2016 In-Service Training Head and Neck Injuries

2016 In-Service Training The Skull and Brain

2016 In-Service Training Zygoma (cheek) Maxilla Mandabile (Jaw) Orbit Nasal Bones CRANIUM FACE

2016 In-Service Training The Skull Cranial Skull – helmet-like bony covering Basilar Skull – floor of the skull

2016 In-Service Training Cerebrospinal Fluid A colorless fluid that circulates throughout the skull and spinal column, protects the brain and spinal cord against impact, and combats infection and cleanses brain and spinal cord

2016 In-Service Training Dura mater – outermost meninges; composed of a double layer of tough, fibrous tissue Arachnoid – middle meninges Pia Mater - innermost meninges in contact with brain. Subarachnoid space – separates aracnoid and pia mater The Meninges

2016 In-Service Training The Meninges Bone Dura mater Arachnoid Pia mater Subarachnoid space Intracerebral

2016 In-Service Training Bleeding in the Meninges Epidural bleeding – occurs between dura mater and skull Subdural bleeding – occurs beneath dura mater, usually venous Subarachnoid hemorrhage – occurs between arachnoid and surface of brain, can be fatal in minutes

2016 In-Service Training Cerebrum Largest part of the brain Made up of four lobes Is responsible for most conscious and sensory functions, the emotions, and the personality

2016 In-Service Training Brain Stem Brain’s funnel-shaped inferior part and the most primitive and best protected part of brain Controls most automatic functions, including cardiac, respiratory, and vasomotor Made up of pons, midbrain, and medulla oblongata

2016 In-Service Training Types of Head Injury

2016 In-Service Training Very vascular; tend to bleed very heavily Underlying fascia may be torn while skin stays intact Bleeding under the skin can mimic skull deformity

2016 In-Service Training Open skull deformity – break in the continuity of skin and bone Closed skull deformity – intact scalp

2016 In-Service Training Direct – from penetrating trauma Indirect – from a blow to the skull Secondary – from lack of oxygen, buildup of carbon dioxide, change in blood pressure

2016 In-Service Training Closed Head Injury No opening to brain, yet brain damage can be extensive. Open Head Injury Break in skull, providing an opening to the brain.

2016 In-Service Training Types of Brain Injuries Concussion Temporary loss of brain’s ability to function Contusion Bruising or swelling of the brain

2016 In-Service Training Types of Brain Injuries Hematoma Pooling of blood within the brain Laceration Tearing of brain tissue

2016 In-Service Training Assessment and Care

2016 In-Service Training Assessment and Care Scene Size-Up Always be alert for signs of head injury during trauma scene size-up. Non-traumatic injuries can be caused by clots or hemorrhaging and can cause altered mental status and signs and symptoms similar to those of trauma cases

2016 In-Service Training Assessment and Care Initial Assessment Be alert for cervical spine injury Apply manual in-line stabilization as the first step If patient is unresponsive or with altered mental status, establish an airway using the jaw thrust maneuver while holding in-line stabilization

2016 In-Service Training Assessment and Care Initial Assessment If patient is breathing adequately, provide oxygen by non-rebreather mask at 15 lpm If patient is not breathing adequately, provide positive pressure ventilations with supplemental oxygen

2016 In-Service Training Assessment and Care Initial Assessment Assess mental status using AVPU Keep in mind that patient’s mental status may change Determine baseline mental status Record patient’s responses Purposeful responses Non-purposeful responses Unresponsive

2016 In-Service Training Glasgow Coma Scale Eye OpeningSpontaneous4 To Voice3 To Pain2 None1 Verbal ResponseOriented5 Confused4 Inappropriate3 Incomprehensible2 None1 Motor ResponseObeys Commands6 Localizes Pain5 Withdraw4 Flexion3 Extension2 None1

2016 In-Service Training Assessment and Care Focused History / Physical Exam First perform rapid trauma assessment Next check vital signs and obtain a SAMPLE history If patient’s mental status worsens at any stage of the assessment or treatment, transport immediatly

2016 In-Service Training Rapid Trauma Assessment Palpate gently for Deformities, depressions, lacerations, or impaled objects The Head

2016 In-Service Training Rapid Trauma Assessment The Eyes Check patient’s pupils with bright light Check eye movement Note any discoloration (“Racoon sign” may indicate intracranial injury or be a late sign of a skull fracture)

2016 In-Service Training Rapid Trauma Assessment The Ears and Nose Check for leakage of blood or clear fluid Look for Battle’s sign, a purplish discoloration of the mastoid area behind the ear (can be a late sign of a skull fracture)

2016 In-Service Training Rapid Trauma Assessment Motor/Sensory – Alert Patient Check ability to move fingers & toes Test for equal grip strength Ask patient to tell you which finger or toe you are touching Pinch each extremity and ask patient to identify pain Ask if patient feels any weakness on one side of the body

2016 In-Service Training Rapid Trauma Assessment Motor/Sensory – Altered Mental Status Watch for grimace response Watch for withdrawal from painful stimulus

2016 In-Service Training Baseline Vital Signs Blood Pressure If systolic is high or rising, suspect pressure inside skull If systolic is low or dropping, suspect blood loss that has led to shock, and check rest of body for bleeding

2016 In-Service Training Baseline Vital Signs Pulse If high or rising, suspect hemorrhage elsewhere in body or early onset of hypoxia If slow or dropping, suspect pressure inside the skull or severe hypoxia

2016 In-Service Training Baseline Vital Signs Respirations Look for respiratory patterns that indicate intracranial pressure Extremely fast and shallow Completely irregular Absent Cushing’s reflex * Blood Pressure increases, Pulse decreases, Irregular respirations

2016 In-Service Training Baseline Vital Signs Respirations If no definite signs of severe head injury and positive pressure ventilation is needed; Ventilate at a rate of 12 ventilations/minute with supplemental oxygen

2016 In-Service Training SAMPLE History How did the incident occur? What is the patient’s chief complaint? Does the patient feel tingling, numbness, or paralysis? Where? Have the symptoms changed? Did the patient lose consciousness at any time? For how long? Was the patient moved after the incident?

2016 In-Service Training Look for Signs & Symptoms Altered mental status Irregular breathing patterns Mechanism of injury Blood or fluid leakage from the ears and nose Bruising around the eyes and behind the ears. Nausea and/or vomiting Neurologic disability; Seizure activity Unequal pupils with altered mental status

2016 In-Service Training Assessment and Care Emergency Medical Care Take BSI precautions Apply manual in-line stabilization Maintain patent airway and adequate oxygen Monitor airway, breathing, pulse, and mental status for deterioration Be prepared for seizures Transport

2016 In-Service Training Assessment and Care Detailed Physical Exam Ongoing Assessment Repeat assessment every 5 minutes

2016 In-Service Training More About Brain Injuries

2016 In-Service Training Concussion Momentary confusion Retrograde amnesia Antegrade amnesia Combativeness Irritability Nausea and vomiting Restlessness Inability to answer questions or obey commands appropriately

2016 In-Service Training Concussion Mild- Transient loss of consciousness, followed by a headache Severe-May cause prolonged loss of consciousness and disruption of certain vital functions of the brainstem Treatment-Observe and watch for ICP

2016 In-Service Training What every Athlete should know about Concussions ! A concussion is a brain injury that: Is caused by a bump, blow, or jolt to the head or body. Can change the way your brain normally works. Can occur during practices or games in any sport or recreational activity. Can happen even if you haven’t been knocked out. Can be serious even if you’ve just been “dinged” or “had your bell rung.” All concussions are serious. A concussion can affect your ability to do schoolwork and other activities (such as playing video games, working on a computer, studying, driving, or exercising). Most people with a concussion get better, but it is important to give your brain time to heal.

2016 In-Service Training What are the symptoms of a concussion? You can’t see a concussion, but you might notice one or more of the symptoms listed below or that you “don’t feel right” soon after, a few days after, or even weeks after the injury. Headache or “pressure” in head Nausea or vomiting Balance problems or dizziness Double or blurry vision Bothered by light or noise Feeling sluggish, hazy, foggy, or groggy Difficulty paying attention Memory problems Confusion

2016 In-Service Training What should I do if I think I have a concussion? Tell your coaches and your parents. Never ignore a bump or blow to the head even if you feel fine. Also, tell your coach right away if you think you have a concussion or if one of your teammates might have a concussion. Get a medical check-up. A doctor or other healthcare professional can tell if you have a concussion and when it is OK to return to play. Give yourself time to get better. If you have a concussion, your brain needs time to heal. While your brain is still healing, you are much more likely to have another concussion. Repeat concussions can increase the time it takes for you to recover and may cause more damage to your brain. It is important to rest and not return to play until you get the OK from your health care professional that you are symptom-free.

2016 In-Service Training How can I prevent a concussion? Every sport is different, but there are steps you can take to protect yourself. Use the proper sports equipment, including personal protective equipment. In order for equipment to protect you, it must be: The right equipment for the game Worn correctly and the correct size and fit Used every time you play or practice Follow your coach’s rules for safety and the rules of the sport. Practice good sportsmanship at all times. If you think you have a concussion: Don’t hide it. Report it. Take time to recover.

2016 In-Service Training What every Parent should know about concussions!!! Signs Observedby Parents or Guardians Appears dazed or stunned Is confused about assignment or position Forgets an instruction Is unsure of game, score, or opponent Moves clumsily Answers questions slowly Loses consciousness (even briefly) Shows mood, behavior, or personality changes Can’t recall events prior to hit or fall Can’t recall events after hit or fall Symptoms Reported by Athlete Headache or “pressure” in head Nausea or vomiting Balance problems or dizziness Double or blurry vision Sensitivity to light or noise Feeling sluggish, hazy,foggy, or groggy Concentration or memory problems Confusion Just not “feeling right” or is “feeling down”

2016 In-Service Training Contusion Coup-contrecoup injury Decreasing mental status or unresponsiveness Paralysis Unequal pupils Vomiting Alteration of vital signs Profound personality changes

2016 In-Service Training

Subdural Hematoma Deterioration of level of responsiveness Vomiting Dilation of one pupil Abnormal respirations or apnea Possible increasing systolic blood pressure Decreasing pulse rate

2016 In-Service Training Epidural Hematoma Loss of responsiveness followed by return of responsiveness and rapidly deteriorating responsiveness Decreasing mental status Severe headache Pupil fixed and dilated on side of impact Seizures Increasing systolic blood pressure and decreasing heart rate

2016 In-Service Training