©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. 21 Injuries to the Head and Spine

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. OBJECTIVES DIRECTORY Objectives for this chapter can be referenced on page 504 of your textbook.

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. TOPICS Anatomy Head Injuries Special Circumstances Spinal Injuries

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. INTRODUCTION Axial skeleton Protect and house –Nervous system –Brain –Heart –Lungs

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Environment –Sunny day in July –90 degrees Fahrenheit with high humidity Dispatch –Called to a public pool for a diving accident –Dispatch advises that the patient has been removed from the water by bystanders THE CALL

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Anatomy

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed.

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Anatomy Five regions of the spinal column –Cervical –Thoracic –Lumbar –Sacral –Coccygeal

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Head Injuries

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Photo: © Edward T. Dickinson, MD

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Closed Head Injuries Swelling and bleeding Signs –Altered mental status –Weakness, numbness, or paralysis –Posturing –Pupil changes –Loss of balance –Nausea and vomiting Photo: © Edward T. Dickinson, MD

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Closed Head Injury Herniation Signs of herniation –Profound altered mental status –Cushing triad Decreasing pulse rate Increasing blood pressure Abnormal respiratory patterns –Posturing –Change in pupil response

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment: Concussion Temporary interruption of brain function Signs and symptoms –Brief loss of consciousness –Temporary altered mental status –Amnesia –Repetitive questioning –Seizure –Nausea and vomiting –Incontinence

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment: Open Head Injury Signs and symptoms –Obvious deformity or visible fracture –Pain or tenderness –Cerebrospinal fluid leakage –Pupil changes –Battle sign –Raccoon eyes –Signs and symptoms of brain injury

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Emergency Care: Head Injuries Maintain airway and breathing Stabilize the head and spine Reassess Care for soft tissue injuries

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Special Circumstances

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment and Care: Penetrating Wounds A penetrating wound to the head is always a serious emergency –Allow blood to drain –Stabilize impaled object

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment and Care: Face, Ears, Nose, and Throat Maintain a patent airway Show empathy

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment and Care: Soft Tissue Injuries of the Face Mouth, tongue, and cheek Ear Nose Jaw Teeth

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment and Care: Neck Injuries Possibility of severe bleeding Pulmonary embolism Blunt trauma Photo: © Edward T. Dickinson, MD

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment: Eye Injuries Tenderness or deformity to the orbits Soft tissue injury around eye Foreign objects Injury to the globe Pupil reactivity Double vision Inability to move eye normally

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Emergency Care: Eye Injuries Dress or cover both eyes Gentle pressure for bleeding Do not remove clots Do not force eye open Do not flush unless chemicals are present

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment and Care: Foreign Objects in the Eye Flush with water Remove objects with sterile gauze Use lower lashes to remove objects Cover the eyes

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment and Care: Impaled Objects in the Eye Major threat to vision Never remove object Stabilize

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment and Care: Globe Injuries and Extruding Eyeballs Globe injury –Cover with sterile dressing –Cover both eyes Extruding eyeballs –Do not attempt to replace eyeball –Cover with moist dressing –Cover both eyes

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment and Care: Orbit Injuries Deformity Difficulty moving eye Double or impaired vision Numbness around eye

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment and Care: Chemical Burns to the Eye Take immediate action Flush for 30–60 minutes Personal protection Remove contact lenses

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment and Care: Removing a Contact Lens Open the eyelid Press down and forward on the edges of lens Slide lens out of the eye Remove and place lens in safe keeping

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. 18-year-old boy lying on concrete deck of pool Patient does not appear to be moving Bystanders state that he dove into shallow end of pool Patient had to be assisted out of pool Your partner takes manual stabilization of spine Patient is wet and shivering THE RESPONSE

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Responsive and answers questions Airway is patent; breathing normal; rapid radial pulse Alert and oriented with no loss of consciousness Vital signs –Pulse: 116 –Respirations: 24 –BP: 118/76 THE RESPONSE

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Secondary assessment reveals tenderness to posterior neck, good distal circulation, and sensory and motor function in all extremities He states that he struck his head after diving in He had a difficult time swimming after diving in THE RESPONSE

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Spinal Injuries

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed.

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Spinal Injuries Secondary injury –Swelling, compression, hypoxic tissue –Unstable fractures

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Spinal Injuries Assume spinal injury Mechanism of injury Spinal precautions

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Patient Assessment: Spinal Cord Injury Signs and symptoms –Pain, tenderness, or pain with movement –Numbness or tingling in arms or legs –Paralysis or difficulty moving –Loss of sensation –Incontinence –Priapism –Deformity of the spine

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Emergency Care: Spinal Cord Injury Treat immediate life threats Take spinal precautions Assess for signs of spinal injury Immobilize the patient

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Emergency Care: Spinal Cord Injury Spinal immobilization –Maintain neutral position –Assess extremities for Circulation, sensation, and movement

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Cervical collars EMR Emergency Care: Spinal Cord Injury

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Emergency Care: Spinal Cord Injury Long backboard immobilization

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Log roll EMR Emergency Care: Spinal Cord Injury

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Emergency Care: Seated Patient

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMR Emergency Care: Seated Patient Rapid extrication

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Helmet Removal Stabilize helmet. Loosen and remove chin strap. Transfer manual stabilization to a second rescuer. Second rescuer will place his hands on patient’s jaw and back of head. continued

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. Helmet Removal (cont.) Remove the helmet at a slow and steady pace. Adjust stabilization. Remove the helmet completely.

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. EMTs arrive, and you summarize the mechanism of injury and assessment findings They fully immobilize the patient with your assistance You complete your call documentation TRANSITION

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. REVIEW Define the following terms: –Axial skeleton –Cerebrospinal fluid –Vertebrae –Articulation –Posturing –Foramen magnum –Herniation

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. REVIEW Define the following terms: –Cushing triad –Concussion –Battle sign –Raccoon eyes –Orbit

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. STOP, REVIEW, REMEMBER Which of the following bones is part of the axial skeleton? a.Skull b.Pelvis c.Femur d.Radius

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. STOP, REVIEW, REMEMBER There are _____ bones that make up the spinal column. a.22 b.33 c.37 d.11

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. STOP, REVIEW, REMEMBER A large laceration to the scalp that has an associated fracture of the skull would be considered a(n): a.open head injury. b.contusion. c.abrasion. d.closed head injury.

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. STOP, REVIEW, REMEMBER When treating an extruded eyeball, you should: a.replace it in the socket. b.apply direct pressure. c.wrap the eyeball in a dry dressing. d.never replace it in the socket.

©2014 Pearson Education, Inc. EMR Complete: A Worktext, 2 nd Ed. REVIEW Discussion 1.Discuss the difference between open and closed head injuries. 2.List the signs and symptoms of a closed head injury. 3.List the signs and symptoms of a spinal cord injury.