INJURY TO THE HEAD & SPINE
Injuries to the Head and Spine are Extremely Serious and May Result in Permanent Disability or Death. Mismanagement Can Make a Bad Situation Even Worse.
HEAD & SPINE
NERVOUS SYSTEM
- Central Nervous System
- Brain
- Spinal Cord
- Peripheral Nervous System
- Autonomic Nervous System
NERVOUS SYSTEM
- Central Nervous System
- Controls All Basic Body Functions
- Responds to External Changes
- Peripheral Nervous System
- Network of Motor & Sensory Nerves
- Connects CNS to Rest of Body
- Autonomic Nervous System
- Parallels Spinal Cord
- Separately Controls Glands, Vessels, Viscera, External Genitalia, Heart, & Organ Function
SKELETAL SYSTEM
- SPINE
- 33 Vertebra
- 7 Cervical
- 12 Thoracic
- 5 Lumbar
- 5 Sacral (Fused)
- 4 Coccyx (Fused)
- Tailbone
SKELETAL SYSTEM
- SKULL (Anterior)
- Frontal
- Orbits
- Nasal
- Zygomatic
- Maxillae
- Mandible
SKELETAL SYSTEM
- SKULL (Lateral)
- Temporal
- Parietal
- Occipital
- Temporomandibular Joint
BRAIN & SPINAL CORD PROTECTION
- Numerous Layers Between Skull & Brain
- Cerebral Spinal Fluid
- Clear Watery
- Cushion
- Encases Brain
- Encases Spinal Cord
HEAD INJURIES
- Non-Traumatic Brain Injury
- Clots or Hemorrhaging
- Increase of Intracranial Pressure
- Pain and/or Altered LOC
- No Mechanism of Injury
- Signs & Symptoms Parallel Traumatic Brain Injury
HEAD INJURIES
- Scalp Injuries
- Very Vascular
- Bloody
- Direct Pressure to Control
HEAD INJURIES
- Skull Injury
- MOI Present
- Contusions, Lacerations, & Hematomas
- Deformity
- Blood and/or CSF from Nose or Ears
HEAD INJURIES
- Skull Injury
- "Coons Eyes" and/or "Battle’s Sign" - Late
HEAD INJURIES
- Level of Consciousness
- Altered or Decreasing
- Confused, Disoriented, Repetitive Questioning
- Unresponsive
- Irregular Breathing Patterns
- Cheyne-Stokes Breathing (example)
- Common in disturbances of the Central Nervous System. In this pattern, periods of rapid, irregular breaths – starting shallowly, becoming deeper, then becoming shallower – alternate with periods of Apnea.
GLASGOW COMA SCALE
HEAD INJURIES
- Signs of Skull and/or Scalp Injury
- Neurologic Disability
- Nausea and/or Vomiting
- Projectile Vomiting
- Unequal Pupil Size w/ Alt LOC Present
- Increased BP / Decreased Heart Rate
- Seizures
OPEN HEAD INJURIES
- Many of the Same S & S as Discussed
- Deformity of Skull
- Penetrating Trauma
- Do Not Remove
- Secure Impaled Objects
- Do Not Probe Holes
- Soft Area or Depression
- Exposed Brain Tissue – "Gray Matter"
EMERGENCY CARE
of HEAD INJURIES
- BSI, Airway, Ventilate, Oxygenate
- Suspect Spinal Injury w/ Head Injury
- CNS Immobilization
- Monitor Airway, Vital Signs, & Mental Status
- Control Bleeding
- Don’t Use Direct Pressure w/ Skull Injury
- Medical Non-Traumatic
- Can Be Transported on Left Side
TYPES OF
- Compression
- Falls, Diving, MVA
- Excessive Flexion, Extension, Rotation
- Lateral Bending
- Dis-Traction
- Hanging, Pulling Apart Spine
- C-3 -4 -5 Keep the Diaphragm Alive
MECHANISM of INJURY
- Maintain High Index of Suspicion
- MVA
- Vehicle vs. Pedestrian Accidents
- Falls
- Blunt Trauma
- Penetrating Trauma of Head, Neck, or Torso
MECHANISM of INJURY
- Maintain High Index of Suspicion
- Motorcycle Accidents
- Hangings
- Diving
- Unconscious Trauma Patients
SIGNS & SYMPTOMS
Spinal Cord Injuries
- Injury May be Present Even With No Neurologic Deficit or Pain
- Tenderness
- Pain With Movement
- Don’t Test It, Take the Pt’s. Word
- Pain Independent of Movement or Palpation
- Pain Without Movement
- Deformity of Spine
SIGNS & SYMPTOMS
- Soft Tissue Injuries Associated w/ Trauma
- Head & Neck – Cervical Spine
- Shoulders, Back, Abdomen – Thoracic or Lumbar
- Lower Extremities – Lumbar or Sacral
SIGNS & SYMPTOMS
- Numbness, Weakness, or Tingling of Extremities
- Loss of Sensation or Paralysis Distal to Injury
- Incontinence
- Priapism
- Persistent Erection of the Penis Due to Spinal Injury
ASSESSING SPINE INJURY PT’S.
- Responsive Patient
- Mechanism of Injury ?
- Approach So Patient Can See You
- Questions
- Does Head, Neck, or Back Hurt?
- Where Does it Hurt?
- What Happened?
- Is PMS Intact in All Extremities?
ASSESSING SPINE INJURY PT’S.
- Responsive Patient (cont.)
- Inspect for DCAP-BTLS
- Assess for Strength & Equality in Extremities
- Grip of Hands
- Push & Pull of Feet
ASSESSING SPINE INJURY PT’S.
- Unresponsive Patient
- Mechanism of Injury ?
- Initial Assessment
- DCAP-BTLS
- Obtain Information From Others at Scene
- About MOI
- About Patient’s Mental Status Prior 2 U
COMPLICATIONS
- Complications of Spinal Injuries
- Inadequate Breathing
- Paralysis
C – SPINE CONTROL
- BSI
- Immobilize C-Spine
- Manual Stabilization
- Head & Neck
- Neutral In-Line Position
- Align Head & Spine
- Maintain Constantly
- Until Head is Immobilized on Spine Board w/ CID
C – SPINE CONTROL
- Initial Assessment
- Airway Control w/ In-Line Immobilization
- Ventilation w/ In-Line Immobilization
- Assess Head & Cervical Region
- Apply Cervical Collar – Rigid Type
- Properly Size Device
- Improper Fit Can Cause More Harm Than Good
- Improvise w/ Rolled Towels & Tape – if Needed
- Maintain Manual Stabilization
C – SPINE CONTROL
- Cervical Collars
- Sizing
- Based on Specific Design
- Improper Fit Can Cause Further Harm
- Do Not Obstruct Airway
- Towels & Tape if All Else Fails
- Precautions
- C-Collar Alone is Not Enough
- Manual Immobilization Until Secured w/ CID
SITTING POSITION
- Short Spine Board
- Extrication Devices
- XP-1
- KED
- Explanation of These Devices Can Not be Done w/ PowerPoint
- Rapid Extrication Must Be Done w/ Life-Threats
- Short Spine Board
- Types
- Immobilize Head, Neck, & Torso
- Use On Non-Critical, Sitting Patient
SPINE BOARD
- Long Spine Board
- Immobilize Entire Body
- Patient Lying, Standing, or From Sitting
- Can Be Used In Conjunction w/ Short Board
SUPINE POSITION
- Position 6’ Spine Board Beside Pt
- Move Pt Using Log Roll
- 1 EMT to Maintain Manual Stabilization Constantly
- This EMT Also Commands All Movements
- 1-3 Others Move Pt’s Body – Roll Onto Side
- Assess Pt’s Posterior While Rolled On Side
- Move Board Under Pt – Roll Back
- Slide to Fit – In-Line Along Axis
SECURING to SPINE BOARD
- Fill Voids
- Adults
- Under Head – Usually CID Plate
- Under Torso & Legs
- Kiddos
- Shoulders to Feet
- Head too Big to Maintain Neutral Position
- Commercial Pediatric Boards Already Compensate
SECURING to SPINE BOARD
- Straps
- Torso / Body
- Head
- Legs
- Reassess PMS
- Record Information and Findings
STANDING POSITION
- Geezz is This Easy
- Best With 3 People
- 1 at Feet to Keep Pt From Sliding
- If Strapped & Secured Properly Pt Should Not Move
- This EMT Also Keeps Board From Kicking Out
SPECIAL CONSIDERATIONS
- Rapid Extrication Indications
- Unsafe Scene
- Unstable Patient
- Patient Blocks Access to Another More Serious Pt
- Based On Patient Condition & Time
SPECIAL CONSIDERATIONS
- Helmet Removal
- Special Assessment
- Airway & Breathing
- Ability to Gain Access to Airway & Breathing
- How is the Fit of the Helmet
SPECIAL CONSIDERATIONS
- Helmet Removal
- Indications to Leave Helmet in Place
- Good Fit with Little or No Movement of Head
- No Impending Airway or Breathing Problem
- Removal May Cause Further Harm
- Proper Immobilization Can Be Done
SPECIAL CONSIDERATIONS
- Helmet Removal
- Indications to Remove Helmet
- Inability to Assess Airway
- Restriction of Airway & Breathing Management
- Improper Fit, Allowing too Much Movement
- Proper Immobilization Can Not be Performed
- Cardiac Arrest
GENERAL RULES of REMOVAL
- Depends on Type of Helmet
- Remove Eye Glasses
- One, EMT Holds Helmet
- Second, Removes Strap
- Second, Hold Mandible w/ 1 Hand, Other Hand Holds Occipital
GENERAL RULES of REMOVAL
- One, Pry Sides of Helmet Open, Slide Half Way Off
- Second, Reposition Hands, Sliding Occipital Up. Don’t Let Head Fall
- One, Completes Removal
- Immobilize as Usual
INFANTS & CHILDREN
- Immobilize In Usual Fashion, Except
- Size Appropriate Equipment
- Pad Shoulders to Heel, to Keep Head Neutral
- Kids Heads are Like Melons
- Some Pediatric Equipment Already Compensates
- Properly Size C-Collar
- If Not Possible, Use Towel Roll
- Improper Size Can Do More Harm