Trauma to the Head, Neck & Spine Flashcards
Nervous System Overview
• Controls thought, sensations, and motor
functions
Central nervous system
– Brain, spinal cord
Peripheral nervous system
– Vertebral nerves
– Cranial nerves
– Body’s motor and sensory nerves
Anatomy of the Head - what are the bones
• Cranium • Facial Bones (14) – Mandible – Maxillae – Nasal bones – Malar (zygomatic)
Anatomy of the Spine - Vertebrae - what are the bones
– Cervical (7) – Thoracic (12) – Lumbar (5) – Sacral (5) – Coccyx (4)
Scalp Injuries- characteristics
– Lots of blood vessels
– Profuse bleeding
Skull Injuries - types
– Open head injury
– Closed head injury
Traumatic Brain Injuries (TBI) - types
– Concussion – Contusion • Coup • Contrecoup – Laceration – Hematoma • Subdural Hematoma • Epidural Hematoma • Intracerebral Hematoma
Think about it - Trauma to the Head, Neck & Spine
- Does my patient have a serious or potentially serious head injury? Should the patient be transported to a trauma center?
- Do my patient’s complaint and MOI indicate spinal stabilization? Is immobilization warranted?
Injuries to the Head & Face
• Cranial injuries with impaled objects – Stabilize object in place • Injuries to the face and jaw – Primary concern: Airway – When possible, position to allow for drainage from mouth
Nontraumatic Brain Injuries
- Many signs of brain injury may be caused by an internal brain event (hemorrhage, blood clot)
- Signs are the same as for traumatic injury, except no evidence of trauma and no MOI.
Glasgow Coma Scale (GCS)
• May use GCS in addition to AVPU for ongoing neurological assessment
• Considerations for use of GCS
– Eye opening
– Verbal response
– Motor response
• Do not spend extra time at the scene calculating
Wounds to the Neck
- Large, major vessels close to surface create the potential for serious bleeding
- Pressure in large vein is lower than atmospheric pressure
- Great possibility of air embolus being sucked through
- Treatment: stop bleeding, prevent air embolism
Treatment: Open Neck Wound
- Ensure open airway
- Place gloved hand over wound
- Apply occlusive dressing
- Apply pressure to stop bleeding
- Bandage dressing in place
- Immobilize spine if MOI suggests cervical injury
Injuries to the Spine
• Assume possible cervical-spine injury if MOI exerts great force on upper body or if soft-tissue damage to head, face, or neck
• Spinal cord is a relay between most of body and brain for sending messages
• Neurogenic shock: form of shock resulting from nerve paralysis; causes uncontrolled
dilation of blood vessels
Assessment: Spinal Injury - what to consider
- Paralysis of extremities
- Pain without movement
- Pain with movement
- Tenderness anywhere along spine
- Impaired breathing
- Deformity
- Priapism
- Loss of bowel or bladder control
Treatment: Spinal Injury
- Provide manual in-line stabilization
- Assess ABC’s
- Rapidly assess head and neck; apply rigid cervical collar
- Rapidly assess for sensory and motor function
- Apply appropriate spinal immobilization device
- Reassess sensory and motor function
Steps for Applying a Cervical Collar
• Always maintain manual stabilization
• Use in conjunction with a long
backboard
Immobilizing a Seated Patient
• Low priority: Use a short board or vest-immobilization device
• High priority: Maintain manual
stabilization while moving patient
Steps for Applying a Long Backboard
• Log roll patient • Pad voids between board and head/torso • Secure head last • If pregnant, tilt board to left after immobilizing
Standing Patient - Steps
• Rapid takedown
– Requires three providers, cervical collar, and long backboard
Patient Found Wearing a Helmet - when should it be left in place
• When to leave helmet in place
– Fits snugly, allowing no movement
– Absolutely no impending airway or breathing issues
– Removal would cause further injury
– Proper spinal immobilization can be done with helmet in place
Patient Found Wearing a Helmet - when should it be removed
• When to remove helmet – Interferes with ability to assess and manage airway – Improperly fitted – Interferes with immobilization – Cardiac arrest
Chapter Review: Trauma to the Head, Neck & Spine
- The two main divisions of the nervous system are the central nervous system and the peripheral nervous system.
- Maintain a high index of suspicion for head or spine injury whenever there is a relevant mechanism of injury.
Chapter Review: Trauma to the Head, Neck & Spine
- Provide cervical spine stabilization before beginning any other patient care when head or spine injury is suspected.
- Altered mental status is an early and important indicator of head injury. Monitor and document your patient’s mental status throughout the call.
Chapter Review: Trauma to the Head, Neck & Spine
• A traumatic brain injury is any injury that disrupts function of the brain and may include anything from a slight concussion
to a severe hematoma.
• Always secure the torso to the backboard before the head.
Remember: Trauma to the Head, Neck & Spine
• The key components of the nervous system are the brain and the spinal cord.
These organs regulate thought,
sensations, and motor functions.
• The skull, vertebrae, and cerebrospinal fluid efficiently protect the brain and spinal
cord.
Remember: Trauma to the Head, Neck & Spine
- In a closed head injury, the skull remains intact. This is dangerous, for the skull is a closed container with little room for bleeding or swelling.
- Neck wounds are at risk for massive bleeding and air entry, causing emboli.
Remember: Trauma to the Head, Neck & Spine
• The spine is injured most often by compression or excessive flexion, by extension, or rotation from falls, by diving injuries, and by motor-vehicle collisions.
These injuries can interrupt nervous system control of body functions.
Remember: Trauma to the Head, Neck & Spine
• In-line immobilization of 33 spinal bones is the essential component of spinal injury
immobilization.
• Specific procedures apply to different immobilization and extrication situations.
EMTs should be proficient in handling the basics of these procedures.
Questions to Consider: Trauma to the Head, Neck & Spine
- Does my patient have a mechanism of injury that would indicate the need for spinal immobilization?
- Do my patient’s potential head or spine injuries require prompt transport to a trauma center?
Critical Thinking: Trauma to the Head, Neck & Spine
• You are treating a patient with a head injury. He has an altered mental status and a significant MOI to the head. Your partner thinks you should hyperventilate.
When should you hyperventilate? What are the signs and symptoms that would indicate this is necessary?
sensory nerves - sensed the hot plate
motor
.
mandible
.
7, 12, 5 5 4
of spine
concussion
mild closed head injury without detectable damage to the brain.
contusion
in brain injuries, a bruised brain is caused when the force of a blow to the head is great enough to rupture blood vessels
basalar fractures
battle signs, CSF
4x4 - halo efect
coup / contrecoup
.
752
Meninges
dura mater - tough mother
arachniod space
pia mater
subdural bleed - th pt is bleeding btwn the dura mater & arachnoid space
epidural - outside the dural mater
intercerebral
knowing that the brain and spinal cord have covering
intracranial pressure
Cushings Triad
increase BP
decrease Pulse
slow & altered response
pupils on the affected side will dilate
1st sign of head trauma
-altered mental status
2nd Dialated pupil
-pressure on the
Then Cushings Traid
very high BP
exactly opposite than shock
PP = Perfusion Pressure
B/P - ICP (intercranial pressure)
90 =120-30
90=150-60
Body wants a constant perfusion pressure
perfusion pressure wants to stay constant at 90
.
biggest problem to head and face injuries
airway injury
gcs
used to measure LOC
761
assume possible spinal injury if…
injuries to the spine must be considered whenever there is serious trauma to any part of the body
Assessment of Spinal Injury
.
priapism
.
when to leave a helmet in place
review - airway and breathing is the reason you leave it on.
