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1 Nervous System Temple College EMS Professions. 2 Nervous System Components Central Nervous System –Brain –Spinal Cord Peripheral Nervous System –Motor.

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Presentation on theme: "1 Nervous System Temple College EMS Professions. 2 Nervous System Components Central Nervous System –Brain –Spinal Cord Peripheral Nervous System –Motor."— Presentation transcript:

1 1 Nervous System Temple College EMS Professions

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 Responsible for organizing functions of other body organ systems

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 and response

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

9 9 Spinal Cord Connects brain with body Serves as center for reflex action Surrounded, protected by spinal column Damage cuts brain off from body structures distal to injury site

10 10 Peripheral Nerves Brain Sensory Nerves Motor Nerves Spinal Cord

11 11 Nervous System Voluntary Nervous System Autonomic Nervous System Conscious Functions Unconscious (Visceral) Functions

12 12 Brain/Spinal Cord Enclosed in protective box –Skin –Muscle –Bone –Meninges

13 13 Meninges Three layers of tissue enclosing brain, spinal cord –Dura mater –Arachnoid –Pia mater

14 14 Cerebrospinal Fluid (CSF) Surrounds brain, spinal cord in space between arachnoid and pia mater (subarachnoid space) Acts as a shock absorber Protects brain from jolts, shocks

15 15 Injuries to Scalp and Skull Scalp Lacerations Skull Fracture

16 16 Scalp Lacerations VERY vascular area Can distract EMT from possible underlying injuries Care for laceration, but ask, “WHAT HAPPENED TO BRAIN AND NECK?”

17 17 Scalp Lacerations Bleeding usually NOT severe enough to produce hypovolemic shock If shock present, think about other injuries Exceptions –Laceration that involves a large artery –Scalp injuries in children. Why?

18 18 Skull Fractures Injury to rigid box around brain Indicates significant force What happened to brain and neck?

19 19 Types of Skull Fracture Linear –Most common –Crack in skull –Detected only on x-ray Comminuted –Multiple cracks radiate from impact point

20 20 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


22 22 Injuries to Brain

23 23 Concussion Temporary disturbance in brain function Probably due to brain being “rattled” inside the skull by a blow to the head Usually confused or unconscious Retrograde amnesia--“What happened?” Effects clear without residual effects

24 24 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 brain decreases

25 25 Cerebral Contusion Signs and Symptoms –Personality changes –Loss of consciousness –Paralysis (one-sided or total) –Unequal pupils –Vomiting

26 26 Epidural Hematoma Usually associated with skull fracture in temporal area Fracture damages artery on skull’s inside Blood collects in epidural space between skull and dura mater Since skull is closed box, intracranial pressure rises

27 27 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

28 28 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

29 29 Subdural Hematoma Signs and Symptoms –Deterioration of consciousness –Dilated pupil on side of injury –Weakness, paralysis on side of body opposite injury –Seizures Because of slow or delayed onset, may be mistaken for stroke

30 30 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

31 31 Assessment of Head Injury Early detection of increased intracranial pressure is critical If pressure inside skull exceeds average blood pressure, blood flow to brain stops Increasing intracranial pressure can force brain downward into spinal canal, crushing it

32 32 Assessment of Head Injury Level of consciousness is BEST indicator of patient’s condition –AVPU system –Glasgow scale

33 33 AVPU System Alert Responds to Verbal Stimulus Responds to Painful Stimulus Unresponsive

34 34 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

35 35 Assessment of Head Injury Vital Signs –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

36 36 Cushing’s Triad Increased BP Slow Pulse Altered Breathing

37 37 Vital Signs Isolated head injury does not cause hypotension or tachycardia! Signs of shock in head injured patient indicate other injuries are present!

38 38 Pupils Diffuse cerebral edema –Dilated –Equal –Sluggish or absent response

39 39 Pupils Focal lesion (contusion, hematoma) –Unequal –Dilated pupil sluggish or fixed Dilated pupil is on SAME side as injury

40 40 Assessment of Head Injury Other Indicators of Increased ICP –Headache –Nausea –Vomiting (often projectile) –Seizures

41 41 Management of Head Injury ABCs with C-spine control C-collar, long board, CID Ensure adequate oxygenation If signs of increased ICP present, controlled hyperventilation with BVM at 20-24 breaths/minute Any patient with significant head injury has neck injury until proven otherwise

42 42 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

43 43 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, ears Do NOT remove penetrating objects

44 44 Spinal Injuries

45 45 Significance Spinal injury can lead to spinal cord injury Spinal cord injury can lead to: –Paraplegia –Quadraplegia

46 46 Most important spinal injury indicator… MECHANISM

47 47 Common Mechanisms Compression Flexion Extension Rotation Lateral bending Distraction Penetration

48 48 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)

49 49 Significant Head Injury = Neck Injury Until Proven Otherwise

50 50 Other indications Decreased LOC in trauma patient Pain in spine or paraspinal area Pain in back of head, shoulders, arms, legs Absent, altered sensation (numbness, paresthesias, loss of temperature, position, touch sense) Absent, altered motor function (weakness, paralysis)

51 51 Other indications Diaphragmatic breathing (paralysis of chest wall) Shock with slow heart rate and dry skin Incontinence Priapism

52 52 Or, there may be no signs at all... Neurologic deficits are a result of cord injury Spinal injury without cord involvement may produce no significant signs and symptoms

53 53 Management ABCs with C-spine control Ensure adequate oxygenation, ventilation Keep ENTIRE spine immobilized Repeatedly assess, document neurologic status: –Position sense –Pain –Motion Repeatedly monitor respirations, blood pressure

54 54 Spinal Trauma Complications Respiratory Failure –Chest wall innervated from thoracic spine –Diaphragm innervated from C3,4,5 via phrenic nerve –Cord injury can produce paralysis of respiratory muscles, lead to ventilatory failure

55 55 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

56 56 Spinal Trauma Complications Hypothermia –Damage to cord produces peripheral vasodilation –Peripheral vasodilation causes increased heat loss through skin

57 57 Spinal Trauma Complications How would you manage: –Ventilatory failure caused by spinal injury? –Hypoperfusion caused by spinal injury? –Hypothermia caused by spinal injury?

58 58 PowerPoint Source Slides for this presentation from Temple College EMS: oint.html oint.html

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