Ch 14: Head and Spine Injuries

Question 1

Epidural Hematoma

Answer 1

Arterial bleeding between the skull and dura mater

Question 2

Signs and Symptoms of Epidural Hematoma

Answer 2

• Yoyo-ing of LOC with rapid decline
• Pupils become sluggish, dilated or non-reactive
• Motor function impaired on one side

Question 3

Subdural Hematoma

Answer 3

Venous bleeding in the subdural space

Question 4

Signs and Symptoms of Subdural Hematoma

Answer 4

• Signs of trauma to the head
• Headache
• Visual disturbance
• Personality changes
• Difficulty speaking
• Deficits in motor function

Question 5

Intracerebral Hematoma

Answer 5

Damage to the blood vessels in the brain itself

Question 6

Signs and Symptoms of Intracerebral Hematoma

Answer 6

• More than one contusion

- Specific neurological findings depend on the location and size of the hematoma

Question 7

Types of Spine Injuries

Answer 7

• Fracture the vertebrae
• Sprain the ligaments
• In severe injuries the vertebrae may shift and compress or sever the spinal cord, causing paralysis or even death

Question 8

Types of MOI’s that can lead to spinal injury

Answer 8

• Motor vehicle crash or ejection from vehicle
• Fall from a height greater than the individuals
• Occurrence of a broken helmet
• Blunt force to the head or trunk
• Injuries that penetrate the head or trunk
• Diving mishaps
• Unconsciousness of an unknown cause
• Lightening strike

Question 9

Care for Head and Spine Injuries

Answer 9

H+S injuries can become life threatening when patient stops breathing, so care will also include support of the respiratory, circulatory and nervous systems.

• Minimize movement of the head and spine
• Maintain an open airway
• Control external bleeding
• Provide ongoing survey and care
• Administer O2

Question 10

Minimize Movement

Answer 10

• Instruct the patient to remain still and minimize movement
• Place your hands on both sides of the patients head.
• Slowly rotate the head until the chin is in line with the middle of the chest.
• Maintain manual stabilization and continue care
• Do not remove your hands from the patient until they are immobilized on a spine board
• The head is in anatomically correct, neutral position to prevent further damage.
• Apply a cervical collar and use in conjunction with manual in line stabilization

Question 11

Signs and Symptoms of Head and Spine Injuries

Answer 11

Changes in the level of consciousness

• Severe pain or pressure in the head, neck or back
• Swelling
• Tingling or loss of sensation in the extremities
• Partial or complete loss of movement of any body part
• Unusual bumps or depressions on the head, neck or back
• Blood or other fluids draining from the ears, nose, mouth or open wounds
• Profuse external bleeding of the head, neck or back
• Irregular breathing
• Open wounds to the scalp
• Seizures
• Sudden impaired breathing or vision
• Unusual or unequal pupil size
• Nausea or vomiting
• Persistent headache
• Loss of balance
• Incontinence
• Specific changes in blood pressure and pulse
• Bruising of the head especially around the eyes

Question 12

Do not align the head when:

Answer 12

• The head is severely angled to one side
• Patient complains of pain, pressure or muscle spasms in the neck when you begin to align
• When you feel resistance when attempting to move the head

Support the patients head in the position found, except when the patient’s airway cannot be maintained

Question 13

Sizing a Cervical Collar

Answer 13

• Patient’s head is in neutral position
• Apply manual stabilization, making sure fingertips to not extend beyond patient’s earlobe.
• The distance between the top of patient’s trapezius to an imaginary horizontal line at the jaw is the approximate length you have to achieve.
• Match this length to the appropriate size of collar
• Assemble the chin piece
• Angle the collar for placement and position the bottom
• Position the front of the collar under the chin while maintaining alignment
• Secure the collar
• Maintain in line stabilization

Question 14

Immobilizing the Patient

Answer 14

• Equipment: Backboard, large towel or blanket, straps or folded triangular bandage
• Log roll patient onto the backboard, checking the back for DCAP-BLS-TIC before placing them on the spine board.
• Babies and children may require padding under their body to line it up with their head.
• Ensure that they are in the correct position, pulling them straight down then straight up to align them
• Secure the body to the spine board
• Secure the head
• Fill in any spaces

Question 15

Procedure of Securing Patient to Spine Board

Answer 15

• Make sure they are in proper alignment, pull them down, then up to realign
• Strap the torso from above the right shoulder to below the left hip, then again from the left shoulder to the right hip in a criss cross fashion
• Secure the hips above the point where the torso straps are secured, in criss cross fashion to just below the thigh.
• Secure the legs straight across at the thigh and at the ankles
• Secure the head with headblocks and a velcro straps at the chin and forehead

Question 16

Applying a KED

Answer 16

Acronym: MBLHT
My Baby Looks Hot Tonight

Strap Order: Middle Bottom Legs Head Top

Question 17

Rapid Extrication

Answer 17

-The freeing of a patient or object from an entanglement or difficulty

Question 18

In what way do you maintain an open airway in a suspected head/spine injury?

Answer 18

The Jaw Thrust

Question 19

what maneuver is used to roll a patient with a suspected head/spine injury?

Answer 19

The Log Roll Method

Question 20

How do you perform a log roll technique?

Answer 20

Responder 1: Maintain in line stabilization of the head and neck, calls when to turn.

Responders 2, 3 and 4 line up on the same side of the patient and wait for direction from responder 1

while maintaining in line stabilization, gently roll the patient to one side, then gently roll them back. The hardest part is maintaining alignment of the head and neck without twisting.

This is not used on patients with fractures of the femur or pelvis.

Question 21

Procedure of taking off a motorcycle helmet:

Answer 21

• Remove glasses
• Responder 1: applies stabilization
• Responder 2: holds stabilization from below helmet area while responder 1 removes helmet, readjusting support grip as helmet is removed
• Once helmet is removed, patients head is gently brought level with the body and a cervical collar is applied

Question 22

When do we take off sports helmets?

Answer 22

• It limits access to the airway
• The helmet does not securely hold the head in place
• The helmet prevents immobilization of the patient for transport

Question 23

Signs and symptoms of a skull fracture

Answer 23

• Visible damage to the scalp
• Deformity of the skull or face
• Pain or swelling
• Fluid form the nose, ears, mouth or head wound
• Unusual pupil size
• Raccoon Eyes
• Battle’s Signs

Question 24

Brain Damage: Signs and Symptoms

Answer 24

• Changes in LOC
• Paralysis or flaccidity
• Unequal facial movement
• Disturbance in vision or pupils
• Ringing in the ears or disturbances in hearing
• Limb rigidity
• Loss of balance
• Pulse that becomes rapid and weak
• High blood pressure with slow pulse
• Breathing problems
• Incontinence

Question 25

Coupe

Answer 25

When the brain initially strikes the skull in an acceleration injury

Question 26

Contre-coup

Answer 26

The second point of contact when the brain hits the back of the skull in an acceleration injury.

Question 27

Concussion

Answer 27

A complex injury affecting the brain that usually does not result in permanent physical damage to the brain tissue.

anyone suspected of a concussion should be examined by a physician

Question 28

Concussion: Signs and Symptoms

Answer 28

• Confusion
• Inability to recall what happened just before and after the injury
• Repetitive questioning
• Irritability, uncooperativeness, combativeness
• Inability to answer questions or follow commands
• Persistent vomiting
• Headache
• Balance problems
• Dizziness
• Nausea and or vomiting
• Ringing in the ears
• Fatigue
• Restlessness
• Seizures
• Brief loss of consciousness

Question 29

Penetrating wounds of the head

Answer 29

Leave the object in place and stabilize it with bulky dressings.

Question 30

Controlling bleeding of the head

Answer 30

Avoid putting direct pressure to a head in jury that may involve a skull fracture. If you feel a depression, spongy area or bone fragments, control bleeding with pressure on the area around the wound.

Question 31

Care for Cheek injuries

Answer 31

• Examine the inside and outside of the cheek
• Control bleeding by placing several folded dressings inside the mouth against the cheek and then secure with a pressure bandage.

Question 32

Care for imbedded objects in the cheek

Answer 32

• The object may become dislodged and obstruct the airway
• remove the object by pulling it the same way it entered
• if it is too difficult or painful, leave in place and stabilize with bulky dressings
• if the object has passed all the way through and has become imbedded, you may have to remove it to control bleeding and airway management.

Question 33

Care for Epistaxis

Answer 33

• Have the patient sit with their head slightly forward, pinching the nostrils together
• Apply an ice pack to the bridge of the nose or put pressure on the upper lip just beneath the nose.

Obtain more advanced medical care if the bleeding cannot be controlled within 10-15 minutes, it stops then reoccurs, or the patient says the bleeding is the result of high blood pressure.

Place patient on their side if they lose consciousness to let the blood drain from their nose.

Question 34

Examining the eye for injuries

Answer 34

Orbits: bruising, swelling, lacerations, tenderness, depression and deformity

Eyelids: bruising, swelling and lacerations

Mucous membranes: Redness, pus, foreign objects

Globes: Abnormal coloring, laceration, and foreign objects.

Pupils: Size, shape, equality, reactive to light

Eye movement: Eyes can move in all directions

Question 35

Care for an Injured Eye

Answer 35

• Do not flush the eye unless it is a chemical injury
• Do not put salves or medicines in the eye
• Do not remove blood or thrombus from eye
• Only force the lid open to flush chemicals
• Do not allow patient to walk without help
• Do not allow patient to eat or drink
• Never panic and reassure the patient constantly
• Transport in supine.

Question 36

Signs and Symptoms Foreign Objects in Eye

Answer 36

Signs and Symptoms:

• Pain
• Excessive Tears
• Abnormal Sensitivity to Light

Question 37

Care for Objects in Eye:

Upper, Lower, Embedded

Answer 37

-Do not allow patient to rub eye

Removal should be done by higher care, but if necessary:
-Hold lids apart and flush with clean water (follow protocol)

Under Upper Lid:

• Draw upper lid over lower lid (unless patient wearing makeup), drawing the lashes of the lower lid across the undersurface of the upper.
• Grab the upper lashes and turn the lid up with a cotton swab.
• Use a corner of sterile gauze to remove object.

Under lower lid:

• Pull down lower lid to expose inner surface
• Use a corner of sterile gauze to remove object.

Embedded Object:

• Do not remove
• Fold a triangular bandage into a donut shape and carefully place on eye with object in center.
• Using rolled gauze, secure the donut in place, leaving the object uncovered. Make sure to cover undamaged eye so that patient is less likely to move.

Question 38

Orbits

Answer 38

Eye Sockets

Question 39

Orbit Trauma:

Signs and Symptoms

Answer 39

• Double or decreased vision
• Numbness above brow or over cheek
• Massive discharge from Nose
• Fractures of lower orbit cause paralysis of upward gaze.

Question 40

Orbit Trauma:

Care

Answer 40

-Patient requires hospitalization and surgery

• No injury to eyeball, place cold packs over area to reduce inflammation.
• Transport

-Injury to eye, do not apply cold pack

Question 41

Eyelid Trauma:

Signs and Symptoms

Answer 41

• Bruising (Contusion)
• Swelling or drooping (Edema)
• Burns
• Lacerations

*If eyelid has trauma, chances are eyeball has trauma

Question 42

Eyelid Trauma:

Care

Answer 42

• Apply light pressure to control bleeding if globe is intact.
• Do not remove embedded material.
• Use saline soaked dressings to keep area moist.
• If lid has been avulsed, preserve it and send with patient for later grafting.