Presentation on theme: "30: Head and Spine Injuries. 5-4.1State the components of the nervous system. 5-4.2List the functions of the central nervous system. 5-4.3Define the structure."— Presentation transcript:
30: Head and Spine Injuries
5-4.1State the components of the nervous system 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 Describe the implications of not properly caring for potential spine injuries State the signs and symptoms of a potential spine injury. Cognitive Objectives (1 of 5)
5-4.7Describe the method of determining if a responsive patient may have a spine injury Relate the airway emergency medical care techniques to the patient with a suspected spine injury Describe how to stabilize the cervical spine Discuss indications for sizing and using a cervical spine immobilization device Establish the relationship between airway management and the patient with head and spine injuries. Cognitive Objectives (2 of 5)
5-4.12Describe a method for sizing a cervical spine immobilization device Describe how to log roll a patient with a suspected spine injury Describe how to secure a patient to a long spine board List instances when a short spine board should be used Describe how to immobilize a patient using a short spine board. Cognitive Objectives (3 of 5)
5-4.17Describe the indications for the use of rapid extrication List the steps in performing rapid extrication State the circumstance when a helmet should be left on the patient Discuss the circumstances when a helmet should be removed Identify different types of helmets Describe the unique characteristics of sports helmets. Cognitive Objectives (4 of 5)
5-4.23Explain the preferred methods to remove a helmet Discuss alternative methods for removal of a helmet Describe how the patient’s head is stabilized to remove the helmet Differentiate how the head is stabilized with a helmet compared to without a helmet. Cognitive Objectives (5 of 5)
5-4.27Explain the rationale for immobilization of the entire spine when a cervical spine injury is suspected Explain the rationale for utilizing immobilization methods apart from the straps on the cots Explain the rationale for utilizing a short spine immobilization device when moving a patient from the sitting to the supine position. Affective Objectives (1 of 2)
Affective Objectives (2 of 2) Explain the rationale for utilizing rapid extrication approaches only when they indeed will make the difference between life and death Defend the reasons for leaving a helmet in place for transport of a patient Defend the reasons for removal of a helmet prior to transport of a patient.
5-4.33Demonstrate opening the airway in a patient with a suspected spinal cord injury 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. Psychomotor Objectives (1 of 3)
Psychomotor Objectives (2 of 3) Demonstrate securing a patient to a long spine board Demonstrate using the short board immobilization technique Demonstrate the procedure for rapid extrication Demonstrate preferred methods for stabilization of a helmet Demonstrate helmet removal techniques.
Psychomotor Objectives (3 of 3) Demonstrate alternative methods for stabilization of a helmet Demonstrate completing a prehospital care report for patients with head and spinal injuries.
Anatomy and Physiology of the Nervous System
Central Nervous System
Sensory and Connecting Nerves The connecting nerves in the spinal cord form a reflex arc. If a sensory nerve in this arc detects an irritating stimulus, it will bypass the brain and send a direct message to a motor nerve.
How the Nervous System Works The nervous system controls virtually all of our body activities including reflex, voluntary and involuntary activities Voluntary activities are action that we consciously perform (ie, passing a dish) Involuntary activities are actions that are not under our control (ie, body functions) Body functions are controlled by the autonomic nervous system
Autonomic Nervous System Two components Sympathetic nervous system –Reacts to stress with a flight or fright response. –Some common responses are dilated pupils, increased pulse rate, or rising BP. Parasympathetic nervous system –Causes the opposite effect of the sympathetic nervous system
Anatomy and Physiology of the Skeletal System Two layers of bone protect the brain. Skull is divided into cranium and face. Injury to the vertebrae can cause paralysis. Vertebrae are connected by intervertebral disks.
Head Injuries Scalp lacerations Skull fractures Brain injuries Medical conditions Complications of head injuries
Scalp Lacerations Scalp has a rich blood supply. There may be more serious, deeper injuries.
Skull Fracture Indicates significant force Signs –Obvious deformity –Visible crack in the skull –Raccoon eyes –Battle’s sign
Concussion (1 of 2) Brain injury Temporary loss or alteration in brain function May result in unconsciousness, confusion, or amnesia
Concussion (2 of 2) Brain can sustain bruise when skull is struck. There will be bleeding and swelling. Bleeding will increase the pressure within the skull.
Intracranial Bleeding Laceration or rupture of blood vessel in brain –Subdural –Intracerebral –Epidural
Other Brain Injuries Brain injuries are not always caused by trauma. Medical conditions may cause spontaneous bleeding in the brain. Signs and symptoms of nontraumatic injuries are the same as those of traumatic injuries. –There is no mechanism of injury.
Complications of Head Injury Cerebral edema Convulsions and seizures Vomiting Leakage of cerebrospinal fluid
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 the ear Clear or pink CSF leakage
Signs and Symptoms (2 of 3) Failure of pupils to respond to light Unequal pupils Loss of sensation and/or motor function Period of unconsciousness Amnesia Seizures
Signs and Symptoms (3 of 3) Numbness or tingling in the extremities Irregular respirations Dizziness Visual complaints Combative or abnormal behavior Nausea or vomiting
Spine Injuries Compression injuries occur from a fall. Motor vehicle crashes or other types of trauma can overextend, flex, or rotate the spine. Distraction: When spine is pulled along its length; causes injuries. –Hangings are an example.
Significant Mechanisms of Injury Motor vehicle crashes Pedestrian-motor vehicle collisions Falls Blunt or penetrating trauma Motorcycle crashes Hangings Driving accidents Recreational accidents
You are the provider Your unit is on standby at the All American College during a gymnastic tournament. A bystander comes to you and states a 19-year-old female gymnast has fallen head first from a balance beam. You find the patient prone on a rubber mat awake and breathing normal. No threats to life are observed.
You are the provider continued What is the mechanism of injury? What injuries do you suspect? What is the next step in the assessment process?
Scene Size-up Observe scene for hazards; take BSI precautions. Anticipate problems with ABCs. Pay attention for changes in level of consciousness. Call for ALS backup as soon as possible when serious MOI is present. Look for a deformed helmet or deformed windshield.
You are the provider continued (1 of 2) You manually stabilize the spine and log roll the patient. You assess the ABCs and place the patient on oxygen via nonrebreathing mask. She said she felt pain in her neck right away and has tingling in her arms and legs. You begin a rapid trauma assessment.
You are the provider continued (2 of 2) Why did you do a rapid trauma assessment? What steps comes next?
Initial Assessment Ask the patient: –What happened? –Where does it hurt? –Does your neck or back hurt? –Can you move your hands and feet? –Did you hit your head? Confused or slurred speech, repetitive questioning, or amnesia indicate head injury. Ask when patient lost consciousness. Stabilize the spine.
ABCs Use jaw-thrust maneuver to open airway. Vomiting may occur. Suction immediately. Move patient as little as possible. Do not remove c-collar. Consider providing positive pressure ventilations. A pulse that is too slow can indicate a serious condition. Assess and treat for shock.
Transport Decision If patient has problems with ABCs, provide rapid transport.
You are the provider continued (1 of 3) You check for an absence of a distal pulse. Pulse is normal. Bleeding is not noted. You determine that this patient is a low-priority transport.
You are the provider continued (2 of 3) What do you need to be sure to ask during the SAMPLE history? Describe the rest of your emergency care.
You are the provider continued (3 of 3) You quickly inspect and palpate the chest for DCAP-BTLS. This was unremarkable. You start the patient on high-flow oxygen. You apply a cervical collar and immobilize her to a long board. The patient could vomit. Be ready to reposition the long board and suction.
Focused History and Physical Exam The absence of pain does not rule out a potential spinal injury. Do not ask patients with possible spinal injuries to move their neck.
Rapid Physical Exam for Significant Trauma (1 of 2) Quickly use DCAP-BTLS. Decreased level of consciousness is the most reliable sign of head injury. Expect irregular respirations. Look for blood or CSF leaking from ears, nose, or mouth.
Rapid Physical Exam for Significant Trauma (2 of 2) Look for bruising around eyes, behind ears. Evaluate pupils. Do not probe scalp lacerations. Do not remove an impaled object.
Focused Physical Exam for Nonsignificant Trauma Watch for change in level of consciousness. Use Glasgow Coma Scale. Pain, tenderness, weakness, numbness, and tingling are signs of spinal injury. May lose sensation or become paralyzed May become incontinent
Baseline Vital Signs/ SAMPLE History Complete set of baseline vital signs is essential. Assess pupil size and reactivity to light; continue to monitor. Gather as much history as possible while preparing for transport.
Interventions (1 of 2) Control bleeding. Fold torn skin flaps back down onto the skin bed. Do not apply excessive pressure. If dressing becomes soaked, place a second dressing over it.
Interventions (2 of 2) Once bleeding has been controlled, secure with a soft self-adhering roller bandage. Monitor and treat for shock. Protect airway from vomiting. Provide immediate transport.
Detailed Physical Exam Perform if time permits. Can help identify subtle or covert injuries
Ongoing Assessment Focus on reassessing ABCs, interventions, vital signs. Communication and documentation –Hospital may prepare better with info from your assessment. –Document changes in level of consciousness. –Include history. –Document vital signs every 5 minutes if unstable, every 15 minutes if stable.
Emergency Medical Care of Spinal Injuries 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.
Stabilization of the Cervical Spine (1 of 3) Hold head firmly with both hands. Support the lower jaw. Move to eyes-forward position.
Stabilization of the Cervical Spine (2 of 3) Support head while partner places cervical collar. Maintain the position until patient is secured to a backboard.
Stabilization of the Cervical Spine (3 of 3) Do not force the head into a neutral, in-line position if: –Muscles spasm –Pain increases –Numbness, tingling, or weakness develop –There is a compromised airway or breathing problems.
Emergency Medical Care of Head Injuries Establish an adequate airway. Control bleeding and provide adequate circulation. Assess the patient’s baseline level of consciousness.