1. First Aid for Colleges and Universities 10 Edition Chapter 13 © 2012 Pearson Education, Inc. Head and Spine Injuries Slide Presentation prepared by Randall Benner, M.Ed., NREMT-P

2. Learning Objectives Describe the appropriate first aid care for injury to the scalp. Describe the physiology of injury to the brain. List the four types of skull fractures. List the signs and symptoms of a skull fracture. Distinguish between open and closed head injuries. Discuss signs and symptoms of both open and closed head injuries. © 2012 Pearson Education, Inc.

3. Learning Objectives Describe and demonstrate the appropriate first aid care for a head injury. Describe the common mechanisms of spinal injury. Describe the assessment of spinal injury victims. List the signs and symptoms of spinal injury. Describe and demonstrate the appropriate first aid care for spinal injury. Describe the technique for removing a helmet from a head- or spinal-injured victim. © 2012 Pearson Education, Inc.

4. Introduction 1.5 million Americans suffer head injuries yearly. Any trauma severe enough to injure the brain can also injure the spine. The First Aider must be able to quickly identify and manage these types of injuries to prevent further harm or deterioration. © 2012 Pearson Education, Inc.

5. Types of Head Injuries Injury to the scalp –Similar injury patterns as other soft tissue injuries –Contusions, lacerations, abrasions, avulsions –Bleeding may be minimal or severe Injured scalp management –Apply direct pressure with dry sterile dressing. –Avoid pressure over possible fracture site. –Consider management for spinal injury as well. © 2012 Pearson Education, Inc.

6. Types of Injury to the Brain Primary injury Secondary injury Results of brain injury –Pressure increases inside the skull –Excessive pressure causes more tissue death –Eventually the brain stem is compressed, which complicates the heart rate, breathing, and blood pressure © 2012 Pearson Education, Inc.

7. Signs and Symptoms of a Brain Injury –Main symptom is altered mental status –Nausea and/or vomiting –Headache, weakness, loss of balance –Pupils may be unequal –Seizures –Heart rate slows and breathing becomes irregular © 2012 Pearson Education, Inc.

8. Signs and Symptoms of a Brain Injury © 2012 Pearson Education, Inc.

9. Brain Injury Management –Suspect concurrent spinal injury (immobilize). –Establish and maintain an airway. –Provide breathing assistance if needed. –Be prepared to logroll patient if they vomit. –Keep the victim warm and in supine position. –Do NOT elevate the legs. © 2012 Pearson Education, Inc.

10. Injury to the Skull (Skull Fracture) Takes significant force to fracture the skull Usually results in minor injury unless brain is also injured Types of skull fractures –Depressed –Linear –Comminuted –Basilar © 2012 Pearson Education, Inc.

11. Types of Skull Fractures © 2012 Pearson Education, Inc.

12. Assessing Head Injuries Assessing a victim with a head injury –Determine mechanism of injury. –While keeping spine aligned, assess the head, pupils, neck, chest, abdomen, arms, and legs. © 2012 Pearson Education, Inc.

13. Signs and Symptoms of a Skull Fracture –Suspect skull fracture with any significant head injury –Presence of soft tissue trauma –Deformities may be noted to the skull –Pain, tenderness, swelling at injury site –Raccoon eyes or Battle’s sign (bruising behind ears) –Clear discharge from ears, nose, or mouth © 2012 Pearson Education, Inc.

14. Signs and Symptoms of a Skull Fracture © 2012 Pearson Education, Inc.

15. Assessment, Signs, and Symptoms of Head Injury Closed and open head injuries –Open head injury causes brain to be exposed –Closed head injury has no open wound –Either type of injury may or may not have concurrent brain damage © 2012 Pearson Education, Inc.

16. Assessment, Signs, and Symptoms of Head Injury Signs and symptoms of a closed head injury –Altered mental status is best indicator –Patient may become unresponsive or have seizures –Soft tissue injuries may be present –Raccoon’s eyes or Battle’s sign may be present –Loss of motor/sensory reflexes in half of the body –Pupillary and vital sign changes –Nausea, vomiting © 2012 Pearson Education, Inc.

17. Assessment, Signs, and Symptoms of Head Injury Signs and symptoms of an open head injury –Evidence of trauma to the head –Depressed region of the skull –Exposed brain tissue –External bleeding © 2012 Pearson Education, Inc.

18. First Aid Care for Head Injury Establish inline immobilization, activate EMS. Maintain an open airway (modified jaw thrust). Support ventilations if breathing is inadequate. Control bleeding. Never remove any penetrating object. Provide ongoing care while awaiting EMS. © 2012 Pearson Education, Inc.

19. Injuries to the Spine Spinal column and cord injuries –Column injury is damage to vertebrae –Cord injury is damage to spinal cord itself –Either column or cord injury may occur without the other one present –Mismanagement can result in permanent disability © 2012 Pearson Education, Inc.

20. Spinal Column and Cord Injuries Certain regions of column more likely to be injured (cervical and lumbar) © 2012 Pearson Education, Inc.

21. Injuries to the Spine Common mechanisms for spinal injuries –Compression, flexion, extension, rotation, lateral bending –Distraction (pulling apart – as with hangings) –Damage from bony fragments penetrating in Situations commonly causing spinal injuries are similar to other traumatic mechanisms (falls, motor vehicle collisions, sports, etc.) © 2012 Pearson Education, Inc.

22. Complications of Spinal Injury Inadequate breathing –Damage to nerves that stimulate the diaphragm (high in cervical region) results in inability to breathe Paralysis –With spinal cord damage, there may be weakness, loss of sensation, or paralysis –Often these symptoms become permanent © 2012 Pearson Education, Inc.

23. Injuries to the Spine Assessment considerations –Note the mechanism of injury. –Do not logroll the victim unless necessary. –Palpate gently for deformity or tenderness. –Assess motor function of the hands and feet on each side of the body; both sides should be the same. Ask the following questions –What happened and how did it happen? –Does your neck or back hurt? –Can you move your hands and feet? –Can you feel me pinching your toes and fingers? © 2012 Pearson Education, Inc.

24. Signs and Symptoms of Spinal Injury Suspect spinal injury with any serious injury Spinal injury symptoms –Tenderness or pain in area of injury –Soft tissue trauma in area of injury –Numbness, tingling, weakness to extremities –Urinary or fecal incontinence –Impaired breathing with high spinal injuries © 2012 Pearson Education, Inc.

25. First Aid Care for Spinal Injury Attempt only if properly equipped and trained –Activate EMS and maintain inline stabilization. –Establish and maintain airway and adequate breathing. –Provide rescue breathing, if needed. –Assess pulses and perform CPR, if needed. –Control any external hemorrhage. © 2012 Pearson Education, Inc.

26. First Aid Care for Spinal Injury Helmet Removal –Keep helmet in place if the following apply Helmet fits well No impending airway or breathing problems Removal of helmet may further injure the victim Helmet does not prevent proper immobilization Helmet does not interfere with assessment and reassessment © 2012 Pearson Education, Inc.

27. First Aid Care for Spinal Injury Helmet Removal –Remove the helmet if the following apply Helmet does not fit well The victim is in cardiac arrest The helmet interferes with proper assessment of airway and breathing functions The helmet interferes with proper management of airway and breathing functions © 2012 Pearson Education, Inc.

28. Summary An open head injury is the result of a traumatic event Any concurrent brain injury typically decides life or death. Priority for any head injury is to treat lost function to the airway, breathing, and circulatory components. When faced with a spinal injury, keep the body immobile until EMS arrives. © 2012 Pearson Education, Inc.