Transcript CBT 442 Stroke

Overview of CBT 445
Head, Spine and Chest Trauma
Complete course available at www.emsonline.net
Copyright 2009 Seattle/King County EMS
Introduction
Head, Spine and Chest Trauma
• Head, spine, chest have contain the most vital
organs
• You must determine SICK or NOT SICK, assess
the extent of the injuries and stabilize so that no
further injury occurs
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Practical Skills
To receive CBT or OTEP credit, you must perform the
following practical skills:
• Rapid trauma exam
• Backboard
• Control of major bleeding
• Jaw thrust
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Terms
arachnoid — A delicate membrane that encloses the spinal
cord and brain and lies between the pia mater and dura mater.
brain herniation — A condition in which part of the brain is
squeezed through an opening in the skull.
cardiac tamponade — Accumulation of fluid in the pericardial
space which reduces ventricular filling and causes shock.
cerebral edema — Swelling of the brain.
dura mater — The tough fibrous membrane covering the brain
and the spinal cord and lining the inner surface of the skull. It is
the outermost of the three meninges.
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Terms, continued
meninges — The membranes that cover the brain and spinal
cord: the dura mater, the arachnoid mater and the pia mater.
parasthesia — A pins and needles sensation in the arms or legs.
paresis — Weakness
petechiae — Small red or purple spots on the skin, caused by
broken capillary blood vessels.
pia mater — The fine vascular membrane that closely envelops
the brain and spinal cord under the arachnoid and the dura mater.
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Brain Structures
Different body functions are controlled by cerebrum,
cerebellum, brain stem
Graphic illustration credit: LifeART(R) image, Copyright 1998, Lippincott Williams & Wilkins. All rights reserved.
Copyright 2009 Seattle/King County EMS
Layers of Defense
• Skull
• Meninges - dura mater, arachnoid, pia mater
• Cerebrospinal fluid (CSF)
Graphic illustration credit: LifeART(R) image, Copyright 1998, Lippincott Williams & Wilkins. All rights reserved.
Copyright 2009 Seattle/King County EMS
Spine
• Thirty-two vertebrae form spinal column
• Tendons, ligaments, muscles secure and protect
Graphic illustration credit: LifeART(R) image, Copyright 1998, Lippincott Williams & Wilkins. All rights reserved.
Copyright 2009 Seattle/King County EMS
Spinal Cord
• Made of nerve tissue
• Surrounded by CSF
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Nervous System
Brain and spinal cord make up central nervous system
Peripheral nervous system is made up of all nerves that
project out of brain and spinal cord
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Chest
• Contains heart, lungs and great vessels
• Protected by ribs, sternum, scapulae, clavicles, spine
Graphic illustration credit: LifeART(R) image, Copyright 1998, Lippincott Williams & Wilkins. All rights reserved.
Copyright 2009 Seattle/King County EMS
Head Injuries
• Scalp laceration
• Concussion
• Contusion
• Skull fracture
• Head bleed
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Cerebral Edema
• Swelling of the brain
• Early sign is unconsciousness
• Late signs of cerebral edema and increased
intracranial pressure (ICP):
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–
–
–
–
Irrational or combative behavior
Changing level of consciousness
Abnormal respiratory pattern
Unequal pupils
Posturing
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Level of Consciousness
A change in level of consciousness is the single
most important observation you can make in assessing
the severity of brain injury.
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Hypovolemic Shock
If a head-injured patient shows signs of hypovolemic
shock, assess for other internal injuries.
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Care for a Head Injury
Emergency care for potential internal head injury:
• Protect airway
• Provide oxygen and ventilatory assistance, if needed
• Maintain neutral in-line, cervical stabilization and
stabilize spine
• Closely monitor vital signs and neurologic status
• Control bleeding
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Forces That Can Injure the Spine
• Compression
• Flexion
• Extension
• Rotation
• Lateral
• Distraction
• Penetration
Graphic illustration credit: LifeART(R) image, Copyright 1998, Lippincott Williams & Wilkins. All rights reserved.
Copyright 2009 Seattle/King County EMS
Symptoms of Spine Injury
• Weakness
• Numbness
• Tingling or paralysis in the extremities
• Pain along spine
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Care for a Spine Injury
• Open airway using jaw thrust
• Provide neutral, in-line cervical stabilization
• Provide oxygen
• Assist ventilation, if needed
• Immobilize spine using a backboard
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Care for a Spine Injury, cont.
• Keep backboard in a level position, if pt. is
hypotensive*
• Monitor vital signs
• Monitor neurological status
*There is little data to support the
use of the Trendelenburg position
when compare to a flat, level position.
Therefore we recommend keeping a hypotensive, backboarded
patient in a supine and level position. For non-backboarded
patients, use the shock position (legs only elevated).
Follow your local protocols.
Copyright 2009 Seattle/King County EMS
When Not to Immobilize
Immobilization may be unnecessary if ALL apply:
•
•
•
•
•
•
•
No significant MOI
No back or neck pain with or without movement
No pain or tenderness of back or neck on exam
No altered LOC
No history of loss of consciousness
No recent alcohol or drug use
Patient is reliable historian
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Helmet Removal
• Leave football helmet and shoulder pads on if it
stabilizes head and does not impair breathing or
airway
• If you need to remove:
– Manually stabilize neck and head and remove
face guard
– Remove chinstrap and have one rescuer stabilize
head while another removes helmet
• Remove motorcycle and bicycle helmets
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Chest Trauma
• Pneumothorax
• Hemothorax
• Tension pneumothorax
• Flail chest
• Traumatic asphyxia
• Myocardial contusion
• Cardiac tamponade
• Lacerations of great vessels (e.g., aortic tear)
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Care for a Chest Injury
• Ensure ABC’s
• Administer high flow oxygen via NRB
• Assist ventilations, if needed
• Anticipate cardiac arrest
• Treat for shock
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Summary
Structures of the brain are cerebrum, cerebellum,
brain stem
Signs of cerebral edema and increasing ICP:
•
•
•
•
•
Irrational or combative behavior
Changing LOC
Abnormal respiratory pattern
Unequal pupils
Posturing
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Summary, continued
Emergency care for a potential internal head injury:
• Protect airway
• Provide oxygen and ventilatory assistance
• Maintain neutral in-line, cervical stabilization and
stabilize spine
• Monitor vital signs and neurological status
• Control bleeding
Major symptoms for spine injury are weakness,
numbness, tingling, impaired sensation or paralysis
in the extremities, pain in the spinal area.
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Summary, continued
You may not need to immobilize the spine if ALL
these criteria are met:
•
•
•
•
•
•
•
No significant MOI
No back or neck pain with or without movement
No pain or tenderness of back or neck on exam
No altered LOC
No history of loss of consciousness
No recent alcohol or drug use
Patient is a reliable historian
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Summary, continued
Care for spine injury:
• Manually stabilize the head and aligning neck
in a neutral, in-line position
• Apply cervical collar
• Carefully move patient and place on a
backboard and secure
Assessment and treatment of the ABC’s is your
highest priority for a suspected spine injury
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Summary, continued
Signs of an internal chest injury
• Localized pain and tenderness
• Possible dyspnea
Care for a chest injury may require:
•
•
•
•
•
Ensure ABC’s
High flow oxygen via NRB
Assist ventilations, if needed
Anticipate cardiac arrest
Treat for shock
Copyright 2009 Seattle/King County EMS