1. Head and Spinal Injuries
Chapter 12
Head and Spinal Injuries

2. Head Injuries Any head injury is potentially serious. Scalp wounds
Skull fractures
Brain injuries

3. Scalp Wounds
Scalp wounds bleed profusely because the scalp has many blood vessels.

4. Skull Fracture Many different types but only one cause: Common s/s:
Blow to head hard enough to break cranium
Common s/s:
Swelling and/or tenderness around area
Facial Bruising
Bleeding from nose and ears

5. Types of Fractures

6. Linear Fracture Most common Fracture in bone but no displacement
Typically no intervention needed
Usually from low energy transfer from blunt force spread across skull
Only a big deal if in a venous grove then things like a subdural hematoma can develop

7. Depressed Fracture High energy transfer
Baseball bat to head
Bone fragments driven inward
Comminuted with bone fragments starting at point of impact and spreading peripherally
Typically to anterior aspect where bones are thinner
Significant and requires surgery to fix

8. Diastatic Fracture Along suture lines Mostly in newborns
Suture lines are widened

9. Basilar Skull Fracture
Most severe; linear at base of skull
High energy transfer from blunt trauma with axial compression
Hospitalization typically required

10. Caring for Scalp Wounds (1 of 3)
Apply direct pressure with a dry, sterile dressing.
If dressing becomes blood filled, add another dressing on top.

11. Caring for Scalp Wounds (3 of 3)
Keep head and shoulders slightly elevated if spinal injury is not suspected.
Seek medical care.

12. Caring for Scalp Wounds (2 of 3)
If skull fracture is suspected:
Apply pressure around edges of wound and over broad area rather than on center of wound.

13. Skull Fracture A skull fracture is a break or crack in the cranium.
May be open or closed
Difficult to determine without X-ray or CT scan

14. Signs and Symptoms of a Skull Fracture (1 of 2)
Pain at point of injury
Deformity of skull
Bleeding from ears and nose
Cerebrospinal fluid (CSF) leaking from ear or nose
Discoloration around eyes
Courtesy of Rhonda Beck.

15. Signs and Symptoms of a Skull Fracture (2 of 2)
Discoloration behind ear
Heavy scalp bleeding if the skin is broken
Penetrating wound
© Scott Camazine/Photo Researchers, Inc.

16. Care for a Skull Fracture
Monitor breathing and begin cardiopulmonary resuscitation (CPR) if necessary.
Stabilize victim’s neck.
Elevate victim’s head and shoulders if no spinal injury is suspected.
Cover wounds with a sterile dressing.
Apply pressure around edges of wound.

17. Brain Injuries (1 of 2)
Injury to the brain causes most short- and long-term problems.
Mishandling a victim could result in permanent damage or death.
The brain will swell from bleeding when it is injured, and swelling can interfere with brain functioning.

18. Brain Injuries (2 of 2) Brain injuries can be caused by:
A penetrating foreign object
Bony fragments from a skull fracture
The brain striking the inside of the skull
Deceleration injury occurs when a person’s head hits a stationary object.
Acceleration injury occurs when a person has been hit by a moving object.

19. Traumatic Brain Injuries Concussions (1 of 4)
Occur when a blow to the head alters the function of the brain
Recovery can last from several minutes to months.
Some symptoms may represent a blood clot pushing the brain against the skull.

20. Traumatic Brain Injuries Concussions (2 of 4)
Seek immediate medical care if:
Loss of consciousness
Persistent, worsening headache
Weakness, numbness, decreased coordination
Vomiting or nausea
Slurred speech
Very drowsy or cannot be awakened
Increasingly confused, restless, or agitated

21. Traumatic Brain Injuries Concussions (3 of 4)
Seek immediate medical care if (cont’d):
Unusual behavior
One pupil is larger than the other.
Convulsions or seizures
Inability to recognize people or places
A child will not stop crying and cannot be consoled.
A child will not nurse or eat.

22. Traumatic Brain Injuries Concussions (4 of 4)
Helmets should not be removed unless:
airway obstruction is suspected.
the helmet is so loose that you cannot stabilize the spine.
If you remove the helmet you MUST remove the shoulder pads!!!

23. Other Traumatic Brain Injuries
Contusion: direct blow to the head
Coup-contrecoup: blow to the head that causes a contusion at site of impact and hits brain to opposite side of head
Diffuse axonal: shaking or strong rotation of the head that causes a tearing injury
Penetration: a bullet, knife, or other sharp object enters the brain

24. Acquired Brain Injuries
Developed during or after birth and are not the result of injuries
Infection
Stroke
Tumors
Anoxia

25. Further Care of Brain Injuries (1 of 2)
Further care required if:
Headache lasts more than 1 or 2 days.
Nausea lasts more than 2 hours.
Vomiting occurs hours after initial episodes of vomiting have stopped.
Victim cannot respond or appears confused or disoriented after waking him or her every 2 hours.

26. Further Care of Brain Injuries (2 of 2)
Further care required if (cont’d):
Victim sees double, the eyes do not move together, or one pupil appears larger than the other.
The arms and legs are not as mobile.
Walking is unsteady.
Speech is slurred or victim cannot talk.
Victim suffers seizures or convulsions.

27. Eye Injuries
The eyes are easily damaged by trauma and should be examined by an ophthalmologist or other physician as soon as possible after injury.

28. Penetrating Eye Injuries
Penetrating eye injuries are severe injuries that result when a sharp object penetrates the eye.

29. Care for Penetrating Eye Injuries (1 of 2)
Seek immediate medical care.
Stabilize the object.
Use bulky dressings or clean cloths.
Place a protective paper cup or piece of cardboard folded into a cone over the affected eye.

30. Care for Penetrating Eye Injuries (2 of 2)
For short objects:
Surround the eye without touching the object with roller gauze bandage or cloths held in place with a roller bandage.

31. Blows to the Eye (1 of 2) Range in severity
A black eye occurs when blood vessels around the eye rupture.

32. Blows to the Eye (2 of 2)
A fist, a ball, or other blunt object can break the bone.
Symptoms:
Double vision
Inability to look upward

33. Care for Blows to the Eye
Apply an ice or cold pack for about 15 minutes.
Do not apply pressure to the eye.
Seek medical care immediately if there is double vision, pain, or reduced vision.

34. Cuts of the Eye or Lid
The signs of a cut eyeball or lid include the following:
Cut appearance of the cornea or sclera
Inner liquid filling of the eye may come out through the wound.
Lid is cut.

35. Care for Cuts of the Eye or Lid
If eyeball is cut, do not apply pressure.
Apply a sterile or clean dressing with gentle pressure if only the eyelid is cut.
Bandage both eyes lightly.
Seek medical care.

36. Chemicals in the Eyes (1 of 2)
Chemicals in the eyes can threaten sight.
Alkalis cause greater damage than acids.
Damage can occur in 1 to 5 minutes.

37. Chemicals in the Eyes (2 of 2)
Common alkalis:
Common acids:
Drain cleaners
Cleaning agents
Ammonia
Cement
Plaster
Caustic soda
Hydrochloric acid
Nitric acid
Sulfuric acid (battery acid)
Acetic acid

38. Care for Chemicals in the Eyes
Keep eye open wide.
Flush with water.
Warm water
At least 20 minutes
From the nose side
Victim should roll eye.
Loosely bandage eyes with cold, wet dressings.
Seek immediate medical care.

39. Eye Avulsion
An eye avulsion is when the eye is knocked out of its socket.
This is a very serious injury.

40. Care for Eye Avulsion
Cover eye loosely with sterile dressing moistened with clean water.
Do not try to push eyeball back in socket.
Protect the injured eye.
Cover undamaged eye.
Seek medical care immediately.

41. Loose Objects in the Eye
Loose objects in the eye are the most frequent eye injury and can be very painful.

42. Care for Loose Objects in the Eye (1 of 2)
Lift upper lid over lower lid and blink.
Flush out object with warm water.
Examine lower lid by pulling it down gently.
Remove object with moistened sterile gauze or clean cloth.

43. Care for Loose Objects in the Eye (2 of 2)
Examine underside of upper lid.
Grasp lashes of upper lid.
Place matchstick or cotton-tipped swab across upper lid.
Roll lid upward over stick or swab.
Remove visible object with moistened sterile gauze or clean cloth.

44. Light Burns to the Eye
Burns can result if a person looks at a source of ultraviolet light.
Severe pain occurs 1 to 6 hours after exposure.

45. Care for Light Burns to the Eye
Cover both eyes with cold, wet packs.
Do not rub the eyes.
Rest in a darkened room.
Do not allow light to reach burned eyes.
Give pain medication, if needed.
Seek medical care.

46. Ear Injuries Most ear problems are not life-threatening.
Only disk batteries and live insects must be removed immediately.
First aiders should seek medical care for the victim.

47. Insect Removal Shine a light into the ear.
Place several drops of light mineral oil or vegetable oil into the ear.
Carefully irrigate the ear with warm water when the insect is near the opening.
Suck out the insect with a bulb syringe.
Seek medical care if the insect cannot be removed.

48. Objects in Ears
If an object is visible near the ear canal opening, cautiously remove the object with tweezers.
Small objects can sometimes be removed by irrigating with warm water.
Do not irrigate vegetable matter.

49. Nosebleeds Anterior nosebleeds (from front of nose):
Most common
Blood flows from one nostril.
Posterior nosebleeds (from back of nose):
Involve massive bleeding
Blood usually flows backward into the mouth or down the back of the throat.
Requires medical care

50. Care for Anterior Nosebleeds
Keep head higher than level of the heart.
Sit and lean slightly forward.
Pinch the soft parts of the nose together.
Continue compressing for 5 to 10 minutes.
Apply ice pack to the nose and cheeks.

51. If Bleeding Continues (1 of 2)
Gently blow the nose to clear blood clots.
Spray a decongestant spray into nostril.
Pinch the nose again for 10 minutes.

52. If Bleeding Continues (2 of 2)
Seek medical care if:
The nosebleed continues.
Bleeding cannot be stopped or keeps reappearing.
Bleeding is rapid or blood loss is large.
Weakness or fainting is present.
Blood begins to go down back of throat rather than out front of nose.

53. Care After a Nosebleed Sneeze through an open mouth.
Avoid too much physical activity.
Elevate head when lying down.
Keep nostrils moist; apply petroleum jelly just inside the nostrils for 1 week.
Increase humidity in bedroom during winter months.
Avoid picking or rubbing the nose.

54. Recognizing a Broken Nose
Pain, swelling, and a possible crooked appearance
Bleeding and difficulty breathing through the nostrils
Black eyes appearing 1 to 2 days after injury

55. Care of a Broken Nose Seek medical care.
Give care for a nosebleed if necessary.
Apply ice pack to nose for 15- minute intervals.
Do not try to straighten a crooked nose.

56. Care for Objects in the Nose
Induce sneezing.
Have victim gently blow the nose while gently compressing one nostril.
Use tweezers to pull out visible objects.
Seek medical care if the object cannot be removed.

57. Dental Injuries
An object might be caught between the teeth if the victim says there is something caught between his or her teeth even if it is difficult to see.

58. Care for Objects Caught Between the Teeth
Try to remove object with dental floss.
Do not try to remove object with a sharp or pointed instrument.
If unsuccessful, seek dental care.

59. Recognizing a Bitten Lip or Tongue
Signs of a bitten lip or tongue include:
Immediate pain when it happens
Blood may be seen.

60. Care for a Bitten Lip or Tongue
Apply direct pressure with sterile gauze or a clean cloth.
Clean area with a cloth.
Apply ice pack or have victim suck on a popsicle or ice chips if there is swelling.
If bleeding does not stop, seek medical care.

61. Loosened Tooth
Trauma can cause teeth to become loosened. Any tooth movement indicates a possible loose tooth.

62. Care for a Loosened Tooth
Have victim bite down on a piece of gauze.
Consult a dentist or an oral surgeon.

63. Knocked-Out Tooth A knocked-out tooth is a dental emergency.
Time is crucial.
Prevent the tooth from drying and protect the ligament fibers from damage.

64. Care for a Knocked-Out Tooth
Rinse mouth.
Put a rolled gauze pad in the socket.
Find tooth, and handle by the crown.
A tooth can often be reimplanted if it is replaced within 30 minutes after injury.

65. Transporting a Knocked-Out Tooth
Do not transport a tooth dry.
Use victim’s saliva for less than an hour.
Use whole milk for 3 hours.
The best medium is Hank’s solution.
A tooth may be kept in an older victim’s mouth for transportation.

66. Care for a Knocked-out Tooth in a Remote Location
Try to replace the tooth into the socket.
Apply pressure on the tooth so that the top is even with the adjacent teeth.
Do not use this method for children or others who may swallow the tooth.

67. Broken Tooth
Front teeth are frequently broken by falls or direct blows.

68. Care for a Broken Tooth Rinse the mouth with warm water.
Apply an ice pack on the face in the area of the injured tooth.
Stabilize the jaw if a jaw fracture is suspected.
Seek immediate dental care.

69. Toothache The most common reason is dental decay.
Victims frequently complain of pain limited to one area.
Pain can also affect the ear, eye, neck, or opposite side of the jaw.

70. Care for a Toothache Rinse mouth with warm water.
Use dental floss to remove any food.
Paint the tooth using a small cotton swab with oil of cloves or Orajel if you suspect a cavity.
Give acetaminophen or ibuprofen.
Seek dental care.

71. Spinal Injuries (1 of 2)
The spine is a column of vertebrae stacked from the tailbone to the base of the skull.
Consists of long tracts of nerves that join the brain with all other body organs and parts
If a broken vertebra pinches spinal nerves, paralysis can result.

72. Spinal Injuries (2 of 2)
Suspect spinal injury whenever significant cause of injury occurs.

73. Signs and Symptoms of a Spinal Injury
Pain radiating into the arms or legs
Neck or back pain
Numbness, tingling, weakness, burning, or lessened sensation in the arms or legs
Loss of bowel or bladder control
Paralysis of the arms or legs
Deformity

74. Questions to Ask a Responsive Victim (1 of 3)
Is there pain?
Can you wiggle your fingers?
Can you feel pressure on your finger?

75. Questions to Ask a Responsive Victim (2 of 3)
Can you squeeze my hand?
Can you wiggle your toes?

76. Questions to Ask a Responsive Victim (3 of 3)
Squeeze victim’s toes.
Can you push your foot against my hand?

77. Treating an Unresponsive Victim (1 of 2)
Look for cuts, bruises, and deformities.
Pinch victim’s hand.
Pinch victim’s foot.

78. Treating an Unresponsive Victim (2 of 2)
Use the Babinski test.
Ask bystanders what happened.
Assume victim has a spinal injury until proven otherwise.

79. Care for Spinal Injuries
Monitor breathing.
Stabilize the victim.
Grasp head over ears.
Hold head and neck until EMS arrives.
Kneel with head between your knees.
Place objects on each side of head to prevent rolling.