Transcript SECTION 2 - Sam Scheller

Chapter 26
Head and Spine
Injuries
Chapter 26: Head and Spine Injuries
Objectives (1 of 5)
• List the functions of the central nervous system.
• Define the structure of the skeletal system as it
relates to the nervous system.
• Relate mechanism of injury to potential injuries
of the head and spine.
• State the signs and symptoms of a potential
spinal injury.
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Chapter 26: Head and Spine Injuries
Objectives (2 of 5)
• Describe the method of determining if a
responsive patient may have a spinal injury.
• Relate the airway emergency medical care
techniques to the patient with a suspected
spinal injury.
• Describe how to stabilize the cervical spine.
• List the steps in performing rapid extrication.
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Chapter 26: Head and Spine Injuries
Objectives (3 of 5)
• Explain the rationale for immobilization of the entire
spine when a cervical spine injury is suspected.
• Explain the rationale for utilizing rapid extrication
approaches only when they indeed will make the
difference between life and death.
• Demonstrate opening the airway in a patient with a
suspected spinal cord injury.
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Chapter 26: Head and Spine Injuries
Objectives (4 of 5)
• Demonstrate evaluating a responsive patient
with a suspected spinal cord injury.
• Demonstrate stabilization of the cervical
spine.
• Demonstrate the four-person log roll for a
patient with a suspected spinal cord injury.
• Demonstrate how to log roll a patient with a
suspected spinal cord injury using two people.
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Chapter 26: Head and Spine Injuries
Objectives (5 of 5)
• Demonstrate securing a patient to a long
backboard.
• Demonstrate the procedure for rapid
extrication.
• Demonstrate helmet removal techniques.
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Chapter 26: Head and Spine Injuries
Anatomy and Physiology of
the Nervous System
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Chapter 26: Head and Spine Injuries
Central Nervous System
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Chapter 26: Head and Spine Injuries
Protective Coverings of
the Brain
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Chapter 26: Head and Spine Injuries
Spinal Column
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Chapter 26: Head and Spine Injuries
The Skull
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Chapter 26: Head and Spine Injuries
The Spinal Canal
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Chapter 26: Head and Spine Injuries
Assessment of Spinal Injuries
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Vehicle crashes (snowmobile, car, motorcycle)
Snow rider collisions with fixed objects
Snow rider collisions with other snow riders
Falls from heights
Blunt or penetrating trauma
Blunt trauma
Hangings
Diving accidents
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Chapter 26: Head and Spine Injuries
Questions to Ask
Responsive Patients
• Does your neck or back hurt?
• What happened?
• Where (specific location) does it hurt?
• Can you feel me touching your fingers?
Your toes?
• Can you move your hands and feet?
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Chapter 26: Head and Spine Injuries
Assessment of Spinal Injuries
• Assess DCAP-BTLS.
• Avoid any excessive motion.
• Assess strength in each extremity and
compare.
• Absence of pain does not rule out injury.
• Ability to move or walk does not rule out
injury.
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Chapter 26: Head and Spine Injuries
Signs and Symptoms of
Spinal Injury
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Pain or tenderness of spine
Deformity of spine
Tingling and/or weakness in the extremities
Loss of sensation or paralysis
Incontinence
Soft-tissue injuries to head, neck, back
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Chapter 26: Head and Spine Injuries
Emergency Medical Care
• Follow BSI precautions.
• Manage the airway.
– Perform the jaw-thrust maneuver to
open the airway.
– Consider inserting an oropharyngeal
airway.
– Administer oxygen.
• Stabilize the cervical spine.
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Chapter 26: Head and Spine Injuries
Stabilization of the Cervical
Spine (1 of 3)
• Hold patient’s head
firmly with both hands.
• Support the lower jaw.
• Move to patient’s head
to eyes-forward position.
• Maintain position until
patient is secured to
backboard.
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Chapter 26: Head and Spine Injuries
Stabilization of the Cervical
Spine (2 of 3)
• Assess and monitor CMS functions.
• Cervical collars do not replace manual
stabilization.
• Improperly fitted collars may be harmful.
• Towel rolls and/or blanket rolls can be
substituted for cervical collar.
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Chapter 26: Head and Spine Injuries
Stabilization of the Cervical
Spine (3 of 3)
• Do not force the head into a neutral, in-line
position if the following develop:
– Muscles spasms
– Increase in pain
– Numbness, tingling, or weakness
– Compromised airway or breathing
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Chapter 26: Head and Spine Injuries
Preparation for Transport:
Supine Patients (1 of 2)
• Maintain in-line stabilization.
• Assess and monitor distal CMS functions in
each extremity.
• Apply a cervical collar, sized appropriately.
• Have other team members position
immobilization device.
• Log roll patient; quickly assess the back.
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Chapter 26: Head and Spine Injuries
Preparation for Transport:
Supine Patients (2 of 2)
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Center patient on device.
Secure upper torso to device.
Secure pelvis, legs, and feet.
Immobilize and secure the head.
Check and adjust all straps.
Reassess distal CMS functions.
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Chapter 26: Head and Spine Injuries
Preparation for Transport:
Sitting Patients
• Maintain manual in-line stabilization.
• Assess CMS functions, apply a cervical collar.
• Place a short board or short immobilization
device behind patient.
• Position device around patient and secure.
• Turn and lower patient to long backboard.
• Secure short and long backboards together.
• Reassess distal CMS functions.
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Chapter 26: Head and Spine Injuries
Preparation for Transport:
Standing Patients
• Stabilize the head and neck from behind and
apply a cervical collar.
• Position board upright behind patient and
secure.
• A rescuer stands at each side, facing the
patient.
• Reach under each arm, grasp board near
patient’s shoulder.
• Carefully lower patient to ground.
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Chapter 26: Head and Spine Injuries
Head Injuries
• All head injuries are potentially serious.
• Types include:
– Scalp lacerations
– Skull fractures
– Brain injuries
– Medical conditions
– Complications of head injuries
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Chapter 26: Head and Spine Injuries
Scalp Lacerations
• Scalp has a rich blood supply.
• There may be more serious, deeper
injuries.
• Follow BSI precautions.
• Fold skin flaps back down onto scalp.
• Control bleeding by direct pressure.
• Watch for skull fractures
• Add additional dressings as needed.
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Chapter 26: Head and Spine Injuries
Skull Fracture
• Indicates significant force
• Signs:
– Obvious deformity
– Visible crack in skull
– Raccoon eyes
– Battle’s sign
– Cerebrospinal fluid
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Chapter 26: Head and Spine Injuries
Concussion (1 of 2)
• Minor traumatic brain injury (TBI)
• Temporary loss or alteration in brain
function
• May result in unresponsiveness,
confusion, or amnesia
• Retrograde amnesia: forgetting events
leading up to injury
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Chapter 26: Head and Spine Injuries
Concussion (2 of 2)
• Anterograde (posttraumatic) amnesia:
forgetting events after the injury
• Perseveration: repetitive speech patterns
• Brain can sustain bruise when skull is
struck.
• There will be bleeding and swelling.
• Bleeding will increase pressure within
skull.
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Chapter 26: Head and Spine Injuries
Intracranial Bleeding
• Major TBI
• Laceration or rupture
of blood vessel in
brain
– Subdural
– Intracerebral
– Epidural
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Chapter 26: Head and Spine Injuries
Other Brain Injuries
• Brain injuries are not always caused by trauma.
• Medical conditions may cause spontaneous
bleeding in the brain.
– Example: high blood pressure
• Signs and symptoms of nontraumatic injuries
are the same as those of traumatic injuries.
– There is no MOI.
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Chapter 26: Head and Spine Injuries
Complications of Head Injury
• Cerebral edema is one of the most
serious complications.
– Ensure airway and provide oxygen.
• Seizure (convulsion) may occur.
• Vomiting may occur.
– Common in children
• Leakage of cerebrospinal fluid may occur.
– Do not pack ears or nose.
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Chapter 26: Head and Spine Injuries
Assessing Head Injuries (1 of 2)
• Common causes:
– Skier-object (fixed or moving) collisions
– Direct blows (deformed or dented helmet)
– Falls from heights
– Sports injuries, especially involving speed
• Evaluate and monitor level of
responsiveness
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Chapter 26: Head and Spine Injuries
Assessing Head Injuries (2 of 2)
• Blunt injuries are associated with trauma.
• Consider MOI.
• Assess and monitor level of
responsiveness.
• Evaluate and compare pupil size, shape,
and reaction to light.
• Injury may be closed or open.
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Chapter 26: Head and Spine Injuries
Signs and Symptoms (1 of 3)
• Lacerations, contusions, hematomas to scalp
• Soft areas or depression upon palpation
• Visible skull fractures or deformities
• Ecchymosis around eyes and behind ear
• Clear or pink CSF leakage
• Failure of pupils to respond to light
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Chapter 26: Head and Spine Injuries
Signs and Symptoms (2 of 3)
• Unequal pupils (anisocoria)
• Occurs naturally in 5% of the population
• Loss of sensation and/or motor function
• Period of unresponsiveness
• Respiratory distress due to bleeding or
swelling of the airway
• Amnesia
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Chapter 26: Head and Spine Injuries
Signs and Symptoms (3 of 3)
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Seizures
Numbness or tingling in the extremities
Irregular respirations
Dizziness
Visual complaints
Combative or abnormal behavior
Nausea or vomiting
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Chapter 26: Head and Spine Injuries
Level of Responsiveness
• Change in level of responsiveness is the single
most important observation.
• Use the AVPU scale or Glasgow Coma Scale
(depending on local protocols).
• Reassess level of responsiveness:
– Every 15 minutes if patient is stable.
– Every 5 minutes if patient is unstable.
• Levels may fluctuate or progressively deteriorate.
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Chapter 26: Head and Spine Injuries
Change in Pupil Size
• Unequal pupil size may indicate increased
pressure on one side of the brain.
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Chapter 26: Head and Spine Injuries
Emergency Medical Care
• Protect the cervical spine.
• Follow these three principles:
– Establish an adequate airway, provide
high-flow oxygen.
– Control bleeding, provide adequate
circulation.
– Assess baseline vital signs and monitor
patient’s level of responsiveness.
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Chapter 26: Head and Spine Injuries
Managing the Airway
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First priority!
Use jaw-thrust maneuver.
Maintain neutral, in-line stabilization.
Use suction and remove foreign bodies.
Provide high-flow oxygen.
Assist ventilations as needed.
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Chapter 26: Head and Spine Injuries
Circulation
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Start CPR in patients with cardiac arrest.
Control bleeding.
Shock is usually due to bleeding.
Patients with a medical condition or
nontraumatic brain injury should be placed
on side to avoid aspiration.
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Chapter 26: Head and Spine Injuries
Cervical Collar
• Provides preliminary, partial support
• Applied to every patient with a
suspected spinal injury
• Used with manual stabilization until
patient is secured to spinal
immobilization device
• Must be correctly sized
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Chapter 26: Head and Spine Injuries
Applying a Cervical Collar
• One rescuer provides
continuous manual in-line
support of head.
• Measure proper size collar.
• Place chin support snugly
under chin.
• Maintain manual support.
• Wrap collar around neck.
• Ensure that collar fits.
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Chapter 26: Head and Spine Injuries
Backboards
• Short backboards, vests
– Used on patients found in sitting
position
– Used in extrication
• Long backboards
– Provide full-body immobilization
– Can be used to splint many injuries
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Chapter 26: Head and Spine Injuries
Helmet Removal (1 of 5)
• Is airway clear and is patient breathing
adequately?
• Can airway be maintained and ventilations
assisted with helmet in place?
• How well does helmet fit?
• Can patient move within helmet?
• Can spine be immobilized in a neutral
position with helmet on?
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Chapter 26: Head and Spine Injuries
Helmet Removal (2 of 5)
• A helmet that fits well prevents the head from
moving and should be left on, as long as:
– There are no impending airway or breathing
problems.
– It does not interfere with assessment and
treatment of the airway.
– You can properly immobilize the spine.
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Chapter 26: Head and Spine Injuries
Helmet Removal (3 of 5)
• Remove a helmet if:
– It makes assessing the airway difficult.
– It interferes with spinal immobilization.
– It allows excessive head movements.
– Patient is in cardiac arrest.
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Chapter 26: Head and Spine Injuries
Helmet Removal (4 of 5)
• Remove glasses or
goggles.
• Stabilize head and
loosen strap.
• Place hands at the jaw
and back of head.
• Begin to gently slide
helmet up and off.
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Chapter 26: Head and Spine Injuries
Helmet Removal (5 of 5)
• Slide hand up the back
of head to prevent it
from moving.
• Rotate helmet all the
way off head.
• Manually stabilize
cervical spine as
normal.
• Apply cervical collar.
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Chapter 26: Head and Spine Injuries
Pediatric Needs (1 of 2)
• Children will need
additional padding
to prevent neck
flexion.
• Blanket rolls can be
used in place of
cervical collars.
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Chapter 26: Head and Spine Injuries
Pediatric Needs (2 of 2)
• Children may need
extra padding to
maintain
immobilization.
• Car seats can be
used as
immobilization
devices.
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