chapter 28, head and spine trauma 2018notespdf · 2020-03-03 · 1 chapter 28 head and spine trauma...
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Chapter 28Head and Spine TraumaIntroduction (1 of 2)lThe nervous system is a complex network of
____________________ cells that enables all parts of the body to function.
lIncludes:–Brain–Spinal cord–Several billion nerve fibers
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Introduction (2 of 2)lThe nervous system is well protected.
–The brain is protected by the ____________________ .–The spinal cord is protected by the spinal canal.
lDespite this protection, serious injuries can damage the nervous system.
The Nervous SystemlThe nervous system controls virtually all of our body activities
including reflex, voluntary, and involuntary activitieslVoluntary activities are action that we consciously perform (ie,
passing a dish)lInvoluntary activities are actions that are not under our control (ie,
body functions)lBody functions are controlled by the ____________________
nervous systemNervous System2 Anatomical Parts of the Nervous System:
1. Central Nervous System-Nervous system that is covered and protected by ____________________ .
2. Peripheral Nervous System-Cable of nerve fibers that link the ____________________ to the various organs of the body
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____________________ to the various organs of the body
Anatomy and Physiology
Central Nervous SystemlComponents of the Central Nervous System (CNS):
1. The brain
2. The ____________________ cord
The BrainThe Brain is the controlling organ of the body
Cerebrum-Largest area of the brain
lDivided into ____________________ -frontal, parietal, temporal, and occipital
lOne side controls activities of the opposite side of the body
lControls higher functions-senses, motor activities, reasoning, memory, and emotions
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The BrainCerebellum- “Little Brain”
lControls ____________________ , balance, and coordination of skilled movements
Brain Stem
lMost protected part of the CNS
lControls functions necessary for life
lrespirations, digestion, etc.
The BrainThe Spinal CordlLocated in spinal canal created by the vertebrae of the spine
lTransmits message between the brain and ____________________
lMade up of fibers that extend from the brain’s nerve cells
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Protective Coverings of the Nervous Systeml3 Layers of Meninges
1. Dura Mater: outer layer, tough & fibrous
2. Arachnoid: middle layer
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1. Dura Mater: outer layer, tough & fibrous2. Arachnoid: middle layer3. Pia Mater: inner layer
lCerebrospinal Fluid:Between ____________________ and pia materBrain and spinal cord float in CSFClear and watery
Protective Coverings
Cerebrospinal FluidlProduced in a chamber inside the brain called the third ventriclelApproximately 125 to 150 mL of ____________________ in the
brain at one timelPrimarily acts as a shock absorberl
Peripheral Nervous SystemPNS Consists of:l12 pair of cranial nerves that serve the face and headl31 pair of spinal nerves that connect the organs and muscles to the
spinal cordlSensory nerves: senses of the bodylMotor nerves: causes muscles to ____________________ lConnecting nerves: connects sensory and motor nervesPeripheral Nervous SystemFunctional Divisions of the Nervous SystemlSomatic Nervous System
–____________________ functionslAutonomic Nervous System
–involuntary functionsDivisions of the Autonomic Nervous System1.Sympathetic Nervous System2.Parasympathetic Nervous System
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2.Parasympathetic Nervous System Sympathetic Nervous SystemlBody’s response to ____________________ and prepares body for
threatening situationslCalled “Fight or Flight” phenomenon lBlood vessels constrict, heart rate rises, sweating occurs, pupils
dilateParasympathetic Nervous SystemlNon life threatening functions of the bodyl“House keeping functions”l____________________ heart and respiratory rateActivities of the Nervous SystemslVoluntary activity
–requires conscious effortlInvoluntary activity
–requires no conscious effortlReflex activity
–impulse sent directly from the ____________________ nerve to the motor nerve.
Sensory and Connecting NerveslThe connecting nerves in the spinal cord form a reflex arc. lIf a sensory nerve in this arc detects an irritating stimulus, it will
____________________ the brain and send a direct message to a motor nerve.
The Skull (1 of 2)lComposed of two groups of bones: the cranium, which protects the
brain, and the facial bonesl
The Skull (2 of 2)lCranium is composed of ____________________ brain tissue, 10%
blood supply, and 10% CSFlFour major bones make up the cranium: occiput, temples, parietal
regions, and frontal regionlFace is composed of 14 bones
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regions, and frontal region
lFace is composed of 14 bones
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The Spinal ColumnlBody’s central supporting structure
lHas 33 bones ____________________
lDivided into five sections:
–Cervical
–Thoracic
–Lumbar
–Sacral
–Coccygeal
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Spinal ColumnHead InjurieslTraumatic insult to the head that may result in injury to soft tissue,
bony structures, or the brain
lAccount for more than ____________________ of all traumatic
deaths
–Fatal injuries invariably involve the brain.
–Be alert to the fact that the patient may have sustained additional
trauma.
ll
Head InjurieslClosed injuries
–The brain has been injured but there is no opening into the brain.
lOpen injuries
–Often caused by ____________________ trauma
–May be bleeding and exposed brain tissue
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Types of Head Injuriesl____________________ lacerations
lSkull fractures
lBrain injuries
lMedical conditions
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lBrain injuries
lMedical conditions
lComplications of head injuries
Scalp LacerationslScalp has a rich blood supply and can lead to
____________________ shock.
lThere may be more serious, deeper injuries.
lSevere lacerations can lead to de-gloving injury
lFold skin flaps back down onto scalp.
lControl bleeding by direct pressure.
Scalp De-GlovingSkull FracturesIndicates significant force; may be open or closed depending on
whether there is an overlying laceration of the scalp
Signs include:
lObvious deformity
lVisible crack in the skull
l____________________ eyes
lBattle’s sign
Raccoon EyesBattle’s Sign
Linear Skull FracturelMost common skull fx
lOften shows no____________________ signs
Depressed Skull FracturelHigh energy impact
lMost commonly on the frontal and parietal bones
lFragments may be driven into ____________________
Basilar Skull FracturelHigh-energy trauma
lUsually following diffuse impact to the head
lSigns include ____________________ drainage from the ears, raccoon eyes, and Battle’s sign
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lSigns include ____________________ drainage from the ears, raccoon eyes, and Battle’s sign
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Open Skull FracturelResult when severe forces are applied to the headlOften associated with trauma to multiple body systemsl____________________ tissue may be exposed to the environmentl
Traumatic Brain Injury (1 of 4)lMost serious of all head injurieslTwo broad categories: primary (direct) injury and secondary (indirect)
injurylPrimary brain injury results ____________________ from impact to
the head.lSecondary brain injury increases the severity of the primary injury.l
Traumatic Brain Injury (2 of 4)Secondary injury may be caused by:lHypoxialHypotensionlCerebral edemalIntracranial ____________________ lIncreased intracranial pressurelCerebral ischemialInfectionTraumatic Brain Injury (3 of 4)lThe brain can be injured directly by a penetrating object or indirectly
as a result of external forces.lA ____________________ injury can result from striking a
windshield.–Initial impact injures front part of brain–Head falling back against headrest injures rear part of brain
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Traumatic Brain Injury (4 of 4)lCerebral edema (swelling of the brain) may not develop until several
____________________ following the initial injury.
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lCerebral edema (swelling of the brain) may not develop until several ____________________ following the initial injury.
Intracranial Pressure (ICP)lAccumulations of blood within the skull or swelling of the brain can
rapidly lead to an increase in ICP.lIncreased ICP squeezes the brain against bony prominences within
the craniumlSince the skull is rigid the brain ____________________ Intracranial PressurelSigns of increased intracranial pressure
–Abnormal respiratory patterns –Decreased pulse rate, headache, nausea, vomiting, decreased alertness, ____________________ , sluggish or nonreactive pupils, decerebrate posturing, and increased or widened blood pressure
–____________________ reflex
Intracranial BleedinglLaceration or rupture of blood vessel in brainlEpidural hematoma: Accumulation of blood between the skull
and____________________ materlSubdural hematoma: Accumulation of blood beneath the dura mater
but outside the brainlIntracerebral hematoma: Bleeding within the brain tissue itselfl
Intracranial Pressure (1 of 3)lEpidural hematoma
–Accumulation of blood between the skull and dura mater–Nearly always the result of a blow to the headlProduced by a linear fracture of the thin temporal bone
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Intracranial Pressure (2 of 3)lSubdural hematoma
–Accumulation of blood beneath the____________________ mater but outside the brain
–Occurs after falls or injuries involving strong deceleration forcesl
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–Occurs after falls or injuries involving strong deceleration forcesl
Intracranial Pressure (3 of 3)lIntracerebral hematoma
–Bleeding within the ____________________ tissue itself–Can occur following a penetrating injury to the head or because of rapid deceleration forces
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Subarachnoid HemorrhagelSubarachnoid hemorrhage
–Bleeding occurs into the subarachnoid space, where the ____________________ circulates.
–Results in bloody CSF and signs of meningeal irritation–Common causes include trauma or rupture of an aneurysm.
l
Concussion (1 of 2)lBrain can sustain ____________________ when skull is strucklThere will be bleeding and swelling.lBleeding will increase the pressure within the skull.lConsidered a mild TBIConcussion (2 of 2)lTemporary loss or alteration in brain functionlMay result in unconsciousness, confusion, or amnesialAbout ____________________ of patients do not experience a loss
of consciousnesslAssume that a patient with signs or symptoms of concussion has a
more serious injury until proven otherwise.ll
S/S of ConcussionlDizzinesslWeaknessl____________________ changeslNausea and vomitinglDelay of motor functionslInappropriate emotional responses
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lDelay of motor functionslInappropriate emotional responseslllRinging in the earslSlurred speechlInability to focuslLack of coordinationlTemporary headachelDisorientationl
ContusionlMore serious than a concussionlInvolves physical ____________________ to brain tissuelMay sustain long-lasting and even permanent damagelA patient may exhibit any or all of the signs of brain injury.l
Other Brain InjurieslBrain injuries are not always caused by trauma.lMedical conditions may cause spontaneous bleeding in the brain.lSigns and symptoms of ____________________ injuries are the
same as those of traumatic injuries.–There is no mechanism of injury.
Complications of Head InjurylCerebral edemalConvulsions and seizureslVomitinglLeakage of ____________________ fluid
Assessing Head InjurieslCommon causes:
-Motor vehicle crashes-Direct blows-____________________ from heights-Assault-Sports Injuries
lEvaluate and monitor level of consciousness
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-Sports InjurieslEvaluate and monitor level of consciousnessTypes of Head InjurieslClosed:
–Skull is intact –Major concern is swelling
lOpen:–Skull is penetrated or fractured–Causes less swelling–Causes ____________________ damage to brain tissue
Signs and Symptoms (1 of 4)lLacerations, contusions, hematomas to scalplSoft areas or____________________ upon palpationlVisible skull fractures or deformitieslEcchymosis around eyes and behind the earlClear or pink CSF leakagel
Signs and Symptoms (2 of 4)lFailure of pupils to respond to lightlUnequal pupilslLoss of sensation and/or motor functionlPeriod of ____________________ lAmnesialSeizuresSigns and Symptoms (3 of 4)lNumbness or tingling in the extremitieslIrregular respirationslDizzinesslVisual complaintsl____________________ or abnormal behaviorlNausea or vomitingl
Signs and Symptoms (4 of 4)Vital Signs of a closed head injury (Cushing’s triad):l____________________ BPlSlowing Pulse
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l____________________ BPlSlowing PulselIrregular respirationsAn isolated head injury will NOT produce S/S of hypovolemic shock. If
S/S of hypovolemic shock exists, look elsewhere!Level of ConsciousnesslChange in level of consciousness is the single most important
observation.lUse the ____________________ scale or Glasgow Coma Scale
(depending on local protocols)lReassess
–Every 15 minutes if patient is stable.–Every 5 minutes if patient is unstable.
l
Change in Pupil SizelUnequal pupil size may indicate increased pressure on one side of
the brain.Care of Head Injuries (1 of 2)lEstablish an adequate airway. Use jaw thrust maneuverlDo not hyperventilate the patientlProvide high concentration of oxygenlControl bleeding not drainagelAssess the patient’s ____________________ level of
consciousness.Care of Head Injuries (2 of 2)lBe prepared for vomitinglControl ____________________ spinelMove patient as little as possiblelIf patient is combative, contact Paramedic backup to sedate the
patient (if allowed)lRapid transportSpine InjurieslCompression injuries occur from a ____________________ .lMotor vehicle crashes or other types of trauma can overextend, flex,
or rotate the spine.lHyperextension: When spine is pulled along its length; causes
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or rotate the spine.lHyperextension: When spine is pulled along its length; causes
injuries.–Hangings are an example.
Significant Mechanisms of Injury (MOI)lMotor vehicle crasheslPedestrian-motor vehicle collisionslFallslBlunt or ____________________ traumalMotorcycle crasheslHangingslDiving accidentslRecreational accidentsQuestions to Ask Responsive PatientslDoes your neck or back hurt?lWhat happened?lWhere does it hurt?lCan you move your ____________________ and feet?lCan you feel me touching your fingers? Your toes?Signs and Symptoms of Spinal InjurylPain or tenderness of spinelDeformity of spinelTingling in the extremitieslLoss of sensation or paralysisl____________________ lInjuries to the headlPriapism in malesLocation of Spinal InjurieslParalysis around shoulder level and below indicates injury at
____________________ area (Quadriplegia)lParalysis around waist and below indicate injury at the L1 area
(Paraplegia)
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(Paraplegia)Care of Spinal InjurieslFollow BSI precautions.lManage the airway.
-Perform the jaw-thrust maneuver to open the airway.-Consider inserting an oropharyngeal airway.-Administer oxygen.
lStabilize the ____________________ spine.l
When to Immobilize??lThe most important indicator of a possible spinal injury is the
____________________ lIf the MOI is capable of causing a spinal injury, consider spinal motion restriction.lWhen in doubt……?????? IMMOBILIZEApplying a Cervical Collar (1 of 2)lOne EMT-B provides continuous ____________________ in-line
support of the head.lMeasure the proper size collar.Applying a Cervical Collar (2 of 2)lPlace the chin support snuggly under the chin.lWrap the collar around the neck.lEnsure that the collar fits.
Stabilization of the Cervical Spine (1 of 2)lHold head firmly with both hands.lSupport the lower jaw.lMove to ____________________ position.lSupport head while partner places cervical collar.lMaintain the position until patient is secured to a backboard.Stabilization of the Cervical Spine (2 of 2)Do not force the head into a neutral, in-line position if:lMuscles spasml____________________ increaseslNumbness, tingling, or weakness developlThere is a compromised airway or breathing
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lNumbness, tingling, or weakness developlThere is a compromised airway or breathingPreparation for Transport:Supine Patients (1 of 2)lMaintain in-line stabilization.lHave the other team members position the immobilization device.l____________________ patient.Preparation for Transport:Supine Patients (2 of 2)lSecure patient to backboard.lReassess pulse, motor, and sensory function in each extremity and
continue to do so periodically.
Preparation for Transport: Sitting Patients (1 of 2)lMaintain manual in-line stabilization. lApply a____________________ collar.lPlace a short board behind patient.lPosition device around patient.Preparation for Transport: Sitting Patients (2 of 2)lTurn patient and lower to long backboard.lSecure short and long backboards together.lReassess the pulse, motor function, and sensation.Preparation for Transport: Standing PatientslStabilize the head and neck and apply a c-collar.lPosition board ____________________ patient.lCarefully lower the patient to the ground. BackboardslShort backboards
–Used on patients found in a sitting positionlLong backboards
–Provide ____________________ immobilizationHelmet Removal (1 of 7)lIs the airway clear and is the patient breathing adequately?
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Helmet Removal (1 of 7)lIs the airway clear and is the patient breathing adequately?lCan airway be maintained and ____________________ assisted
with helmet in place?lHow well does the helmet fit?lCan the patient move within the helmet?lCan the spine be immobilized in a neutral position with the helmet
on?Helmet Removal (2 of 7)A helmet that fits well prevents the head from moving and should be
left ____________________ , as long as:lThere are no impending airway or breathing problemslIt does not interfere with assessment and treatment of the airwaylYou can properly immobilize the spinel
Helmet Removal (3 of 7)lPreferred method
–Removing a helmet should always be at least a ____________________ job.
–You should first consult with medical control about your decision to remove a helmet.
Helmet Removal (4 of 7)lOpen the face shield.lPrevent head movement.lPartner places hands.lGently slip helmet off ____________________ .Helmet Removal (5 of 7)lPartner slides hands from occiput to back of head.lRemove helmet.lStabilize ____________________ .lApply cervical collar.lPad as needed.lTransport helmet and safety devicesHelmet Removal (6 of 7)lAlternate method
–The advantage is that it allows the helmet to be removed with the
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lAlternate method–The advantage is that it allows the helmet to be removed with the application of less force; therefore, reducing the likelihood of motion occurring in the neck.
–The disadvantage is that it is slightly more____________________ consuming.
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Helmet Removal (7 of 7)lAlternate method (cont’d)
–Remove the chin strap.–Remove the face mask.–Pop the jaw pads out of place.–Place your ____________________ inside the helmet.–Hold the jaw with one hand and the occiput with the other.–Insert padding behind the occiput.
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Pediatric NeedslImmobilize a child in the car ____________________ , if possible.lChildren may need extra padding to maintain immobilization.lC-collar not possible with small children
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