1. Ch. 13-Head and Spine Injuries

2. 13.1 Types of Head Injury Injury to the Scalp Injury to the Brain
Injury to the Skull (skull fracture) 2

3. Signs of increased pressure inside the skull
Decreasing mental status or altered responsiveness.
Combativeness and erratic behavior.
Nausea and/or vomiting.
Pupils that are not equal or reactive to light.
Double vision or other visual disturbances.
Headache, sometimes severe.
Loss of memory, confusion, or disorientation.
Weakness or loss of balance.
Seizures.
Evidence of trauma to the head.
Slow heart rate.
Irregular breathing pattern. 3

4. First Aid Care for Brain Injury
1. Suspect spine injury in any victim with suspected
brain injury; stabilize the head and neck as described
later in this chapter.
2. Establish and monitor the victim’s ABCDs; ensure
the airway is open, provide rescue breathing if the
breathing is inadequate.
3. Anticipate vomiting; be prepared to keep the victim’s
head and neck stabilized as you roll the victim
on his or her side to prevent aspiration.
4. Treat the victim for shock; keep the victim warm,
but do not elevate the legs. 4

5. Vocabulary
Coup-contrecoup- A mechanism of brain injury in which the head comes to a sudden stop but the brain continues to move back and forth inside the skull 5

6. Injury to the Skull (Skull Fracture)
Four basic types:
1. Depressed—An object strikes the skull, leaving an obvious depression or deformity; bone fragments are often driven into the membranes or the brain itself by the force of the impact.
2. Linear—The most common type of skull fracture, a linear fracture causes a thin-line crack in the skull. Linear fractures are the least serious and the most difficult to detect.
3. Comminuted—A comminuted fracture appears at the point of impact, with multiple cracks radiating from the center (it looks like a cracked eggshell).
4. Basilar—A basilar skull fracture occurs when there
is a break in the base of the skull; it is often the result
of a linear fracture that extends to the floor of
the skull. 6

7. 7

8. Victim Assessment
1. Obtain a history that includes the mechanism of injury, whether the victim’s level of consciousness has deteriorated, and whether the victim has been moved.
2. If possible, have someone stabilize the head, neck, and spine in a neutral in-line position. Complete a primary survey to detect and correct any life-threatening problems.
3. Check the head; look for depressions, fractures, lacerations, deformities, bruising, and other obvious problems.
4. Maintain in-line stabilization, check the neck and spine for lacerations, bruises, swelling, protrusions, or other obvious deformities; ask the victim if there is pain, or muscle spasm.
5. Check the arms and legs for paralysis, weakness, or loss of sensation. 8

9. PROGRESS CHECK
1. Bleeding from a scalp laceration, as from any other soft-tissue injury, is best controlled with _________.
(direct pressure/indirect pressure/compression bandages)
2. Coup-contrecoup injury occurs when the head suddenly stops but the brain ____________.
(begins bleeding/keeps moving/leaks fluid)
3. ____________ skull fracture occurs when an object strikes the skull and leaves an obvious deformity. (Depressed/Linear/Comminuted)
4. ____________ skull fracture resembles a cracked egg.
(Linear/Comminuted/Depressed)
5. ____________ skull fracture is the most common. (Comminuted/Linear/Basilar) 9

10. Signs and Symptoms of Skull Fracture
Contusions, lacerations, or hematomas to the scalp
Deformity of the skull
Blood or cerebrospinal fluid (clear fluid) leaking from the ears, nose or mouth
Bruising around the eyes in the absence of trauma to the eyes (raccoon eyes) is a very late sign
Bruising behind the ears, or mastoid process (Battle’s sign) is a very late sign
Damage to the skull visible through lacerations in the scalp
Pain, tenderness, or swelling at the site of injury 10

11. Signs and Symptoms of Closed Head Injuries
Altered or decreasing mental status—the best indicator of a brain injury
Irregular breathing pattern
Obvious signs of a mechanism of injury—contusions, lacerations, or hematomas to the scalp or deformity to the skull
Blood or cerebrospinal fluid leaking from the ears or nose
Bruising around the eyes (raccoon eyes)
Bruising behind the ears, or mastoid process (Battle’s sign)
Loss of movement or sensation
Nausea and/or vomiting; vomiting may be forceful or repeated
Unequal pupil size (dilated) that does not react to light (fixed) with altered mental status
Possible seizures
Unresponsiveness 11

12. Signs and Symptoms of Open Head Injuries
Obvious results of the mechanism of injury—contusions, lacerations, or hematomas to the scalp
Deformity to the skull or obvious penetrating injury
A soft area or depression detected during palpation
Brain tissue exposed through an open wound
Bleeding from an open bone injury 12

13. PROGRESS CHECK
1. The most serious complication of head injury is ____________ to the brain. (contusion/laceration/lack of oxygen)
2. During assessment, check for scalp and skull wounds by ____________.
(visually examining/probing/separating the edges of the wound)
3. During assessment, check the arms and legs for paralysis and ____________. (pulse/fractures/loss of sensation)
4. In closed head injury, the _________ is not broken. (scalp/skull/tough tissue)
5. Raccoon eyes, a classic sign of skull fracture, involves bruising around the ____________. (ears/eyes/mastoid process)
6. Head injury is indicated by blood or ______________ dripping from the ears, nose, or mouth. (lymph fluid/cerebrospinal fluid/mucus) 13

14. 13.3 First Aid Care for Head Injury
1. The top priority is establishing and maintaining an open airway with adequate oxygenation
2. Control bleeding; face and scalp wounds may bleed heavily, but such bleeding is usually easy to control with direct pressure.
3. Never try to remove a penetrating object
4. If the victim sustained a medical or nontraumatic injury, place the victim on the left side; elevate the head slightly, keep the victim warm, but avoid overheating
5. While waiting for emergency personnel to arrive:
Dress any facial and scalp wounds that have not been dressed.
Continue to monitor vital signs.
Stay alert to the possibility of vomiting or seizures; work quickly to prevent aspiration.
Continually monitor the airway and the victim’s
neurological status. 14

15. Vocabulary
Raccoon eyes- Bruising around the eyes in the absence of trauma to the eyes; a very late sign of skull fracture
Battle’s sign- Bruising behind the ears (mastoid process); a very late sign of skull fracture
Distraction- The sudden pulling apart of the spine that stretches and tears the cord, as in hanging 15

16. PROGRESS CHECK
1. The top priority in treating victims of head injury is establishing and maintaining ____________.
(an open airway/circulation/hemorrhage control)
2. Use the modified ____________ technique to open the airway.
(head-tilt/chin-lift/jaw-thrust)
3. If there is blood or fluid dripping from the ear, ____________.
(control it with pressure/pack the ear with gauze/cover the ear loosely with gauze to absorb the flow)
4. If you suspect a fracture beneath a bleeding scalp wound, ____________. (do not apply pressure/apply pressure/use a compression bandage)
5. _________ any object protruding from the head.
(Remove/Cut off/Stabilize and leave in place) 16

17. Excessive flexion, extension, or rotation Lateral bending
13.4 Injuries to the Spine
Compression (the weight of the body is driven against the head, as in falls)
Excessive flexion, extension, or rotation
Lateral bending
Distraction (a sudden “pulling apart” of the spine that stretches and tears the spinal cord, as in hangings) 17

18. Complications of Spinal Injury
Inadequate Breathing Effort
Paralysis 18

19. Victim Assessment 1. Note the mechanism of injury—especially the
type of movement and amount of force that was
involved in the injury
2. Ask: Does your neck or back hurt? What happened? Where does it hurt? Can you move…? Can you feel…?
3. Inspect the back for contusions, deformities, lacerations, punctures, penetrations, and swelling
4. Palpate gently for areas of tenderness or deformity
5. Assess equality of strength in the victim’s extremities 19

20. To assess an unresponsive victim:
1. Note the mechanism of injury. If the mechanism
of injury suggests spinal injury and the victim is
unconscious, assume spinal injury has occurred.
2. Inspect for contusions, deformities, lacerations,
punctures, penetrations, or swelling; palpate for
areas of deformity.
3. Ask others at the scene about the mechanism of
injury and the victim’s mental status before you
arrived on the scene. 20

21. PROGRESS CHECK 1. The vertebrae most likely to be injured are the
____________. (thoracic/lumbar/cervical)
2. One mechanism of spinal injury is distraction, or _____________ of the vertebrae. (compression/pulling apart/rotation)
3. The first step in assessment of spinal injury victims is to note the ____________.
(mental status/loss of motor function/mechanism of injury)
4. If the victim is ____________ and the mechanism of injury suggests it, suspect spinal injury.
(paralyzed/unconscious/in pain) 21

22. 13.5 Signs and Symptoms of Spinal Injury
Tenderness in the area of the injury; lacerations, cuts, punctures, or bruises over or around the spine indicate forceful injury.
Pain associated with movement; suspect spinal injury if the victim complains of pain when moving an apparently uninjured neck, shoulder, or leg.
Pain independent of movement or palpation along the spinal column or in the lower legs.
Obvious deformity of the spine upon palpation (not a usual sign).
Soft-tissue injuries associated with trauma in the head and neck (causing cervical spine injury); shoulders, back, or abdomen (causing thoracic or lumbar injury); or the legs (causing lumbar or sacral injury).
Numbness, weakness, or tingling in the arms or legs.
Loss of sensation, weakness, or paralysis in the arms or legs
Urinary or fecal incontinence.
Impaired breathing 22

23. PROGRESS CHECK
1. The ability to walk or move the arms and legs does not rule out ____________. (priapism/deformity/spinal injury)
2. The most reliable sign of spinal injury in a conscious victim is ____________.
(priapism/incontinence/paralysis of the extremities
3. Breathing that involves little or no chest movement indicates that the victim is breathing with only the ____________. (abdomen/diaphragm/mouth) 23

24. 13.6 First Aid Care for Spinal Injury
1. Establish and maintain in-line stabilization.
2. Establish and maintain an open airway and adequate ventilation. 24

25. Helmet Removal
1. Take the victim’s eyeglasses off before you attempt to remove the helmet.
2. One First Aider should stabilize the helmet by placing hands on each side of the helmet, fingers on the mandible (lower jaw) to prevent movement.
3. A second First Aider should loosen the chin strap.
4. The second First Aider should place one hand on the mandible at the angle of the jaw, and the other hand at the back of the head.
5. The First Aider holding the helmet should pull the sides of the helmet apart (to provide clearance for the ears), gently slip the helmet halfway off the victim’s head, then stop.
6. The First Aider who is maintaining stabilization of the neck should reposition, sliding the hand under the victim’s head to secure the head from falling back after the helmet is completely removed.
7. The first First Aider should remove the helmet completely.
8. The victim should then be immobilized as described on pages 243–244. 25

26. PROGRESS CHECK
1. The general rule for management of spinal injury is to ____________ the spine, head, torso, and pelvis. (reduce/straighten/immobilize)
2. The first priority in caring for spinal injury is to ensure adequate ____________.
(air supply/circulation/immobilization) 26