1. HEAD AND SPINE INJURIES
OEC Chapter 21
HEAD AND SPINE INJURIES
Steve Labalme and Philip Klinck

2. The Central Nervous System (CNS)
The part of the nervous system that includes the brain and spinal cord
CNS controls a person’s ability to sense and react to the external world
CNS injuries are among the most serious that OEC Technicians encounter:
CNS trauma associated with high mortality and morbidity rates, severely impacted quality of life
It is imperative that OEC Technicians:
--understand the mechanisms responsible for traumatic CNS injuries
--are able to quickly recognize the signs and symptoms of specific CNS injuries
--be able to safely manage patients with traumatic head, neck and back injuries while minimizing additional injury

3. Traumatic Brain Injury (TBI)
Physical trauma to the brain, can be localized or diffuse
One of the most severe forms of CNS trauma
Leading cause of traumatic death in individuals under 45 (occurs approximately every 15 seconds in the U.S.)
Side effects: memory loss, reduced problem-solving capacity, stress and anger-management issues, depression, chronic seizure disorders, increased risk of Alzheimer's, Parkinson’s, and other brain disorders that become more prevalent with age

4. Anatomy: Axial Skeleton
Composed of skull, ____ vertebrae 33
Cervical
1-7
Thoracic
1-12
Lumbar
1-5
Atlas (C1)
Axis (C2)
Sacrum
1-5
Coccyx (4 fused into 1)

5. CNS Anatomy: Brain Cerebrum Cerebellum Brain Stem
Integrates sensory perception and motor control
Involved in attention, processing language, music, and other sensory stimuli
Cerebellum
Integration of sensory perception and motor control (coordination)
Brain Stem
Adjoining and structurally continuous with spinal cord

6. CNS Anatomy: Brain Brain Stem Cerebral cortex
Outer cortex controls sensory perception, voluntary movement, attention; processes language, music, and other sensory stimuli
Controls basic body functions: cardiac, respiratory, and brain-processing functions.
Composed of:
Hypothalamus
Thalamus
Control center for autonomic nervous system (body temperature, hunger, thirst, sleep)
Pons
Medulla oblongata

7. CNS Anatomy: Brain Brain is made up of gray and white matter:
Gray matter: closely packed neuron cell bodies involved in muscle control, sensory perceptions (seeing, hearing, etc.) memory, emotions, and speech.
White matter: neuronal tissue mainly containing long nerve cells called axons.
Axons are long, slender projections of nerve
cells (neurons) that conduct electrical impulses
away from the neuron’s cell body

8. CNS Anatomy: Spinal Cord
Tubular bundle of nervous tissue that extends from the brain downward to the sacrum within the vertebral canal. Peripheral nerves connect, forming PNS
Brain and spinal cord protected by three-layered membrane called the meninges.
Cerebrospinal fluid (CSF): serum-like fluid that functions in shock absorption for CNS structures; circulates through brain and within meninges surrounding brain and spinal cord
Brain and spinal cord, which together make up the central nervous system

9. Divisions of the Spinal Cord
Cervical (1-8): control vital functions, movement of upper body
Thoracic (1-12): control temperature regulation, trunk muscles
Lumbar (1-5): control leg motion, some reproductory functions
Sacral (1-5): control foot motion, rep. function
“C3, 4, 5, keep the diaphragm alive”
Phrenic nerve originates at C3-5, controls movement of diaphragm (breathing)
Right above where the nerves to your arm come out, which is why some quadriplegics can still breathe on their own

10. Common MOIs Most common mechanisms of injury to CNS:
Rapid deceleration (impact-related trauma)
Rapid acceleration
Compression injury to spinal column (falling object, diving)
Penetrating or impaled object
Near drowning
Hypothermia and hyperthermia
Electrical injury, including lightning strikes
Important in scene assessment: determine if there is a potential for neurologic injury:
Fall greater than 3 times the patient’s height
Moderate to high-speed motor vehicle collision
Pedestrian or cyclist being struck by a motor vehicle
Skier/skier collision, skier collides with a fixed object like a lift pole or tree
Gunshot wound
Avalanche burial
Lightning strike

11. Coup-Contrecoup Injury
Caused by rapid deceleration of the head: upon impact, brain keeps moving forward and strikes front of skull, then rebounds and strikes back of skull
Can result in severe intracranial bleeding, swelling, and can compromise normal brain function
Pediatric and geriatric patients experience more severe coup-contrecoup injuries due to increased room for brain to move within skull

12. Common Injuries to the CNS
Two Types:
-Closed Injuries → Injuries in which the integrity
of the cranium and spinal column is not
compromised
→ include contusions; hematomas; fractures
of the skull, vertebrae, scapula, and posterior
ribs; diffuse axonal injury
-Open Injuries → Injuries in which brain matter or bone fragments are exposed, or injuries in which CSF is leaking

13. Skull Fractures
-Open or closed skull fractures are the result of blunt trauma to the skull
-- linear skull fracture: a single nondisplaced fracture line
→ significant swelling and tenderness
-- depressed skull fracture: a comminuted fracture with
displacement
→ a “soft spot” over the fracture is typical
-- basilar fracture: a fracture at the base of skull
→ typically results from high-velocity blunt trauma (like skiing into a tree!)
→ a leakage of CSF is common is common, battle signs and
raccoon eyes will likely be present.

14. Traumatic Brain Injury
-A mechanical injury to the brain
that results in short-term and/or
long term neurologic deficit
- Males are twice as likely to
suffer TBI and four times as likely
to be killed by TBI !!
Examples of TBIs: concussion, cerebral contusions or hematomas, diffuse axonal injury or intracerebral hemorrhages

15. Concussion
A temporary disruption of coordinated brain function caused by trauma
Mild Concussion:
Minor disruption of brain function, no loss of responsiveness
Symptoms may include confusion, dizziness, nausea, vomiting, headache
Moderate Concussion:
Loss of responsiveness of less than 5 mins
some disruption of brain function
Severe Concussion:
loss of responsiveness of more than 5 mins
significant disruption of normal brain function

16. Concussion cont’d
With both moderate and severe concussions, other symptoms of TBI will likely be present
Post-concussive syndrome:
Complex range of systems including permanent memory loss
Symptoms may lead to difficulty focusing and other behavioral and psychological problems
Can take years to resolve itself as the brain heals

17. Amnesia
Amnesia: memory loss (some form of amnesia will usually occur with a concussion)
Retrograde amnesia: patients have no recollection of events before the injury, including the injury itself
Antegrade amnesia: patients have no recollection of events occurring after the injury
Amnesia often presents as a distinctive speech pattern and repetitive questions, this is called perseveration

18. Recurrent Traumatic Brain Injury
-Recurrent mild TBIs that occur in close proximity can cause cumulative damage and even death
-If a previous TBI has not completely healed, a second mild TBI can cause serious health complications
!!Always ask patients if they have
had any recent brain trauma!!

19. Cerebral Contusion A bruise involving the brain
-involves the rupture of small superficial blood vessels and
generally affects localized areas of the brain
-This is more serious than a concussion, but may present with identical symptoms

20. Cerebral Hematoma
-A hematoma is an accumulation of blood outside the vascular system
-As the cranium is an enclosed space, a hematoma with this space can compress the brain and cause serious damage.

21. Hematomas Cont’d
Epidural hematoma: arterial bleeding between the skull and the dura matter
→ “lucid period” patient is initially unresponsive, then
becomes relatively alert before slipping back into
unresponsiveness
Subdural hematoma: a collection of venous
blood between the dura matter and the brain
→ no “lucid period”
Intracranial hematoma: a hemorrhage within
the brain matter itself

22. Hematomas Cont’d
-Typically caused by rapid deceleration injuries (skiing into a tree)
-Subdural hematomas can be associated with an underlying cerebral contusion; can take hours days or weeks for symptoms to present as blood is venous in origin
-All types of hematomas
are potentially life
threatening and require
surgical correction

23. Diffuse Axonal Injury
-Devastating TBI that is caused by high-velocity rotational acceleration/deceleration (skiing reeeeaaally fast into a tree)
-It is believed to be caused by a shearing of the white matter away from the gray matter in the brain
-suppresses electrical activity within the brain
-Patients with DAI may be unresponsive
or become unresponsive later
-As many as 90% of patients with
DAI do not recover.

24. Intracerebral Hemorrhage
A bleed with the brain due to trauma, which, because of the vascular nature of the brain, disrupts normal cerebral function
Can be life threatening due to the rise in
Intracranial pressure
Patients who take blood thinners have an
especially poor prognosis

25. Spinal Injuries
Spinal Cord Injuries (SCI) can occur in all four sections of the spine, and are usually associated with high speeds, heights and rapid acceleration/deceleration
Common neck and back injuries include soft tissue injuries, muscle or ligament strains, and fractures.
Ex: Whiplash
Occurs when the head is
violently thrown backward

26. Spinal Injuries Cont’d
Spinal Fractures:
- Cervical and Lumbar vertebrae are more susceptible to hyperflexion and rotational injury as they have more flexibility
Thoracic and Coccygeal vertebrae are prone to blunt and compression trauma
Cervical vertebrae are the
most prone to fracture as they
are the thinnest

27. Spinal Injuries Cont’d
C1 fracture: known as a Jefferson fracture, caused by a severe axial loading of the spine
C2 fracture: known as a Hangman’s fracture, generally caused when the face forcibly strikes an object, causing the neck to snap backward
A fracture of C1 and C2 is known as an atlas-axis injuries and most often occur when the neck is forcibly hyperextended
A fracture to C3-C5 can damage nerves that innervate the diaphragm, making the patient unable to breathe on their own

28. Spinal Injuries Cont’d
Final Things to Know:
Fractures of the scapula usually occur as a result of significant blunt trauma
Posterior ribs are more prone to fracture than anterior ribs as they are less flexible (connected to thoracic vertebrae)
Most common fractures of the spine are lower thoracic and lumbar fractures
Injuries to the sacral vertebrae are rare, but
to the coccyx is common
Neurologic Injuries can result when broken
or displaced vertebra lacerate the
spinal cord or put pressure on it
Can lead to neural ischemia (brain/spinal cord
receives too little oxygenated blood, organ
damage can result after only a few minutes)

29. Neurogenic Shock
A form of shock that is caused by disruption of the autonomic nervous system
This causes blood pressure to drop, bradycardia
It is most commonly caused by a SCI, but could also be caused by a TBI
Rare, but potentially life threatening complication to any head or spine trauma

30. tHAnKs!!!