the different parts of the body are doing relative to their surroundings  Motor Nerves Cause stimulation of a muscle or organ 15

16 Functions of Central Nervous System  Automatic  Reflex  Conscious  Voluntary control of muscles  Involuntary control of muscles 16

17 17 Injuries to Brain and Skull

18 18 Scalp Lacerations  VERY vascular area  Control bleeding with direct pressure  Can distract EMT from possible underlying injuries  Care for laceration, but ask yourself, “WHAT HAPPENED TO BRAIN AND NECK?”

19 19 Scalp Lacerations  Bleeding usually NOT severe enough to produce hypovolemic shock  Exceptions Laceration that involves a large artery Scalp injuries in children.

20 20 Injury to the Brain  Injury of the brain tissue or bleeding into the skull will cause an increase of pressure within the skull

21 21 Skull Fractures  Indicates significant force  What happened to brain and neck?

22 22 Types of Skull Fracture  Linear Most common Crack in skull Detected only on x-ray  Comminuted Multiple cracks radiate from impact point (egg shell fracture)

23 23 Types of Skull Fracture  Depressed Bone fragments pressed inward Places pressure on brain Brain tissue may be exposed through injury  Basilar Fractures in floor of skull Diagnosis made clinically Signs and symptoms  Periorbial ecchymosis (Raccoon eyes)  Battle’s sign  CSF drainage from nose, ears

24 24 Skull Injury – signs and symptoms  Contusions, lacerations, hematomas to the scalp  Deformity of the skull  Unequal pupil dilation  Blood or fluid (cerebrospinal fluid) leakage from the ears or nose  Bruising around the eyes (raccoons eyes) Bruising behind the ears (battle sign) DO NOT TRY TO STOP FLOW OF BLOOD, FLUID FROM NOSE OR EARS

25 25 Concussion  Temporary disturbance in brain function  Due to brain being “rattled” inside the skull by a blow to the head  Can present confused or unconscious  Retrograde amnesia--“What happened?”  Effects clear without residual effects

26 26 Cerebral Contusion  Bruising, swelling  Results from brain hitting skull’s inside  Coup-contracoup pattern  Since brain is in closed box, pressure increases as brain swells, blood flow to the brain decreases

27 27 Cerebral Contusion  Signs and Symptoms Personality changes Loss of consciousness Paralysis (one-sided or total) Unequal pupils Vomiting

28 28 Epidural Hematoma

29 29 Epidural Hematoma  Usually associated with skull fracture in temporal area  Fracture damages artery on skull’s inside = rapid onset of symptoms  Blood collects in epidural space between skull and dura mater  Since skull is closed box, intracranial pressure rises

30 30 Epidural Hematoma  Signs and Symptoms Loss of consciousness followed by return of consciousness (lucid interval) Headache Deterioration of consciousness Dilated pupil on side of injury Weakness, paralysis on side of body opposite injury Seizures

31 31 Subdural Hematoma

32 32 Subdural Hematoma  Usually results from tearing of large veins between dura mater and arachnoid  Blood accumulates more slowly than in epidural hematoma  Signs and symptoms may not develop for days to weeks

33 33 Subdural Hematoma  Signs and Symptoms Deterioration of consciousness Dilated pupil on side of injury Weakness, paralysis on side of body opposite the injury Seizures Because of slow or delayed onset, may be mistaken for stroke

34 34 Epidural = Rapid Onset Subdural = Gradual Onset

35 35 Cerebral Laceration  Tearing of brain tissue  Can result from penetrating or blunt injury  Can cause: Massive destruction of brain tissue Bleeding into cranial cavity with increased intracranial pressure

36 36 Assessment of Head Injury  Level of consciousness is BEST indicator of patient’s condition AVPU system Glasgow scale - GCS

37 37 AVPU System  A lert  Responds to V erbal Stimulus  Responds to P ainful Stimulus  U nresponsive

38 38 Glasgow Scale  Eye Opening Spontaneous = 4 To Voice = 3 To Pain = 2 None = 1  Verbal Response Oriented = 5 Confused = 4 Inappropriate Words = 3 Incomprehensible Sounds = 1 None = 1  Motor Response Follows Commands = 6 Localizes Pain = 5 Withdraws = 4 Flexion = 3 Extension = 2 None = 1 Score each response then total scores Maximum Score = 15Minimum Score = 3

39 39 Assessment of Head Injury  Vital Signs Early detection of increased intracranial pressure is critical Body responds to increasing intracranial pressure by raising BP Increased BP moves blood into brain against rising ICP Heart rate falls in response to rising BP Increased BP Slow Pulse Altered Breathing Cushing’s Triad

40 40 Pupils  Cerebral edema (contusion, hematoma) Dilated Equal Sluggish or absent response Unequal Dilated pupil sluggish or fixed Dilated pupil is on SAME side as injury

41 41 Assessment of Head Injury  Other Indicators of Increased ICP Headache Nausea Vomiting (often projectile) Seizures  Decorticate  Abnormal flexion, toes pointed away from the body.  Arms pulled up to the chest  Decerebrate  Abnormal extension, toes pointed away from the body  Arms down along-side the body

42 42

43 43 Management of Head Injury  ABCs with C-spine control  C-collar, long board  Ensure adequate oxygenation  If signs of increased ICP present, controlled hyperventilation with BVM at breaths/minute Any patient with significant head injury has neck injury until proven otherwise

44 44 Management of Head Injury  Controlled hyperventilation Lowers blood carbon dioxide levels Causes constriction of blood vessels in brain As vessels constrict brain shrinks As brain shrinks intracranial pressure drops

45 45 Management of Head Injury  Do NOT apply pressure to open or depressed skull fractures  Do NOT attempt to stop flow of blood or CSF from nose or ears  Do NOT remove penetrating objects

46 46 Spinal Injuries

47 47 Significance  Spinal injury can lead to spinal cord injury  Spinal cord injury can lead to Paraplegia Quadriplegia

48 48 Most important spinal injury indicator… MECHANISM

49 49

50 50

51 51 Suspect spinal injury with...  Sudden decelerations (MVCs, falls)  Compression injuries (diving, falls onto feet/buttocks)  Significant blunt trauma above clavicles  Very violent mechanisms (explosions, cave-ins, lightning strike)  Distraction (hangings, pulling apart of the spine) Maintain a high index of suspicion: MVC’s Pedestrian-vehicle collisions Penetrating trauma to head, neck or torso Motorcycle crashes Unconscious trauma victims

52 52 Significant Head Injury = Neck Injury Until Proven Otherwise

53 53 Other indications  Tenderness in the area of the injury  Pain associated with moving  Obvious deformity of the spine upon palpation  Numbness, weakness, tingling in the extremities  Loss of sensation or paralysis Below the suspected level of injury In the upper or lower extremities

54 54 Other indications  Incontinence  Priapism  Posturing  Soft tissue injuries associated with trauma: Head, neck and cervical spine Shoulders, back or abdomen – thoracic, lumbar Lower extremities – lumbar, sacral

55 55 Management  ABCs with C-spine control Apply a rigid collar MUST maintain head stabilization until head is secured to the backboard  Ensure adequate oxygenation, ventilation  Keep ENTIRE spine immobilized  Repeatedly assess, document neurologic status: PMS  Monitor respirations, blood pressure

56 56 Management  Rapid Extrication Unsafe scene Use with “C” or “U” patients When a patient blocks access to another, more seriously injured patient

57 57 Spinal Trauma Complications  Respiratory Failure Chest wall innervated from thoracic spine Diaphragm innervated from C3,4,5: Cord injury can produce paralysis of respiratory muscles, lead to ventilatory failure

58 58 Spinal Trauma Complications  Neurogenic Shock Damage to cord produces peripheral vasodilation Peripheral resistance to blood flow decreases, BP falls Heart rate remains normal or slows Skin below level of injury is flushed, dry

59 59 Immobilizing Infants & Children If the car seat is intact, you may immobilize the infant in the car seat If c-collar cannot be applied, consider using a rolled towel Consider using a KED; acts as a papoose Pad all voids to maintain neutral immobilization Try to keep mother and child together; this will help keep the infant calm Re-assure the child as you are placing them in a c- collar and on a backboard. Parent presence may be helpful as well

60 60 Helmet Removal  Should only remove helmet when: Inability to assess airway and breathing Improperly fitted helmet allowing for excessive head movement within the helmet Patient has respiratory compromise or is in cardiac arrest

61 61 Helmet Removal  Leave helmet in place if: There are no pending airway/breathing problems Removal would cause further injury to the patient Proper spinal immobilization can be performed with the helmet in place  If the patient is wearing shoulder pads: Both pads and helmet need to be removed  You MUST have at least 2 people to remove the helmet

62 62 Eye Injuries

63 63 Eye Anatomy ScleraChoroid Retina Cornea IrisPupil Lens

64 Eye Anatomy 64

65 65 Eye Anatomy  Aqueous humor: watery fluid which occupies the space between cornea and lens (anterior chamber)  Vitreous humor: jelly-like fluid which fill space behind lens (posterior chamber)  Conjunctiva: smooth membrane that covers front of eye

66 66 Types of Eye Injuries  Foreign objects – upper lid  Lacerations and contusions  Chemical, heat and light burns

67 67 Foreign Body  Signs and Symptoms Pain, foreign body sensation Excessive tearing Reddening of conjunctiva Decreased visual acuity  Management Cover BOTH eyes Avoid putting pressure on the eye Washing the Eye – use sterile water – wash away from the nose. DO NOT attempt if globe is lacerated or penetrated

68 68 Impaled Objects  Never attempt to remove the object Make a thick dressing – cut hole the size of the eye Placing dressing over the object Place crushed cup over the object. Cover injured eye. Patient in supine position

69 69 Blunt Trauma  Extruded eye Pressure from blow pushes eye partially out of orbit Management  Do NOT attempt to replace  Keep eye surface moist  Cover with cup  NO pressure

70 70 Cushing’s Triad Increased BP Slow Pulse Altered Breathing

71 New NYS BLS Protocol Suspected Spinal Injury (not meeting major trauma criteria)




75 Friday Night Lights  16 year old male football player  Made a spear tackle during the game and remains down  Assessment finds tenderness to the posterior of the neck Should the patient be immobilized? Why or Why not?

76 Motorcycle Accident  35 year old female  Single vehicle accident in the rain  Laid the motorcycle down to avoid striking another car  Pain to left elbow & shoulder  No other unusual findings Should the patient be immobilized? Why or Why not?

77 Two Cars, Two Drivers  Driver # 1 Ambulatory, Agitated, 50 year old male Rear ended by driver # 2 at a stoplight  Driver # 2 Belted and still in vehicle 19 year old female Couldn’t stop in time, struck other vehicle Should either patient be immobilized? Why or Why not?

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