Head and Spine Injuries Chapter 26 Head and Spine Injuries

Objectives (1 of 5) 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. State the signs and symptoms of a potential spinal injury.

Objectives (2 of 5) Describe the method of determining if a responsive patient may have a spinal injury. Relate the airway emergency medical care techniques to the patient with a suspected spinal injury. Describe how to stabilize the cervical spine. List the steps in performing rapid extrication.

Objectives (3 of 5) Explain the rationale for immobilization of the entire spine when a cervical spine injury is suspected. Explain the rationale for utilizing rapid extrication approaches only when they indeed will make the difference between life and death. Demonstrate opening the airway in a patient with a suspected spinal cord injury.

Objectives (4 of 5) Demonstrate evaluating a responsive patient with a suspected spinal cord injury. Demonstrate stabilization of the cervical spine. Demonstrate the four-person log roll for a patient with a suspected spinal cord injury. Demonstrate how to log roll a patient with a suspected spinal cord injury using two people.

Objectives (5 of 5) Demonstrate securing a patient to a long backboard. Demonstrate the procedure for rapid extrication. Demonstrate helmet removal techniques.

Anatomy and Physiology of the Nervous System

Central Nervous System

Protective Coverings of the Brain

Spinal Column

The Skull

The Spinal Canal

Assessment of Spinal Injuries Vehicle crashes (snowmobile, car, motorcycle) Snow rider collisions with fixed objects Snow rider collisions with other snow riders Falls from heights Blunt or penetrating trauma Blunt trauma Hangings Diving accidents

Questions to Ask Responsive Patients Does your neck or back hurt? What happened? Where (specific location) does it hurt? Can you feel me touching your fingers? Your toes? Can you move your hands and feet?

Assessment of Spinal Injuries Assess DCAP-BTLS. Avoid any excessive motion. Assess strength in each extremity and compare. Absence of pain does not rule out injury. Ability to move or walk does not rule out injury.

Signs and Symptoms of Spinal Injury Pain or tenderness of spine Deformity of spine Tingling and/or weakness in the extremities Loss of sensation or paralysis Incontinence Soft-tissue injuries to head, neck, back

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.

Stabilization of the Cervical Spine (1 of 3) Hold patient’s head firmly with both hands. Support the lower jaw. Move to patient’s head to eyes-forward position. Maintain position until patient is secured to backboard.

Stabilization of the Cervical Spine (2 of 3) Assess and monitor CMS functions. Cervical collars do not replace manual stabilization. Improperly fitted collars may be harmful. Towel rolls and/or blanket rolls can be substituted for cervical collar.

Stabilization of the Cervical Spine (3 of 3) Do not force the head into a neutral, in-line position if the following develop: Muscles spasms Increase in pain Numbness, tingling, or weakness Compromised airway or breathing

Preparation for Transport: Supine Patients (1 of 2) Maintain in-line stabilization. Assess and monitor distal CMS functions in each extremity. Apply a cervical collar, sized appropriately. Have other team members position immobilization device. Log roll patient; quickly assess the back.

Preparation for Transport: Supine Patients (2 of 2) Center patient on device. Secure upper torso to device. Secure pelvis, legs, and feet. Immobilize and secure the head. Check and adjust all straps. Reassess distal CMS functions.

Preparation for Transport: Sitting Patients Maintain manual in-line stabilization. Assess CMS functions, apply a cervical collar. Place a short board or short immobilization device behind patient. Position device around patient and secure. Turn and lower patient to long backboard. Secure short and long backboards together. Reassess distal CMS functions.

Preparation for Transport: Standing Patients Stabilize the head and neck from behind and apply a cervical collar. Position board upright behind patient and secure. A rescuer stands at each side, facing the patient. Reach under each arm, grasp board near patient’s shoulder. Carefully lower patient to ground.

Head Injuries All head injuries are potentially serious. Types include: Scalp lacerations Skull fractures Brain injuries Medical conditions Complications of head injuries

Scalp Lacerations Scalp has a rich blood supply. There may be more serious, deeper injuries. Follow BSI precautions. Fold skin flaps back down onto scalp. Control bleeding by direct pressure. Watch for skull fractures Add additional dressings as needed.

Skull Fracture Indicates significant force Signs: Obvious deformity Visible crack in skull Raccoon eyes Battle’s sign Cerebrospinal fluid

Concussion (1 of 2) Minor traumatic brain injury (TBI) Temporary loss or alteration in brain function May result in unresponsiveness, confusion, or amnesia Retrograde amnesia: forgetting events leading up to injury

Concussion (2 of 2) Anterograde (posttraumatic) amnesia: forgetting events after the injury Perseveration: repetitive speech patterns Brain can sustain bruise when skull is struck. There will be bleeding and swelling. Bleeding will increase pressure within skull.

Intracranial Bleeding Major TBI Laceration or rupture of blood vessel in brain Subdural Intracerebral Epidural

Other Brain Injuries Brain injuries are not always caused by trauma. Medical conditions may cause spontaneous bleeding in the brain. Example: high blood pressure Signs and symptoms of nontraumatic injuries are the same as those of traumatic injuries. There is no MOI.

Complications of Head Injury Cerebral edema is one of the most serious complications. Ensure airway and provide oxygen. Seizure (convulsion) may occur. Vomiting may occur. Common in children Leakage of cerebrospinal fluid may occur. Do not pack ears or nose.

Assessing Head Injuries (1 of 2) Common causes: Skier-object (fixed or moving) collisions Direct blows (deformed or dented helmet) Falls from heights Sports injuries, especially involving speed Evaluate and monitor level of responsiveness

Assessing Head Injuries (2 of 2) Blunt injuries are associated with trauma. Consider MOI. Assess and monitor level of responsiveness. Evaluate and compare pupil size, shape, and reaction to light. Injury may be closed or open.

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 and behind ear Clear or pink CSF leakage Failure of pupils to respond to light

Signs and Symptoms (2 of 3) Unequal pupils (anisocoria) Occurs naturally in 5% of the population Loss of sensation and/or motor function Period of unresponsiveness Respiratory distress due to bleeding or swelling of the airway Amnesia

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

Level of Responsiveness Change in level of responsiveness is the single most important observation. Use the AVPU scale or Glasgow Coma Scale (depending on local protocols). Reassess level of responsiveness: Every 15 minutes if patient is stable. Every 5 minutes if patient is unstable. Levels may fluctuate or progressively deteriorate.

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

Emergency Medical Care Protect the cervical spine. Follow these three principles: Establish an adequate airway, provide high-flow oxygen. Control bleeding, provide adequate circulation. Assess baseline vital signs and monitor patient’s level of responsiveness.

Managing the Airway First priority! Use jaw-thrust maneuver. Maintain neutral, in-line stabilization. Use suction and remove foreign bodies. Provide high-flow oxygen. Assist ventilations as needed.

Circulation Start CPR in patients with cardiac arrest. Control bleeding. Shock is usually due to bleeding. Patients with a medical condition or nontraumatic brain injury should be placed on side to avoid aspiration.

Cervical Collar Provides preliminary, partial support Applied to every patient with a suspected spinal injury Used with manual stabilization until patient is secured to spinal immobilization device Must be correctly sized

Applying a Cervical Collar One rescuer provides continuous manual in-line support of head. Measure proper size collar. Place chin support snugly under chin. Maintain manual support. Wrap collar around neck. Ensure that collar fits.

Backboards Short backboards, vests Used on patients found in sitting position Used in extrication Long backboards Provide full-body immobilization Can be used to splint many injuries Instructors: refer back to slides 19—24 for review.

Helmet Removal (1 of 5) Is airway clear and is patient breathing adequately? Can airway be maintained and ventilations assisted with helmet in place? How well does helmet fit? Can patient move within helmet? Can spine be immobilized in a neutral position with helmet on?

Helmet Removal (2 of 5) A helmet that fits well prevents the head from moving and should be left on, as long as: 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.

Helmet Removal (3 of 5) Remove a helmet if: It makes assessing the airway difficult. It interferes with spinal immobilization. It allows excessive head movements. Patient is in cardiac arrest.

Helmet Removal (4 of 5) Remove glasses or goggles. Stabilize head and loosen strap. Place hands at the jaw and back of head. Begin to gently slide helmet up and off.

Helmet Removal (5 of 5) Slide hand up the back of head to prevent it from moving. Rotate helmet all the way off head. Manually stabilize cervical spine as normal. Apply cervical collar.

Pediatric Needs (1 of 2) Children will need additional padding to prevent neck flexion. Blanket rolls can be used in place of cervical collars.

Pediatric Needs (2 of 2) Children may need extra padding to maintain immobilization. Car seats can be used as immobilization devices.