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Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
Head and Spinal Injuries Part 1
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Head and Spinal Injuries Part 1

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  • 1.
    • Head and Spinal Injuries
  • 2.
    • Given a (simulated) patient with demonstrated/suspected head and/or spinal injuries in a pre-hospital environment, describe the appropriate assessment and management techniques to properly immobilize the patient for transport to a medical treatment facility IAW Chapter 30, Emergency Care and Transportation of the Sick and Injured, 8th Edition, American Academy of Orthopedic Surgeons (AAOS).
    Terminal Learning Objective
  • 3.
    • Given an overview of the anatomy and physiology of the nervous system and the signs and symptoms associated with a spinal injury, describe the techniques for manual stabilization, full immobilization and preparation for transport to a medical treatment facility IAW Emergency Care and Transportation of the Sick and Injured, 8th Edition, American Academy of Orthopedic Surgeons (AAOS).
    Enabling Learning Objectives
  • 4.
    • Given an overview of the characteristics of head injuries and the associated complications resulting from brain trauma, describe the techniques for assessing and managing the head injury, with or without spinal involvement, IAW Emergency Care and Transportation of the Sick and Injured, 8th Edition, American Academy of Orthopedic Surgeons (AAOS).
    Enabling Learning Objectives
  • 5. Anatomy and Physiology of the Nervous System
    • Central Nervous System : Brain & spinal cord control all basic bodily functions and respond to external changes
    • Periferal Nervous System : Nerves in the body control motor (voluntary) movements and sensory nerve fibers connect the CNS to the rest of the body
  • 6. Anatomy and Physiology of the Nervous System
    • Autonomic Nervous System :
    • Nerves, ganglia, plexuses that carry impulses to all smooth muscles, secretory glands, and the heart. Regulates the activities of visceral organs, which are usually not under voluntary control
  • 7. Central Nervous System EMT-B/LPC 17 Mar 06 C191W204/1
    • The Brain:
    • Cerebrum (Cerebral Cortex)
    • Voluntary motor and thought
    • Cerebellum
    • Coordinates movement
    • Brainstem
    • Controls life functions
  • 8. Protective Coverings
  • 9. Peripheral Nervous System
    • How the Nervous System Works:
  • 10. Protective Coverings
    • Cranial Vault:
  • 11. Skeletal System
  • 12. Spinal Column
  • 13.  
  • 14. Mechanism Of Injury
  • 15. Signs and Symptoms Localized pain, muscle spasms Loss of sensation, numbness Paresthesias (tingling, pins and needles) Paralysis Priapism Incontinence
  • 16. Spinal Cord Injuries Primary Damage- occurs at the time of injury from the cord being cut, torn, crushed, or it’s blood supply being cut off. Secondary Damage- occurs later from hypotension, hypoxia, injury to blood vessels, swelling or compression of the cord from surrounding hemorrhage.
  • 17. Neurogenic Shock -Malfunction of the autonomic nervous system due to spinal trauma-Autonomic nervous system regulates blood vessel tone and cardiac output-Patient has normal skin color and temperature with hypotension and a slow heart rate-Hypovolemic shock = cool clammy skin, hypotension and rapid pulse
  • 18.  
  • 19. Rapid extrication necessary?Access HABCTreat any life threatening situationsMaintain in-line C-spine stabilization Hand placement on shoulders (not the side of the head) with the head cradled between forearms In a tactical situation
  • 20.  
  • 21.
    • The scalp has a rich blood supply.
    • There may be more serious, deeper injuries.
    • Fold skin flaps back down onto scalp.
    Scalp Lacerations
  • 22.
    • Indicates significant force.
    • Signs:
      • Obvious deformity
      • Visible crack in the skull
      • Raccoon eyes
      • Battle’s sign
    Skull Fracture
  • 23.
    • Brain injury.
    • Temporary loss or alteration in brain function.
    • May result in unconsciousness, confusion or amnesia.
    • Brain can sustain bruise when skull is struck.
    • There will be bleeding and swelling.
    • Bleeding will increase the pressure within the skull.
    Concussion
  • 24.
    • Bruise to the brain.
    • Far more serious than a concussion.
    • Patient may suffer long-lasting and even permanent damage.
    Contusion
  • 25.
    • Laceration or rupture of blood vessel in brain.
      • Subdural:
    Intracranial Bleeding
  • 26.
    • Laceration or rupture of blood vessel in brain.
      • Intracerebral:
    Intracranial Bleeding
  • 27.
    • Laceration or rupture of blood vessel in brain.
      • Epidural:
    Intracranial Bleeding
  • 28.
    • Brain injuries are not always caused by trauma.
    • Medical conditions may cause spontaneous bleeding in the brain.
    • Signs and symptoms of nontraumatic injuries are the same as those of traumatic injuries.
      • There is no obvious mechanism of injury
    Other Brain Injuries
  • 29.
    • Cerebral edema.
    • Convulsions and seizures.
    • Vomiting.
    • Leakage of CSF.
    Complications of Head Injury
  • 30.
    • Lacerations, contusions, hematomas to scalp.
    • Soft areas, depressions.
    • Visible skull fractures or deformities.
    • Ecchymosis around eyes and behind the ear.
    • Clear or pink CSF leakage.
    Signs and Symptoms
  • 31.
    • Failure of pupils to respond to light.
    • Unequal pupils.
    Signs and Symptoms
  • 32.
    • Loss of sensation and/or motor function.
    • Period of unconsciousness.
    • Amnesia.
    • Seizures.
    Signs and Symptoms
  • 33.
    • Numbness or tingling in the extremities.
    • Irregular respirations.
    • Dizziness.
    • Visual complaints.
    • Combative or abnormal behavior.
    • Nausea or vomiting.
    Signs and Symptoms
  • 34.
    • Compression injuries occur from a fall.
    • Motor vehicle crashes or other types of trauma can overextend, flex, or rotate the spine.
    • Distraction: When spine is pulled along its length; causes injuries.
      • Hangings are an example
    Spine Injuries
  • 35.
    • MVC.
    • Pedestrian-MVCs.
    • Falls.
    • Blunt or penetrating trauma.
    • Motorcycle crashes.
    • Hangings.
    • Driving accidents.
    • Recreational accidents.
    Significant Mechanisms of Injury
  • 36.
    • Observe scene for hazards; take BSI precautions.
    • Anticipate problems with ABCs.
    • Pay attention for changes in level of consciousness.
    • Call for ALS backup as soon as possible when serious MOI is present.
    • Look for a deformed helmet or deformed windshield.
    Scene Size-up
  • 37.
    • Ask the patient:
      • What happened?
      • Where does it hurt?
      • Does your neck or back hurt?
      • Can you move your hands and feet?
      • Did you hit your head?
    • Confused or slurred speech, repetitive questioning, or amnesia indicate head injury.
    • Ask when patient lost consciousness.
    • Stabilize the spine.
    Initial Assessment
  • 38.
    • Use jaw-thrust maneuver to open airway.
    • Vomiting may occur. Suction immediately.
    • Move patient as little as possible. Do not remove c-collar.
    • Consider providing positive pressure ventilations.
    • A pulse that is too slow can indicate a serious condition.
    • Assess and treat for shock.
    ABCs
  • 39.
    • If patient has problems with ABCs, provide rapid transport.
    Transport Decision
  • 40.
    • The absence of pain does not rule out a potential spinal injury.
    • Do not ask patients with possible spinal injuries to move their neck.
    Focused History and Physical Exam
  • 41.
    • Quickly use DCAP-BTLS.
    • Decreased level of consciousness is the most reliable sign of head injury.
    • Expect irregular respirations.
    • Look for blood or CSF leaking from ears, nose, or mouth.
    Rapid Physical Exam for Significant Trauma
  • 42.
    • Look for bruising around eyes, behind ears.
    • Evaluate pupils.
    • Do not probe scalp lacerations. Do not remove an impaled object.
    Rapid Physical Exam for Significant Trauma
  • 43.
    • Watch for change in level of consciousness.
    • Use Glasgow Coma Scale.
    • Pain, tenderness, weakness, numbness, and tingling are signs of spinal injury.
    • May lose sensation or become paralyzed
    • May become incontinent
    Focused Physical Exam for Nonsignificant Trauma
  • 44.
    • Complete set of baseline vital signs is essential.
    • Assess pupil size and reactivity to light; continue to monitor.
    • Gather as much history as possible while preparing for transport.
    Baseline Vital Signs/ SAMPLE History
  • 45.
    • Control bleeding.
    • Fold torn skin flaps back down onto the skin bed.
    • Do not apply excessive pressure.
    • If dressing becomes soaked, place a second dressing over it.
    Interventions
  • 46.
    • Once bleeding has been controlled, secure with a soft self-adhering roller bandage.
    • Monitor and treat for shock.
    • Protect airway from vomiting.
    • Provide immediate transport.
    Interventions
  • 47.
    • Perform if time permits.
    • Can help identify subtle or covert injuries
    Detailed Physical Exam
  • 48.
    • Focus on reassessing ABCs, interventions, vital signs.
    • Communication and documentation
      • Hospital may prepare better with info from your assessment.
      • Document changes in level of consciousness.
      • Include history.
      • Document vital signs every 5 minutes if unstable, every 15 minutes if stable.
    Ongoing Assessment
  • 49.
    • 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.
    Emergency Medical Care of Spinal Injuries
  • 50.
    • Hold head firmly with both hands.
    • Support the lower jaw.
    • Move to eyes-forward position.
    Stabilization of the Cervical Spine
  • 51.
    • Support head while partner places cervical collar.
    • Maintain the position until patient is secured to a backboard.
    Stabilization of the Cervical Spine
  • 52.
    • Do not force the head into a neutral, in-line position if:
      • Muscles spasm
      • Pain increases
      • Numbness, tingling, or weakness develop
      • There is a compromised airway or breathing problems.
    Stabilization of the Cervical Spine
  • 53.
    • Establish an adequate airway.
    • Control bleeding and provide adequate circulation.
    • Assess the patient’s baseline level of consciousness.
    Emergency Medical Care of Head Injuries
  • 54.
    • Establish an adequate airway.
    • Use the jaw-thrust maneuver.
    • Maintain head in neutral, in-line position.
    • Place cervical collar.
    • Suction.
    • Provide high-flow oxygen.
    • Continue to assist ventilations and administer oxygen.
    Managing the Airway
  • 55.
    • Begin CPR if patient is in cardiac arrest.
    • Blood loss aggravates hypoxia.
    • Shock can occur.
    • Transport immediately to trauma center.
    • If patient becomes nauseated or vomits, place on left side.
    Circulation EMT-B/LPC 17 Mar 06 C191W204/1
  • 56.
    • Apply and maintain in-line stabilization
    • Assess distal functions (PMS)
    • Apply a rigid C-collar
    • Position the long spine board
    • Log-roll the patient
    • Ensure the patient is centered
    Preparation for Transport: Supine Patients
  • 57.  
  • 58.  
  • 59.
    • Secure upper torso
    • Secure pelvis/upper legs
    • Immobilize the head to board
    • Check and readjust straps
    • Reassess Pulse, Motor, Sensory
    Preparation for Transport: Supine Patients
  • 60.  

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