Injuries to Head and Spine

Nervous and Skeletal System

Nervous System

• Central Nervous System {CNS}

Brain and Spinal cord

• Peripheral Nervous System

Peripheral nerves

• Sensory nerves

Messages from the body to the brain• Motor nerves

Messages from the brain to the muscles

Nerves exit the brain and down the spinal cord and cross over

*an injury to left side of the brain may produce effects on the right side

Autonomic Nervous System• Controls involuntary function

Anatomy of the Head

Cranium and facial bones• Cranium; portion of skull that encloses the brain• Cranial bones are fused to form immoveable

joints

• 14 irregularly shaped bones form the faceall moveable except for the mandible

• Upper jaw is made up of two fused bones called the maxillae

• Bridge of nose contains two nasal bones• Cheek bone

Zygomaticmaxillae form a portion of the orbits

• Cerebrospinal Fluid {CSF}

Bathes the brain

Circulates down the spine and around the spinal cord

Anatomy of the spine

• Made up of 33 irregularly shaped bones

vertebrae

• Each vertebrae has a spinous process

serves for the attachment of muscles and ligaments

• 7 12 5 5 4

Injuries to the Skull and Brain

Scalp injuries

• May bleed profusely

control of bleeding

Skull Injuries

• Open

• Closed

Brain Injuries

• Direct injuries

• Indirect injuries

Types

• Concussion

groggy or have a headache

some loss of memory is common

• Contusion

Bruise to the brain

Bruising on the same side of the blow is a coup; the opposite side, countercoup

• Hematoma

Collection of blood in a tissue

• Named according to location

Subdural {between brain and dura}

Epidural {between dura and skull}

Intracerebral {blood pools in the brain}

Complications

• Limited room for expansion inside skull

• Hematoma increases pressure

*Normal blood flow is impeded

*blood pressure increases; flow decreases

*brain becomes starved for oxygen

*swelling occurs

*decreased respiratory effort

ONE OF THE FIRST AND MOST SIGNIFICANT SIGNS OF HEAD INJURY IS AMS

DO AN ASSESSMENT AND GET A HISTORY

DON’T ASSUME INTOXICATION OR DRUGS

Patient Assessment

• Visible bone fragments or brain tissue

• AMS

• GCS

• Deep laceration or severe bruise to scalp or forehead

• Deep laceration or severe bruise or hematoma to scalp or forehead

• Depression or deformity of skull, large swelling or unusual shape

• Severe pain at the site of a head injurydon’t palpate

• Battle signs• Unequal pupils or unreactive to light• Raccoon eyes• One eye that appears to be sunken

• Bleeding from ears and or nose• CSF• Personality changes; irritable to irrational• Cushing’s triad/reflex

increased b/p and decreased pulse• Irregular breathing patterns• Temperature increase {late sign}• Blurred or double-vision ; one or both eyes

• Impaired hearing or ringing in the ears• Equilibrium problems• Forceful or projectile vomiting• Posturing

decorticatearms flexed, or bent inward on the chest, the hands are clenched into fists, and the legs extended and feet turned inward.

• Decerebrate

The head is arched back, the arms are extended by the sides, and the legs are extended. A hallmark of decerebrate posturing is extended elbows.

Decorticate

• Paralysis on one side of the body

• Seizures

• Deteriorating VS

• Shock

Assume brain injury when MOI or index of suspicion indicates a possible head injury

Care• Standard precautions• Assume spinal injury

*Manual stabilization*Jaw-thrust to open airway

• OP and suction• If unconscious carefully monitor breathing

appropriate airway management

• Apply C-collar

• O2

• Do not hyperventilate; unless sign of critical brain injury *fixed and dilated

pupils

*AMS

*Increased B/P

• Control bleeding• Keep pt. at rest• Provide emotional support• Dress and bandage open wounds• Manage for shock

avoid overheating• Be aware of the possibility of vomiting• Rapid transport monitory VS q 5 minutes

Impaled objects

• Do not remove

• Stabilize the object

• If object must be cut, use a tool that will not cause the object to move or vibrate when finally severed

• Medical direction if needed

Injuries to face and jaw• Airway obstruction

to remove blood and debris• Mandible

pain, discoloration, facial distortionmay not be able to moveimproper alignment of teeth

• Jaw-thrust maneuver to open airway

• Apply C-collar

• Position for drainage

Non-traumatic Brain Injury

• No evidence of trauma and no MOI

Injuries to the Spine

MOI

• Compression

falls

diving accidents

MVA

• Excessive flexion, extension, roatationlateral bendingpulling apart of the spinehangings

• Maintain high index of suspicion for:MVAPedestrian vs. vehicleFalls

• Diving accidents

• Unconscious trauma victims

Assessment

Signs and symptoms

• Paralysis

• Pain without movement

• Tenderness along the spine

• Impaired breathing• Diaphragmatic breathing• Paradoxical breathing {rib injuries}• Deformity• Priapism• Posturing• Loss of bowel or bladder control• Nerve impairment to extremities

• Spinal shock• Soft-tissue injuries associated with trauma• Ask

what happened?where does it hurt?neck or back hurt?PMSNumbness or tingling?strength and grip

• Inspect and palpate

If unconscious

• Rapid trauma assessment

• MOI and MS from bystanders

• Inspect and palpate

Care

• Manual in-line stabilization

• ABCs – jaw-thrust maneuver

• Rapid trauma assessment

assess head and neck then C-Collar

PMS

• If paralysis or weakness adm. O2

• Evaluate the need for artificial ventilation

• Reassess PMS

• Helmets

*remove if tx. warrents

if left on, shields and guards can be removed { while helmet secured}

do not remove if attempts increases pain or difficult to remove*

Guidelines for leaving helmet on:

• Snug fit allowing little or no movement

• Spinal immobilization can be done with helmet in place

• Removal would cause further injury

• Airway and breathing mgt. is not hampered

Guidelines for removing a helmet

• Interference with ABCs mgt.

• Improper fit allowing movement

If wearing shoulder pads leave all in place or remove all

SKILLS