Head & Spine Injury.ppt
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head injury with spinal cord injury all details..
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Head & Spine Injury.ppt
- 1. 1 Nervous System Temple College EMS Professions
- 2. 2 Nervous System Components • Central Nervous System –Brain –Spinal Cord • Peripheral Nervous System –Motor nerves –Sensory nerves
- 3. 3 Brain • Body’s controlling organ • Responsible for organizing functions of other body organ systems
- 4. 4 Brain • Functions localized to specific areas –Cerebrum –Cerebellum –Brainstem
- 5. 5 Cerebrum • Frontal lobe – Foresight, planning, judgment – Movement • Parietal lobe – Sensation from body surface • Temporal lobe – Hearing – Speech • Occipital lobe – Vision Center for conscious perception and response
- 6. 6 Cerebrum Left side of cerebrum Right side of cerebrum Sensory, motor functions of body’s left side Sensory, motor functions of body’s right side
- 7. 7 Cerebellum • Posture • Balance • Equilibrium • Fine motor skills
- 8. 8 Brain Stem • Automatic functions below level of consciousness – Heart rate – Respirations – Blood pressure – Body temperature
- 9. 9 Spinal Cord • Connects brain with body • Serves as center for reflex action • Surrounded, protected by spinal column • Damage cuts brain off from body structures distal to injury site
- 12. 12 Brain/Spinal Cord • Enclosed in protective box –Skin –Muscle –Bone –Meninges
- 13. 13 Meninges • Three layers of tissue enclosing brain, spinal cord – Dura mater – Arachnoid – Pia mater
- 14. 14 Cerebrospinal Fluid (CSF) • Surrounds brain, spinal cord in space between arachnoid and pia mater (subarachnoid space) • Acts as a shock absorber • Protects brain from jolts, shocks
- 15. 15 Injuries to Scalp and Skull • Scalp Lacerations • Skull Fracture
- 16. 16 Scalp Lacerations • VERY vascular area • Can distract EMT from possible underlying injuries • Care for laceration, but ask, “WHAT HAPPENED TO BRAIN AND NECK?”
- 17. 17 Scalp Lacerations • Bleeding usually NOT severe enough to produce hypovolemic shock • If shock present, think about other injuries • Exceptions – Laceration that involves a large artery – Scalp injuries in children. Why?
- 18. 18 Skull Fractures • Injury to rigid box around brain • Indicates significant force • What happened to brain and neck?
- 19. 19 Types of Skull Fracture • Linear – Most common – Crack in skull – Detected only on x-ray • Comminuted – Multiple cracks radiate from impact point
- 20. 20 Types of Skull Fracture • Depressed – Bone fragments pressed inward – Places pressure on brain – Brain tissue may be exposed through injury • Basilar – Fractures in floor of skull – Diagnosis made clinically – Signs and symptoms • Periorbial ecchymosis (Raccoon eyes) • Battle’s sign • CSF drainage from nose, ears
- 21. 21 Skull Fractures DO NOT TRY TO STOP FLOW OF BLOOD, FLUID FROM NOSE OR EARS MAY CAUSE INCREASED INTRACRANIAL PRESSURE AND BRAIN INFECTION
- 23. 23 Concussion • Temporary disturbance in brain function • Probably due to brain being “rattled” inside the skull by a blow to the head • Usually confused or unconscious • Retrograde amnesia--“What happened?” • Effects clear without residual effects
- 24. 24 Cerebral Contusion • Bruising, swelling • Results from brain hitting skull’s inside • Coup-contracoup pattern • Since brain is in closed box, pressure increases as brain swells, blood flow to brain decreases
- 25. 25 Cerebral Contusion • Signs and Symptoms – Personality changes – Loss of consciousness – Paralysis (one-sided or total) – Unequal pupils – Vomiting
- 26. 26 Epidural Hematoma • Usually associated with skull fracture in temporal area • Fracture damages artery on skull’s inside • Blood collects in epidural space between skull and dura mater • Since skull is closed box, intracranial pressure rises
- 27. 27 Epidural Hematoma • Signs and Symptoms – Loss of consciousness followed by return of consciousness (lucid interval) – Headache – Deterioration of consciousness – Dilated pupil on side of injury – Weakness, paralysis on side of body opposite injury – Seizures
- 28. 28 Subdural Hematoma • Usually results from tearing of large veins between dura mater and arachnoid • Blood accumulates more slowly than in epidural hematoma • Signs and symptoms may not develop for days to weeks
- 29. 29 Subdural Hematoma • Signs and Symptoms – Deterioration of consciousness – Dilated pupil on side of injury – Weakness, paralysis on side of body opposite injury – Seizures Because of slow or delayed onset, may be mistaken for stroke
- 30. 30 Cerebral Laceration • Tearing of brain tissue • Can result from penetrating or blunt injury • Can cause: – Massive destruction of brain tissue – Bleeding into cranial cavity with increased intracranial pressure
- 31. 31 Assessment of Head Injury • Early detection of increased intracranial pressure is critical • If pressure inside skull exceeds average blood pressure, blood flow to brain stops • Increasing intracranial pressure can force brain downward into spinal canal, crushing it
- 32. 32 Assessment of Head Injury • Level of consciousness is BEST indicator of patient’s condition – AVPU system – Glasgow scale
- 33. 33 AVPU System • Alert • Responds to Verbal Stimulus • Responds to Painful Stimulus • Unresponsive
- 34. 34 Glasgow Scale • Eye Opening – Spontaneous = 4 – To Voice = 3 – To Pain = 2 – None = 1 • Verbal Response – Oriented = 5 – Confused = 4 – Inappropriate Words = 3 – Incomprehensible Sounds = 1 – None = 1 • Motor Response – Follows Commands = 6 – Localizes Pain = 5 – Withdraws = 4 – Flexion = 3 – Extension = 2 – None = 1 Score each response then total scores Maximum Score = 15 Minimum Score = 3
- 35. 35 Assessment of Head Injury • Vital Signs – Body responds to increasing intracranial pressure by raising BP – Increased BP moves blood into brain against rising ICP – Heart rate falls in response to rising BP
- 36. 36 Cushing’s Triad Increased BP Slow Pulse Altered Breathing
- 37. 37 Vital Signs Isolated head injury does not cause hypotension or tachycardia! Signs of shock in head injured patient indicate other injuries are present!
- 38. 38 Pupils • Diffuse cerebral edema – Dilated – Equal – Sluggish or absent response
- 39. 39 Pupils • Focal lesion (contusion, hematoma) – Unequal – Dilated pupil sluggish or fixed Dilated pupil is on SAME side as injury
- 40. 40 Assessment of Head Injury • Other Indicators of Increased ICP – Headache – Nausea – Vomiting (often projectile) – Seizures
- 41. 41 Management of Head Injury • ABCs with C-spine control • C-collar, long board, CID • Ensure adequate oxygenation • If signs of increased ICP present, controlled hyperventilation with BVM at 20-24 breaths/minute Any patient with significant head injury has neck injury until proven otherwise
- 42. 42 Management of Head Injury • Controlled hyperventilation – Lowers blood carbon dioxide levels – Causes constriction of blood vessels in brain – As vessels constrict brain shrinks – As brain shrinks intracranial pressure drops
- 43. 43 Management of Head Injury • Do NOT apply pressure to open or depressed skull fractures • Do NOT attempt to stop flow of blood or CSF from nose, ears • Do NOT remove penetrating objects
- 45. 45 Significance • Spinal injury can lead to spinal cord injury • Spinal cord injury can lead to: – Paraplegia – Quadraplegia
- 46. 46 Most important spinal injury indicator… MECHANISM
- 47. 47 Common Mechanisms • Compression • Flexion • Extension • Rotation • Lateral bending • Distraction • Penetration
- 48. 48 Suspect spinal injury with... • Sudden decelerations (MVCs, falls) • Compression injuries (diving, falls onto feet/buttocks) • Significant blunt trauma above clavicles • Very violent mechanisms (explosions, cave-ins, lightning strike)
- 49. 49 Significant Head Injury = Neck Injury Until Proven Otherwise
- 50. 50 Other indications • Decreased LOC in trauma patient • Pain in spine or paraspinal area • Pain in back of head, shoulders, arms, legs • Absent, altered sensation (numbness, paresthesias, loss of temperature, position, touch sense) • Absent, altered motor function (weakness, paralysis)
- 51. 51 Other indications • Diaphragmatic breathing (paralysis of chest wall) • Shock with slow heart rate and dry skin • Incontinence • Priapism
- 52. 52 Or, there may be no signs at all. . . • Neurologic deficits are a result of cord injury • Spinal injury without cord involvement may produce no significant signs and symptoms
- 53. 53 Management • ABCs with C-spine control • Ensure adequate oxygenation, ventilation • Keep ENTIRE spine immobilized • Repeatedly assess, document neurologic status: – Position sense – Pain – Motion • Repeatedly monitor respirations, blood pressure
- 54. 54 Spinal Trauma Complications • Respiratory Failure – Chest wall innervated from thoracic spine – Diaphragm innervated from C3,4,5 via phrenic nerve – Cord injury can produce paralysis of respiratory muscles, lead to ventilatory failure
- 55. 55 Spinal Trauma Complications • Neurogenic Shock – Damage to cord produces peripheral vasodilation – Peripheral resistance to blood flow decreases, BP falls – Heart rate remains normal or slows – Skin below level of injury is flushed, dry
- 56. 56 Spinal Trauma Complications • Hypothermia – Damage to cord produces peripheral vasodilation – Peripheral vasodilation causes increased heat loss through skin
- 57. 57 Spinal Trauma Complications • How would you manage: – Ventilatory failure caused by spinal injury? – Hypoperfusion caused by spinal injury? – Hypothermia caused by spinal injury?