1. Injuries to Head and Spine

2. Nervous and Skeletal System
Nervous System
Central Nervous System {CNS}
Brain and Spinal cord
Peripheral Nervous System
Peripheral nerves

3. Sensory nerves
Messages from the body to the brain
Motor nerves
Messages from the brain to the muscles
Nerves exit the brain and down the spinal cord and cross over
*an injury to left side of the brain may produce effects on the right side

4. Autonomic Nervous System
Controls involuntary function
Anatomy of the Head
Cranium and facial bones
Cranium; portion of skull that encloses the brain
Cranial bones are fused to form immoveable joints

5. 14 irregularly shaped bones form the face
all moveable except for the mandible
Upper jaw is made up of two fused bones called the maxillae
Bridge of nose contains two nasal bones
Cheek bone
Zygomatic
maxillae form a portion of the orbits

6. Cerebrospinal Fluid {CSF}
Bathes the brain
Circulates down the spine and around the spinal cord
Anatomy of the spine
Made up of 33 irregularly shaped bones
vertebrae

7. Each vertebrae has a spinous process
serves for the attachment of muscles and ligaments

8. Injuries to the Skull and Brain
Scalp injuries
May bleed profusely
control of bleeding
Skull Injuries
Open
Closed

9. Brain Injuries
Direct injuries
Indirect injuries
Types
Concussion
groggy or have a headache
some loss of memory is common

10. Contusion
Bruise to the brain
Bruising on the same side of the blow is a coup; the opposite side, countercoup
Hematoma
Collection of blood in a tissue

11. Named according to location
Subdural {between brain and dura}
Epidural {between dura and skull}
Intracerebral {blood pools in the brain}
Complications
Limited room for expansion inside skull

12. Hematoma increases pressure
*Normal blood flow is impeded
*blood pressure increases; flow decreases
*brain becomes starved for oxygen
*swelling occurs
*decreased respiratory effort

13. ONE OF THE FIRST AND MOST SIGNIFICANT SIGNS OF HEAD INJURY IS AMS
DO AN ASSESSMENT AND GET A HISTORY
DON’T ASSUME INTOXICATION OR DRUGS

14. Patient Assessment
Visible bone fragments or brain tissue
AMS
GCS
Deep laceration or severe bruise to scalp or forehead
Deep laceration or severe bruise or hematoma to scalp or forehead

15. Depression or deformity of skull, large swelling or unusual shape
Severe pain at the site of a head injury
don’t palpate
Battle signs
Unequal pupils or unreactive to light
Raccoon eyes
One eye that appears to be sunken

16. Bleeding from ears and or nose
CSF
Personality changes; irritable to irrational
Cushing’s triad/reflex
increased b/p and decreased pulse
Irregular breathing patterns
Temperature increase {late sign}
Blurred or double-vision ; one or both eyes

17. Impaired hearing or ringing in the ears
Equilibrium problems
Forceful or projectile vomiting
Posturing
decorticate
arms flexed, or bent inward on the chest, the hands are clenched into fists, and the legs extended and feet turned inward.

18. Decerebrate
The head is arched back, the arms are extended by the sides, and the legs are extended. A hallmark of decerebrate posturing is extended elbows.

19. Decorticate

20. Paralysis on one side of the body
Seizures
Deteriorating VS
Shock
Assume brain injury when MOI or index of suspicion indicates a possible head injury

21. Care
Standard precautions
Assume spinal injury
*Manual stabilization
*Jaw-thrust to open airway
OP and suction
If unconscious carefully monitor breathing
appropriate airway management

22. Apply C-collar O2
Do not hyperventilate; unless sign of critical brain injury *fixed and dilated pupils
*AMS
*Increased B/P

23. Control bleeding
Keep pt. at rest
Provide emotional support
Dress and bandage open wounds
Manage for shock
avoid overheating
Be aware of the possibility of vomiting
Rapid transport monitory VS q 5 minutes

24. Impaled objects
Do not remove
Stabilize the object
If object must be cut, use a tool that will not cause the object to move or vibrate when finally severed
Medical direction if needed

25. Injuries to face and jaw
Airway obstruction
to remove blood and debris
Mandible
pain, discoloration, facial distortion
may not be able to move
improper alignment of teeth

26. Jaw-thrust maneuver to open airway
Apply C-collar
Position for drainage
Non-traumatic Brain Injury
No evidence of trauma and no MOI

27. Injuries to the Spine
MOI
Compression
falls
diving accidents
MVA

28. Excessive flexion, extension, roatation
lateral bending
pulling apart of the spine
hangings
Maintain high index of suspicion for:
MVA
Pedestrian vs. vehicle
Falls

29. Diving accidents
Unconscious trauma victims
Assessment
Signs and symptoms
Paralysis
Pain without movement
Tenderness along the spine

30. Impaired breathing
Diaphragmatic breathing
Paradoxical breathing {rib injuries}
Deformity
Priapism
Posturing
Loss of bowel or bladder control
Nerve impairment to extremities

31. Spinal shock
Soft-tissue injuries associated with trauma
Ask
what happened?
where does it hurt?
neck or back hurt?
PMS
Numbness or tingling?
strength and grip

32. Inspect and palpate
If unconscious
Rapid trauma assessment
MOI and MS from bystanders

33. Care
Manual in-line stabilization
ABCs – jaw-thrust maneuver
Rapid trauma assessment
assess head and neck then C-Collar
PMS
If paralysis or weakness adm. O2

34. Evaluate the need for artificial ventilation
Reassess PMS
Helmets
*remove if tx. warrents
if left on, shields and guards can be removed { while helmet secured}
do not remove if attempts increases pain or difficult to remove*

35. Guidelines for leaving helmet on:
Snug fit allowing little or no movement
Spinal immobilization can be done with helmet in place
Removal would cause further injury
Airway and breathing mgt. is not hampered

36. Guidelines for removing a helmet
Interference with ABCs mgt.
Improper fit allowing movement
If wearing shoulder pads leave all in place or remove all

37. SKILLS