Injuries to the Head and Spine


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Injuries to the Head and Spine

  1. 1. Chapter Injuries to the Head and Spine Twenty-Four
  2. 2. Chapter <ul><li>Mechanism of head and spine injury </li></ul><ul><li>How to stabilize the cervical spine </li></ul><ul><li>Proper application of a cervical spine immobilization device for patients found standing, seated, or supine </li></ul><ul><li>How and when to do rapid extrication </li></ul><ul><li>Procedures for helmet removal </li></ul><ul><li>Proper immobilization of child in car seat </li></ul>Twenty-Four CORE CONCEPTS
  3. 3. Anatomy Review: Nervous System
  4. 4. Spinal Column
  5. 5. Anatomy Review: Skull and Facial Bones
  6. 6. Bone Dura mater Arachnoid Pia mater Subarachnoid space Subdural space Intracerebral Dura mater Arachnoid Skull Pia mater Contents of the Skull Epidural space (potential)
  8. 8. <ul><li>Soft tissue injuries may </li></ul><ul><li>Injuries to brain cause internal </li></ul>bleed profusely. bleeding and increased intracranial pressure. Head Injuries Overview
  9. 9. Direct Occurs when the brain is lacerated, punctured, or bruised by the broken bones of the skull, by bone fragments, or by foreign objects. Brain Injury Indirect Can be the result of closed injuries to the skull and certain types of open skull injuries.
  10. 10. <ul><li>May occur due to clot </li></ul><ul><li>Can cause altered mental status. </li></ul>or hemorrhage. <ul><li>Signs and symptoms are similar </li></ul>to traumatic injury (but no trauma) . Brain Injury Nontraumatic
  11. 11. Patient ASSESSMENT Head Injury Signs and Symptoms <ul><li>Altered or decreased mental status </li></ul><ul><li>Irregular breathing patterns </li></ul><ul><li>Mechanism of injury present </li></ul>(Continued)
  12. 12. Patient ASSESSMENT Head Injury Signs and Symptoms <ul><li>Contusions, lacerations, or hematomas </li></ul><ul><li>Deformity of skull </li></ul><ul><li>Blood/fluid from ears or nose </li></ul><ul><li>Bruising around eyes, behind ears </li></ul>(Continued)
  13. 13. Patient ASSESSMENT Head Injury Signs and Symptoms <ul><li>Neurologic disability </li></ul><ul><li>Nausea and/or vomiting </li></ul><ul><li>Unequal pupil size with altered </li></ul>mental status <ul><li>Seizures </li></ul>
  14. 14. Patient CARE Head Injury Emergency Care Steps <ul><li>Body substance isolation </li></ul><ul><li>Airway, ventilation, oxygen </li></ul><ul><li>Initial assessment with </li></ul>C-spine stabilization (Continued)
  15. 15. Patient CARE Head Injury Emergency Care Steps <ul><li>Complete assessment. </li></ul><ul><li>Immobilize spine. </li></ul><ul><li>Monitor airway, breathing, pulse, </li></ul>mental status closely. (Continued)
  16. 16. Patient CARE Head Injury Emergency Care Steps <ul><li>Control bleeding. </li></ul><ul><li>Do not apply pressure to open or </li></ul>depressed skull injury. <ul><li>Dress and bandage wound. </li></ul>(Continued)
  17. 17. Patient CARE Head Injury Emergency Care Steps <ul><li>Be prepared for changes in </li></ul><ul><li>Transport immediately. </li></ul><ul><li>Monitor vital signs every 5 minutes </li></ul>patient condition. en route.
  18. 18. Tell new EMT-Bs that an epidural hematoma is often associated with severe blows to the temporal regions of the head. If they recognize an epidural hematoma in its early stages and promptly transport the patient to a trauma center, it can make the difference between life and death. Tell them to be aggressive if they suspect an epidural hematoma may be developing. P RECEPTOR P EARL
  20. 20. <ul><li>Motor vehicle crashes </li></ul><ul><li>Auto-pedestrian collisions </li></ul><ul><li>Falls </li></ul><ul><li>Blunt or penetrating trauma </li></ul><ul><li>Motorcycle crashes </li></ul><ul><li>Hangings </li></ul><ul><li>Diving accidents </li></ul><ul><li>Unconscious trauma patients </li></ul>Mechanisms of Spinal Injury
  21. 21. Mechanisms of Spinal Injury
  22. 22. Whiplash
  23. 23. Tell new EMT-Bs that as a rule of thumb, they should assume any fall three times the patient’s height or with enough force to cause open PSDEs to the ankles will also be accompanied by a spine injury. P RECEPTOR P EARL
  24. 24. <ul><li>Compression </li></ul><ul><li>Distraction (pulling apart) </li></ul><ul><li>Lateral bending </li></ul><ul><li>Flexion, rotation, extension </li></ul>Types of Spinal Injuries
  25. 25. Patient ASSESSMENT Spinal Injury Signs and Symptoms <ul><li>Pain and tenderness </li></ul><ul><li>Deformity of spine upon palpation </li></ul><ul><li>Numbness, weakness, or tingling </li></ul>in extremities (Continued)
  26. 26. Patient ASSESSMENT Spinal Injury Signs and Symptoms <ul><li>Pain upon movement: </li></ul><ul><li>Never move or allow a patient to </li></ul><ul><li>move in order to elicit a pain response. </li></ul>(Continued)
  27. 27. Patient ASSESSMENT Spinal Injury Signs and Symptoms <ul><li>Loss of sensation or paralysis </li></ul><ul><li>In extremities </li></ul><ul><li>Below level of injury </li></ul>(Continued)
  28. 28. Patient ASSESSMENT Spinal Injury Signs and Symptoms (Continued) <ul><li>Impaired breathing: </li></ul><ul><li>“ C-3, -4, -5 keep the diaphragm alive” </li></ul>
  29. 29. Patient ASSESSMENT Spinal Injury Signs and Symptoms <ul><li>Soft-tissue injuries associated </li></ul>with trauma <ul><li>Incontinence </li></ul>(Continued) <ul><li>Priapism </li></ul>
  30. 30. Patient ASSESSMENT Spinal Injury Signs and Symptoms <ul><li>Instruct the patient not to move. </li></ul><ul><li>Stabilize cervical spine during </li></ul>initial assessment. <ul><li>Evaluate mechanism of injury. </li></ul>(Continued)
  31. 31. Patient ASSESSMENT Spinal Injury Signs and Symptoms <ul><li>Ask: </li></ul><ul><li>What happened? </li></ul><ul><li>Where does it hurt? </li></ul><ul><li>Does your neck or back hurt? </li></ul>(Continued)
  32. 32. Patient ASSESSMENT Spinal Injury Signs and Symptoms <ul><li>Ask: </li></ul><ul><li>Can you move your hands and feet? </li></ul><ul><li>Can you feel me touching your </li></ul>fingers? Toes?
  33. 33. Assess sensation in all extremities.
  34. 34. Assess motor function.
  35. 35. Assess strength: feet and hands
  36. 36. Patient ASSESSMENT Spinal Injury Signs and Symptoms <ul><li>Inspect. </li></ul><ul><li>Palpate. </li></ul><ul><li>Assess strength of extremities. </li></ul><ul><li>Complications of spinal injury: </li></ul><ul><li>May cause paralysis. </li></ul><ul><li>May affect respiratory effort. </li></ul>
  37. 37. Patient CARE Spinal Injury Emergency Care Steps <ul><li>Use BSI procedures. </li></ul><ul><li>Maintain in-line stabilization. </li></ul><ul><li>Care for airway with in-line </li></ul>stabilization when possible.
  38. 38. Patient CARE Breathing Adequacy Emergency Care Steps <ul><li>Assess pulse, movement, and </li></ul>sensation in extremities. <ul><li>Assess the neck and spine. </li></ul><ul><li>Administer oxygen via </li></ul>nonrebreather mask.
  39. 39. Patient CARE Spinal Injury Emergency Care Steps <ul><li>Apply properly sized cervical spine </li></ul>immobilization device. <ul><li>Apply and secure patient to </li></ul>appropriate immobilization device. (Continued)
  40. 40. Patient CARE Spinal Injury Emergency Care Steps <ul><li>If proper size collar is not available, </li></ul>use rolled towel and tape. <ul><li>Pad around child as necessary to </li></ul>maintain stabilization.
  42. 42. Stabilize and measure.
  43. 43. Choose correct collar size.
  44. 44. Prepare collar.
  45. 45. Slide collar under chin.
  46. 46. Secure collar; maintain in-line position.
  47. 47. <ul><li>Vest type </li></ul><ul><li>Rigid short spine board. </li></ul><ul><li>Stabilize head, neck, torso. </li></ul><ul><li>Used for noncritical, </li></ul>seated patient. (Continued) Short Spine Boards
  48. 48. Select immobilization device.
  49. 49. Manually stabilize patient’s head in neutral, in-line position. Assess distal pulse, motor function, and sensation (PMS).
  50. 50. Apply the appropriately sized extrication collar. Position device behind patient.
  51. 51. Secure device to patient’s torso. Evaluate and pad behind patient’s head as necessary. Secure patient’s head to device.
  52. 52. Evaluate and adjust straps. As needed, secure patient’s wrists and legs.
  53. 53. <ul><li>Stabilize head, neck, torso, </li></ul>pelvis, and extremities. <ul><li>May be applied in: </li></ul><ul><li>Lying, standing, and sitting positions </li></ul><ul><li>Conjunction with short spine boards </li></ul>(Continued) Long Spine Boards
  54. 54. Maintain stabilization; apply collar.
  55. 55. Prepare and position device.
  56. 56. Move patient onto board. Apply padding to voids.
  57. 57. Secure body, then head.
  58. 58. Reassess PMS.
  59. 59. Standing Takedown: Maintain stabilization and apply collar.
  60. 60. Standing Takedown: Position board and EMT-Bs.
  61. 61. Standing Takedown: Grasp board after reaching under patient’s shoulders.
  62. 62. Standing Takedown: Carefully lower patient; then secure board.
  63. 63. <ul><li>Unsafe scene </li></ul><ul><li>Unstable patient condition </li></ul><ul><li>Patient blocks EMT-B’s </li></ul>Indications access to an unstable patient (Continued) Rapid Extrication
  64. 64. Manually stabilize; apply collar.
  65. 65. After putting end of board next to patient, position hands on legs/pelvis and chest/arms.
  66. 66. Rotate patient and reposition hands.
  67. 67. Lower patient to board.
  68. 68. Move patient into position on board.
  69. 69. Secure patient and transport.
  71. 71. Patient ASSESSMENT Helmet Removal Signs and Symptoms <ul><li>Decision to remove helmet is </li></ul><ul><li>Airway and breathing concerns </li></ul><ul><li>Fit of helmet, movement within helmet </li></ul><ul><li>Access for airway and ventilation </li></ul>based on:
  72. 72. <ul><li>Good fit, little movement. </li></ul><ul><li>No current or expected </li></ul>airway problems. <ul><li>Removal would cause </li></ul>further injury. Indications to Leave Helmet in Place (Continued)
  73. 73. <ul><li>Proper immobilization may </li></ul>be performed. <ul><li>No interference with ongoing </li></ul>assessment. Indications to Leave Helmet in Place
  74. 74. <ul><li>Inability to assess or treat </li></ul>airway and breathing <ul><li>Improper fit/movement </li></ul>within helmet Indications for Removing Helmet (Continued)
  75. 75. <ul><li>Inability to immobilize spine </li></ul><ul><li>Cardiac arrest </li></ul>Indications for Removing Helmet
  76. 76. Tell new EMT-Bs that many EMS providers put the controversy of helmet removal vs. nonremoval into the following perspective: If your child’s neck was injured in a football accident, would you want the trainer and the EMT-B to remove the helmet at the scene or would you prefer that this be left to the emergency department staff, who probably will not have the assistance of the trainer or the benefit of frequent practice in the helmet removal technique? P RECEPTOR P EARL
  77. 77. Stabilize head and helmet. Fingers should be on patient’s mandible. Second EMT-B loosens strap. 1 2
  78. 78. Transfer stabilization to second EMT-B. Carefully remove helmet. 3 4
  79. 79. Prevent head from falling once helmet removed. Begin routine stabilization and immobilization. 5 6
  80. 80. Immobilizing a Child in or Out of Car Seat <ul><li>The car seat is a good place to immobilize the child. </li></ul><ul><li>The child will need to be “rapid extricated” out of the seat if it becomes necessary to lay the child down in management. </li></ul>
  81. 81. 1. Describe the mechanisms of head and spinal injury. 2. When should rapid extrication be used? 3. Describe the steps in helmet removal. 4. When is it appropriate to remove a child from a car seat as opposed to immobilizing the child in the seat? R EVIEW QUESTIONS