Injuries to Head and Spine

Nervous and Skeletal System Nervous System Central Nervous System {CNS} Brain and Spinal cord Peripheral Nervous System Peripheral nerves

Sensory nerves Messages from the body to the brain Motor nerves Messages from the brain to the muscles Nerves exit the brain and down the spinal cord and cross over *an injury to left side of the brain may produce effects on the right side

Autonomic Nervous System Controls involuntary function Anatomy of the Head Cranium and facial bones Cranium; portion of skull that encloses the brain Cranial bones are fused to form immoveable joints

14 irregularly shaped bones form the face all moveable except for the mandible Upper jaw is made up of two fused bones called the maxillae Bridge of nose contains two nasal bones Cheek bone Zygomatic maxillae form a portion of the orbits

Cerebrospinal Fluid {CSF} Bathes the brain Circulates down the spine and around the spinal cord Anatomy of the spine Made up of 33 irregularly shaped bones vertebrae

Each vertebrae has a spinous process serves for the attachment of muscles and ligaments 7 12 5 5 4

Injuries to the Skull and Brain Scalp injuries May bleed profusely control of bleeding Skull Injuries Open Closed

Brain Injuries Direct injuries Indirect injuries Types Concussion groggy or have a headache some loss of memory is common

Contusion Bruise to the brain Bruising on the same side of the blow is a coup; the opposite side, countercoup Hematoma Collection of blood in a tissue

Named according to location Subdural {between brain and dura} Epidural {between dura and skull} Intracerebral {blood pools in the brain} Complications Limited room for expansion inside skull

Hematoma increases pressure *Normal blood flow is impeded *blood pressure increases; flow decreases *brain becomes starved for oxygen *swelling occurs *decreased respiratory effort

ONE OF THE FIRST AND MOST SIGNIFICANT SIGNS OF HEAD INJURY IS AMS DO AN ASSESSMENT AND GET A HISTORY DON’T ASSUME INTOXICATION OR DRUGS

Patient Assessment Visible bone fragments or brain tissue AMS GCS Deep laceration or severe bruise to scalp or forehead Deep laceration or severe bruise or hematoma to scalp or forehead

Depression or deformity of skull, large swelling or unusual shape Severe pain at the site of a head injury don’t palpate Battle signs Unequal pupils or unreactive to light Raccoon eyes One eye that appears to be sunken

Bleeding from ears and or nose CSF Personality changes; irritable to irrational Cushing’s triad/reflex increased b/p and decreased pulse Irregular breathing patterns Temperature increase {late sign} Blurred or double-vision ; one or both eyes

Impaired hearing or ringing in the ears Equilibrium problems Forceful or projectile vomiting Posturing decorticate arms flexed, or bent inward on the chest, the hands are clenched into fists, and the legs extended and feet turned inward.

Decerebrate The head is arched back, the arms are extended by the sides, and the legs are extended. A hallmark of decerebrate posturing is extended elbows.

Decorticate

Paralysis on one side of the body Seizures Deteriorating VS Shock Assume brain injury when MOI or index of suspicion indicates a possible head injury

Care Standard precautions Assume spinal injury *Manual stabilization *Jaw-thrust to open airway OP and suction If unconscious carefully monitor breathing appropriate airway management

Apply C-collar O2 Do not hyperventilate; unless sign of critical brain injury *fixed and dilated pupils *AMS *Increased B/P

Control bleeding Keep pt. at rest Provide emotional support Dress and bandage open wounds Manage for shock avoid overheating Be aware of the possibility of vomiting Rapid transport monitory VS q 5 minutes

Impaled objects Do not remove Stabilize the object If object must be cut, use a tool that will not cause the object to move or vibrate when finally severed Medical direction if needed

Injuries to face and jaw Airway obstruction to remove blood and debris Mandible pain, discoloration, facial distortion may not be able to move improper alignment of teeth

Jaw-thrust maneuver to open airway Apply C-collar Position for drainage Non-traumatic Brain Injury No evidence of trauma and no MOI

Injuries to the Spine MOI Compression falls diving accidents MVA

Excessive flexion, extension, roatation lateral bending pulling apart of the spine hangings Maintain high index of suspicion for: MVA Pedestrian vs. vehicle Falls

Diving accidents Unconscious trauma victims Assessment Signs and symptoms Paralysis Pain without movement Tenderness along the spine

Impaired breathing Diaphragmatic breathing Paradoxical breathing {rib injuries} Deformity Priapism Posturing Loss of bowel or bladder control Nerve impairment to extremities

Spinal shock Soft-tissue injuries associated with trauma Ask what happened? where does it hurt? neck or back hurt? PMS Numbness or tingling? strength and grip

Inspect and palpate If unconscious Rapid trauma assessment MOI and MS from bystanders

Care Manual in-line stabilization ABCs – jaw-thrust maneuver Rapid trauma assessment assess head and neck then C-Collar PMS If paralysis or weakness adm. O2

Evaluate the need for artificial ventilation Reassess PMS Helmets *remove if tx. warrents if left on, shields and guards can be removed { while helmet secured} do not remove if attempts increases pain or difficult to remove*

Guidelines for leaving helmet on: Snug fit allowing little or no movement Spinal immobilization can be done with helmet in place Removal would cause further injury Airway and breathing mgt. is not hampered

Guidelines for removing a helmet Interference with ABCs mgt. Improper fit allowing movement If wearing shoulder pads leave all in place or remove all

SKILLS