National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 21 Head and Spine Injuries

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 21.1 Correctly identify the major anatomical components of the central nervous system Define traumatic brain injury Describe common traumatic injuries involving the head, neck, and back Describe the signs and symptoms of potential head injuries involving the brain. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 21.5 Describe the signs and symptoms of potential spinal injuries Describe how to properly assess a patient with a suspected neurologic injury, including neck and spine injuries List the signs and symptoms of increased intracranial pressure Demonstrate how to properly treat a patient with a head, neck, spine, or back injury. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 21.9 Demonstrate how to maintain proper spinal alignment while placing a patient onto a long spine board from the following positions: a.lying b.sitting c.standing Describe and demonstrate how to remove a helmet.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Anatomy and Physiology Common Mechanisms of Injury Increased Intracranial Pressure Coup-Contracoup Common Injuries Head and Brain Injuries continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Spinal Injuries Patient Assessment Management Chapter Summary

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation An unresponsive adult male is lying on his side at the base of a large tree. His helmet is cracked in two places and there is blood leaking from his nose and ears. Tracks show he hit the tree straight on.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Skeletal = skull and vertebrae Brain ◦ 3 parts ◦ White and gray matter Spinal cord – Cerebrospinal fluid Nerve cells Central and peripheral nervous systems

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Mechanisms of Injury Rapid deceleration (impact related) Rapid acceleration Compression Penetrating or impaled object Near drowning Hypothermia or hyperthermia Electrical injury (includes lightning)

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Mechanisms of Injury

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Central Nervous System Injuries Primary injuries occur from external trauma Secondary injuries occur from ◦ Inadequate brain perfusion ◦ Increased intracranial pressure ◦ Hypoxia ◦ Delayed reactions from primary injury Most common among young men

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Increased Intracranial Pressure Skull volume is fixed Increased blood or swelling ◦ Compresses the brain ◦ Reduce cerebral blood flow ◦ Cause cerebral hypoxia ◦ Reduce brain function ◦ May cause death

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Increased Intracranial Pressure

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Coup – Contrecoup Injuries Brain strikes the inside of the skull ◦ Initial impact = coup ◦ Rebound to opposite side = contrecoup Caused by rapid deceleration May have no external signs Cause intracranial bleeding and swelling Pediatric/geriatric injuries may be more severe

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Coup – Contrecoup Injuries

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Injuries Closed ◦ Hematomas ◦ Skull, spine, scapula, posterior rib fractures ◦ Epidural and subdural hematomas continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Injuries continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Injuries Open ◦ Brain matter or bone fragments exposed ◦ CSF is leaking from a wound or nose or ears ◦ Non CNS injuries

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Head and Brain Injuries Scalp injuries – soft tissue Skull fractures Traumatic brain injury (TBI) Recurrent traumatic brain injury Diffuse axonal injury Concussion continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Head and Brain Injuries Amnesia ◦ antegrade and retrograde Cerebral contusion Epidural and subdural hematoma Intracerebral hemorrhage

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Spinal Injuries Include neck/back ◦ Soft tissue injuries ◦ Strains ◦ Fractures Vertebral injuries ◦ Fractures ◦ Causes/types vary by location ◦ Lower thoracic/lumbar most common continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Spinal Injuries continued Copyright Philadelphia Cervical Collar Company.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Spinal Injuries Scapula Posterior rib Neurologic injuries ◦ Primary – direct spinal cord involvement ◦ Secondary (indirect) – pressure from blood or swelling (neural ischemia) Neurogenic shock ◦ Common cause is spinal cord injury

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update You secure the scene, and then you summon assistance. You instruct rescuers to bring a long spine board, a C-collar, oxygen, and a trauma pack, toboggan, a helicopter for transport. The patient’s pulse is 92 and regular. You ensure an open airway. You visually assess the patient’s injuries.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Patient Assessment Focus on MOI Standard assessment procedures – ABCDs, SAMPLE, and vitals Assess mental status (A&O x 4) ◦ Mini-neurologic exam LOC – AVPU Pupillary exam Best motor response

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Patient Assessment

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Patient Assessment Distal motor/sensation function (CSM) Stabilize C-spine (manual, c-collar)

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Maintain vitals – correct life-threats ◦ High flow oxygen Transport avoiding secondary injury ◦ Assume spinal injury with head injury ◦ Immobilize entire spine Check for medical issues Treat other injuries ◦ Do not stop flow of CSF Monitor - ongoing assessments

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY The C-Collar Does NOT provide full stabilization! Should rest on the shoulder and provide firm support under the chin Head/c-spine should be in neutral position Do not use if size is incorrect

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Using Towels or Blankets Copyright Mike Halloran

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY The Long Spine Board Supine position is preferred Spine should be treated as a single long bone Lift or roll patient onto the board Use axial drag for final positioning Secure torso first, head last Seated patients may need a short device before transfer to the LSB

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Standing Backboard Use manual C-spine stabilization Check CSM, apply C-collar Position rescuers to support patient and board Lower patient Position correctly on board Secure patient

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Cautions! Vomiting is common with brain injury patients ◦ Be prepared to tip the board and/or suction Pediatric patients need a ped’s C- collar, and may need padding under the shoulders for neutral position

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Cautions!

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Helmet Removal Remove only if… ◦ It prevents airway/breathing management ◦ It allows patient’s head to move or prevents spinal immobilization ◦ Patient is in cardiac arrest Ensure C-spine stabilization throughout Apply C-collar immediately

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Helmet Removal

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition You place a C-collar on the patient, and with the assistance of other patrollers carefully log-roll him onto a long spine board. His vital signs remain stable. After securing the patient to the LSB, you load him into a toboggan with his head uphill, and quickly transport him to a nearby landing zone. The patient is then flown to the nearest trauma center.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Brain and spinal cord injuries are potentially life altering or life threatening. Spine injury should be assumed in the setting of serious head injury. TBI is the leading cause of traumatic death in patients under age 45. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary “C3, C4, C5, keep the diaphragm alive.” The treatment goals for neurologic injuries are preserving the ABCDs, eliminating spinal movement, and limiting neural ischemia. All patients with a significant MOI or head, neck, and back injuries should be immobilized