spine

1. First Aid for Colleges
and Universities
10 Edition
Chapter 13
© 2012 Pearson Education, Inc.
Head and Spine
Injuries
Slide Presentation prepared by
Randall Benner, M.Ed., NREMT-P

2. Learning Objectives
• Describe the appropriate first aid care for injury
to the scalp.
• Describe the physiology of injury to the brain.
• List the four types of skull fractures.
• List the signs and symptoms of a skull fracture.
• Distinguish between open and closed head
injuries.
• Discuss signs and symptoms of both open and
closed head injuries.
© 2012 Pearson Education, Inc.

3. Learning Objectives
• Describe and demonstrate the appropriate first
aid care for a head injury.
• Describe the common mechanisms of spinal
injury.
• Describe the assessment of spinal injury victims.
• List the signs and symptoms of spinal injury.
• Describe and demonstrate the appropriate first
aid care for spinal injury.
• Describe the technique for removing a helmet
from a head- or spinal-injured victim.
© 2012 Pearson Education, Inc.

4. Introduction
• 1.5 million Americans suffer head injuries yearly.
• Any trauma severe enough to injure the brain
can also injure the spine.
• The First Aider must be able to quickly identify
and manage these types of injuries to prevent
further harm or deterioration.
© 2012 Pearson Education, Inc.

5. Types of Head Injuries
• Injury to the scalp
– Similar injury patterns as other soft tissue injuries
– Contusions, lacerations, abrasions, avulsions
– Bleeding may be minimal or severe
• Injured scalp management
– Apply direct pressure with dry sterile dressing.
– Avoid pressure over possible fracture site.
– Consider management for spinal injury as well.
© 2012 Pearson Education, Inc.

6. Types of Injury to the Brain
• Primary injury
• Secondary injury
• Results of brain injury
– Pressure increases inside the skull
– Excessive pressure causes more tissue death
– Eventually the brain stem is compressed, which
complicates the heart rate, breathing, and blood
pressure
© 2012 Pearson Education, Inc.

7. Signs and Symptoms of a Brain Injury
– Main symptom is altered mental status
– Nausea and/or vomiting
– Headache, weakness, loss of balance
– Pupils may be unequal
– Seizures
– Heart rate slows and breathing becomes
irregular
© 2012 Pearson Education, Inc.

8. Signs and Symptoms of a Brain Injury
© 2012 Pearson Education, Inc.

9. Brain Injury Management
– Suspect concurrent spinal injury (immobilize).
– Establish and maintain an airway.
– Provide breathing assistance if needed.
– Be prepared to logroll patient if they vomit.
– Keep the victim warm and in supine position.
– Do NOT elevate the legs.
© 2012 Pearson Education, Inc.

10. Injury to the Skull (Skull Fracture)
• Takes significant force to fracture the skull
• Usually results in minor injury unless brain is
also injured
• Types of skull fractures
– Depressed
– Linear
– Comminuted
– Basilar
© 2012 Pearson Education, Inc.

11. Types of Skull Fractures
© 2012 Pearson Education, Inc.

12. Assessing Head Injuries
• Assessing a victim with a head
injury
– Determine mechanism of injury.
– While keeping spine aligned,
assess the head, pupils, neck,
chest, abdomen, arms, and legs.
© 2012 Pearson Education, Inc.

13. Signs and Symptoms of a Skull Fracture
– Suspect skull fracture with any significant
head injury
– Presence of soft tissue trauma
– Deformities may be noted to the skull
– Pain, tenderness, swelling at injury site
– Raccoon eyes or Battle’s sign (bruising
behind ears)
– Clear discharge from ears, nose, or mouth
© 2012 Pearson Education, Inc.

14. Signs and Symptoms of a Skull Fracture
© 2012 Pearson Education, Inc.

15. Assessment, Signs, and Symptoms of Head
Injury
• Closed and open head injuries
– Open head injury causes brain to be exposed
– Closed head injury has no open wound
– Either type of injury may or may not have concurrent
brain damage
© 2012 Pearson Education, Inc.

16. Assessment, Signs, and Symptoms of Head
Injury
• Signs and symptoms of a closed head injury
– Altered mental status is best indicator
– Patient may become unresponsive or have seizures
– Soft tissue injuries may be present
– Raccoon’s eyes or Battle’s sign may be present
– Loss of motor/sensory reflexes in half of the body
– Pupillary and vital sign changes
– Nausea, vomiting
© 2012 Pearson Education, Inc.

17. Assessment, Signs, and Symptoms of Head
Injury
• Signs and symptoms of an open head injury
– Evidence of trauma to the head
– Depressed region of the skull
– Exposed brain tissue
– External bleeding
© 2012 Pearson Education, Inc.

18. First Aid Care for Head Injury
• Establish inline immobilization, activate EMS.
• Maintain an open airway (modified jaw thrust).
• Support ventilations if breathing is inadequate.
• Control bleeding.
• Never remove any penetrating object.
• Provide ongoing care while awaiting EMS.
© 2012 Pearson Education, Inc.

19. Injuries to the Spine
• Spinal column and cord injuries
– Column injury is damage to vertebrae
– Cord injury is damage to spinal cord itself
– Either column or cord injury may occur without the
other one present
– Mismanagement can result in permanent disability
© 2012 Pearson Education, Inc.

20. Spinal Column and Cord Injuries
• Certain regions of column
more likely to be injured
(cervical and lumbar)
© 2012 Pearson Education, Inc.

21. Injuries to the Spine
• Common mechanisms for spinal injuries
– Compression, flexion, extension, rotation, lateral
bending
– Distraction (pulling apart – as with hangings)
– Damage from bony fragments penetrating in
• Situations commonly causing spinal injuries are
similar to other traumatic mechanisms
(falls, motor vehicle collisions, sports, etc.)
© 2012 Pearson Education, Inc.

22. Complications of Spinal Injury
• Inadequate breathing
– Damage to nerves that stimulate the diaphragm (high
in cervical region) results in inability to breathe
• Paralysis
– With spinal cord damage, there may be weakness,
loss of sensation, or paralysis
– Often these symptoms become permanent
© 2012 Pearson Education, Inc.

23. Injuries to the Spine
• Assessment considerations
– Note the mechanism of injury.
– Do not logroll the victim unless necessary.
– Palpate gently for deformity or tenderness.
– Assess motor function of the hands and feet on each
side of the body; both sides should be the same.
• Ask the following questions
– What happened and how did it happen?
– Does your neck or back hurt?
– Can you move your hands and feet?
– Can you feel me pinching your toes and fingers?
© 2012 Pearson Education, Inc.

24. Signs and Symptoms of Spinal Injury
• Suspect spinal injury with any serious injury
• Spinal injury symptoms
– Tenderness or pain in area of injury
– Soft tissue trauma in area of injury
– Numbness, tingling, weakness to extremities
– Urinary or fecal incontinence
– Impaired breathing with high spinal injuries
© 2012 Pearson Education, Inc.

25. First Aid Care for Spinal Injury
• Attempt only if properly equipped and trained
– Activate EMS and maintain inline stabilization.
– Establish and maintain airway and adequate
breathing.
– Provide rescue breathing, if needed.
– Assess pulses and perform CPR, if needed.
– Control any external hemorrhage.
© 2012 Pearson Education, Inc.

26. First Aid Care for Spinal Injury
• Helmet Removal
– Keep helmet in place if the following apply
• Helmet fits well
• No impending airway or breathing problems
• Removal of helmet may further injure the victim
• Helmet does not prevent proper immobilization
• Helmet does not interfere with assessment and
reassessment
© 2012 Pearson Education, Inc.

27. First Aid Care for Spinal Injury
• Helmet Removal
– Remove the helmet if the following apply
• Helmet does not fit well
• The victim is in cardiac arrest
• The helmet interferes with proper assessment of
airway and breathing functions
• The helmet interferes with proper management of
airway and breathing functions
© 2012 Pearson Education, Inc.

28. Summary
• An open head injury is the result of a traumatic
event
• Any concurrent brain injury typically decides life
or death.
• Priority for any head injury is to treat lost function
to the airway, breathing, and circulatory
components.
• When faced with a spinal injury, keep the body
immobile until EMS arrives.
© 2012 Pearson Education, Inc.