1. © 2011 National Safety Council 19-1 INJURIES TO THE HEAD AND SPINE LESSON 19

2. © 2011 National Safety Council 19-2 Introduction May be life-threatening or cause permanent damage Trauma to head, neck, torso may result in serious injury Injuries without immediate obvious signs and symptoms may involve potentially life-threatening problem Any head injury may also injure spine

3. © 2011 National Safety Council 19-3 Common Mechanisms of Head and Spinal Injuries Motor vehicle crashes and pedestrian-vehicle collisions Falls Diving Skiing and other sports injuries Forceful blunt or penetrating trauma to head, neck or torso Hanging incidents

4. © 2011 National Safety Council 19-4 Suspect a Head or Spinal Injury With any unresponsive trauma patient When wounds or other injuries suggest large forces involved Observe patient carefully during the primary assessment

5. © 2011 National Safety Council 19-5 Head Injuries

6. © 2011 National Safety Council 19-6 Injuries to the Head May be open or closed Scalp bleeding may be profuse  can cause shock in infants and young children Closed injuries may involve swelling or depression at site of skull fracture Bleeding inside skull may occur with any head injury

7. © 2011 National Safety Council 19-7 General Signs and Symptoms of Head Injuries Lump or deformity in head, neck or back Changing levels of responsiveness Difficulty breathing or shallow breathing Drowsiness Confusion Dizziness Unequal pupils

8. © 2011 National Safety Council 19-8 General Signs and Symptoms of Head Injuries (continued) Headache Clear fluid from nose or ears Stiff neck Inability to move any body part Tingling, numbness or lack of feeling in feet or hands Pain or tenderness Loss of bladder or bowel control

9. © 2011 National Safety Council 19-9 Suspect Spinal Injury in Any Trauma Patient with Risk Factors Patient 65 and older Child older than 2 with trauma of head or neck Motor vehicle or bicycle crash involving driver, passenger or pedestrian Falls from more than the person’s standing height Patient feels tingling in hands or feet, pain in back or neck, or muscle weakness or lack of feeling in torso or arms

10. © 2011 National Safety Council 19-10 Patient is intoxicated or not alert Any painful injury, particularly of head, neck or back An unresponsive patient with unknown mechanism of injury Suspect Spinal Injury in Any Trauma Patient with Risk Factors (continued)

11. © 2011 National Safety Council 19-11 Assessing Head and Spinal Injuries Assessment of patient with head injury should also look for spinal injury Perform standard assessment Take great care when moving or repositioning patient  unless necessary, do not move patient Maintain manual spinal motion restriction

12. © 2011 National Safety Council 19-12 Assessing an Unresponsive Patient If no life-threatening condition, perform limited physical examination for other injuries Do not move patient unless necessary Check for serious injuries Stabilize head and neck in position found

13. © 2011 National Safety Council 19-13 Assessing an Unresponsive Patient (continued) Ask those at scene: -What happened -Patient’s mental status before becoming unresponsive

14. © 2011 National Safety Council 19-14 Assessing a Responsive Patient If nature of injuries suggests potential spinal injury, carefully assess for spinal injury during physical examination Explain the need to hold the head still Ask patient not to move more than you ask during the examination If 2 responders, one should manually stabilize head and neck

15. © 2011 National Safety Council 19-15 Assessing a Responsive Patient (continued) Ask: -Does your neck or back hurt? -What happened? -Where does it hurt? -Can you move your hands and feet? -Can you feel me touching your fingers? -Can you feel me touching your toes?

16. © 2011 National Safety Council 19-16 Physical Examination When checking torso, observe patient for impaired breathing or loss of bladder or bowel control When assessing extremities, compare strength from one side of the body to the other Assess both feet and both hands at the same time Assess all extremities for pulse, movement and feeling

17. © 2011 National Safety Council 19-17 Physical Examination (continued) Don’t assume patient without symptoms has no spinal injury; consider forces involved When in doubt, keep head immobile while waiting for additional EMS

18. © 2011 National Safety Council 19-18 Skill: Assessing Head and Spinal Injuries

19. © 2011 National Safety Council 19-19 1.Check patient’s head

20. © 2011 National Safety Council 19-20 2.Check neck for deformity, swelling and pain

21. © 2011 National Safety Council 19-21 3.Check sensation in feet

22. © 2011 National Safety Council 19-22 4.Ask patient to point toes

23. © 2011 National Safety Council 19-23 5.Ask patient to push against your hands with feet

24. © 2011 National Safety Council 19-24 6.Check sensation in hands

25. © 2011 National Safety Council 19-25 7.Ask patient to make a fist and curl it in

26. © 2011 National Safety Council 19-26 8.Ask patient to squeeze your hands

27. © 2011 National Safety Council 19-27 Brain Injuries

28. © 2011 National Safety Council 19-28 Brain Injuries Can occur with blow to head with/without open wound Brain injury likely with skull fracture Brain swelling or bleeding may occur

29. © 2011 National Safety Council 19-29 Signs and Symptoms of a Brain Injury Severe or persistent headache Altered mental status (confusion, unresponsiveness) Lack of coordination, movement problems

30. © 2011 National Safety Council 19-30 Signs and Symptoms of a Brain Injury (continued) Weakness, numbness, loss of sensation, paralysis Nausea and vomiting Seizures Unequal pupils Problems with vision or speech Airway or breathing problems or irregularities

31. © 2011 National Safety Council 19-31 Assessing Brain Injury Signs and symptoms may occur hours or even days after trauma Do not assume patient with head injury does not have brain injury if signs and symptoms are not immediately apparent

32. © 2011 National Safety Council 19-32 Concussion Brain injury involving temporary impairment Usually no head wound or signs and symptoms of more serious head injury Patient may have been “knocked out” but regained consciousness quickly

33. © 2011 National Safety Council 19-33 Signs and Symptoms of Concussion Temporary confusion Memory loss about event Brief loss of responsiveness Mild or moderate altered mental status Unusual behavior Headache

34. © 2011 National Safety Council 19-34 Medical Evaluation Concussion patient may recover quickly Difficult to determine injury severity More serious signs and symptoms may occur over time Patients with suspected brain injuries require medical evaluation

35. © 2011 National Safety Council 19-35 Emergency Care for Head Injuries Perform standard patient care Use the jaw thrust to open airway Follow local protocol for oxygen Manually stabilize the head and neck Don’t let patient move Closely monitor mental status

36. © 2011 National Safety Council 19-36 Emergency Care for Head Injuries (continued) Control bleeding  but no direct pressure on skull fracture Dress and bandage open wounds Monitor vital signs Expect vomiting Provide additional care for skull fracture

37. © 2011 National Safety Council 19-37 Skull Fracture Check for possible skull fracture before applying direct pressure to scalp bleeding – direct pressure could push bone fragments into brain Skull fracture is life-threatening

38. © 2011 National Safety Council 19-38 Signs and Symptoms of Skull Fracture Deformed area Depressed or spongy area Blood or fluid from ears or nose Eyelids swollen shut or becoming discolored (bruising)

39. © 2011 National Safety Council 19-39 Bruising under eyes (raccoon eyes) Bruising behind ears (Battle’s sign) Unequal pupils An object impaled in skull Signs and Symptoms of Skull Fracture (continued)

40. © 2011 National Safety Council 19-40 Emergency Care for Skull Fractures Care as for any head and spinal injury Don’t clean wound, press on it or remove impaled object Cover wound with sterile dressing

41. © 2011 National Safety Council 19-41 Emergency Care for Skull Fractures (continued) If bleeding, apply pressure only around edges of wound with ring dressing Do not move patient unnecessarily

42. © 2011 National Safety Council 19-42 Spinal Injuries

43. © 2011 National Safety Council 19-43 Spinal Injuries Fracture of neck or back always serious – possible damage to spinal cord

44. © 2011 National Safety Council 19-44 Effects of nerve damage depend on nature and location of injury Movement of head or neck could make injury worse Spinal Injuries (continued)

45. © 2011 National Safety Council 19-45 Emergency Care for Spinal Injuries Perform standard patient care Give general care as for any head or spinal injury Use constant manual spinal motion restriction until patient secured to backboard with head stabilized

46. © 2011 National Safety Council 19-46 Emergency Care for Spinal Injuries (continued) Support head in position found

47. © 2011 National Safety Council 19-47 Emergency Care for Spinal Injuries (continued) Maintain airway and provide needed ventilation without moving head To position patient for ventilations or CPR, keep head in line with body Follow local protocol for oxygen

48. © 2011 National Safety Council 19-48 Positioning a Spinal Patient Move patient only if necessary Roll vomiting patient to one side to drain mouth Roll face down patient onto back for ventilations or CPR Use log roll to turn patient If alone, move vomiting patient into HAINES recovery position

49. © 2011 National Safety Council 19-49 Removing a Helmet

50. © 2011 National Safety Council 19-50 Removing a Helmet Remove helmet only to care for life-threatening condition Remove helmet, following local protocol, only when faceguard prevents giving ventilations With many helmets, faceguard can be removed or pivoted so helmet is left on for ventilations For athletic helmets, first unsnap and remove jaw pads

51. © 2011 National Safety Council 19-51 Removing Motorcycle Helmets with Non-pivoting Faceguard 1.Requires 2 rescuers 2.First rescuer slides 1 hand under neck to support base of skull and holds lower jaw with other

52. © 2011 National Safety Council 19-52 Removing Motorcycle Helmets with Non-pivoting Faceguard (continued) 3.Second rescuer tilts helmet back slightly as first rescuer prevents head movement 4.Second rescuer pulls helmet back until chin is clear of mouth guard 5.Second rescuer tilts helmet forward, slightly moving helmet back past base of skull, then slides it straight off

53. © 2011 National Safety Council 19-53 Cervical Collars Help stabilize head and neck Most EMRs don’t apply cervical collars by themselves but may assist EMTs

54. © 2011 National Safety Council 19-54 Applying a Cervical Collar to a Supine Patient 1.Choose correct size; measure with fingers from top of shoulder to bottom of chin 2.First rescuer holds head in line; second rescuer slips back section of open collar under patient’s neck 3.Correctly position collar to fit chin and neck

55. © 2011 National Safety Council 19-55 Applying a Cervical Collar to a Supine Patient (continued) 4.Close collar with Velcro attachment 5.Ensure collar fits correctly, following manufacturer’s instructions; continue to manually support head and neck in line

56. © 2011 National Safety Council 19-56 Backboarding Potential spinal injury patients usually immobilized on backboard before being moved to stretcher EMRs may assist emergency personnel when positioning patient on backboard Many backboard types are available

57. © 2011 National Safety Council 19-57 Positioning Patients on a Long Backboard 1.3 or more rescuers needed 2.Position long backboard beside patient 3.One rescuer maintains head in line while other rescuers take position 4.On cue from rescuer at patient’s head, other rescuers roll patient toward them as a unit

58. © 2011 National Safety Council 19-58 Positioning Patients on a Long Backboard (continued) 5.Slide backboard next to patient 6.On cue from rescuer at head, other rescuers roll patient as a unit 7.Patient is secured to backboard using straps

59. © 2011 National Safety Council 19-59 Stabilizing the Patient’s Head on the Backboard Various methods used to immobilize patient’s head and neck on backboard Blanket roll may be made and applied Commercial head blocks may be used

60. © 2011 National Safety Council 19-60 Applying a Blanket Roll One rescuer manually stabilizes patient’s head while blanket roll and cervical collar are readied Blanket roll is made by folding and rolling blanket For greater bulk, insert rolled towels before rolling the blanket Cervical collar is applied and patient is secured to backboard Blanket roll is positioned around patient’s head Patient’s head and blanket roll are secured to backboard with tape

61. © 2011 National Safety Council 19-61 Head Blocks Follow manufacturer’s instructions to first secure head blocks to backboard Then secure patient’s head within the blocks