1. Head and Spine Injuries
Chapter 26
Head and Spine Injuries

2. 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.

3. 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.

4. 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.

5. 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.

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

7. Anatomy and Physiology of the Nervous System

8. Central Nervous System

9. Protective Coverings of the Brain

10. Spinal Column

11. The Skull

12. The Spinal Canal

13. 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

14. 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?

15. 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.

16. 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

17. 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.

18. 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.

19. 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.

20. 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

21. 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.

22. 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.

23. 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.

24. 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.

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

26. 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.

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

28. 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

29. 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.

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

31. 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.

32. 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.

33. 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

34. 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.

35. 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

36. 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

37. 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

38. 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.

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

40. 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.

41. 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.

42. 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.

43. 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

44. 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.

45. 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.

46. 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?

47. 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.

48. 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.

49. 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.

50. 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.

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

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