Head neck spine face.r f12

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  • 2/9
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  • Head neck spine face.r f12

    1. 1. THE SPINE
    2. 2. ANATOMY  Bony 7 Cervical Vert  12 Thoracic  5 Lumbar  Atlas  Axis  Spinous Process  Transverse Process  Facets  Body
    3. 3. ANATOMY  Bony 7 Cervical Vert  Atlas  Axis  Spinous Process  Transverse Process  Facets  Body
    4. 4. ANATOMY  Bony 7 Cervical Vert  Atlas  Axis  Spinous Process  Transverse Process  Facets  Body
    5. 5. Anatomy Other – Foreman • Vertebral Foreman • Intervertebral Foreman • Transverse Foreman – Disc • Annulus Fibrosis • Nucleus Propulsus
    6. 6. Anatomy Other – Foreman • Vertebral Foreman • Intervertebral Foreman • Transverse Foreman – Disc • Annulus Fibrosis • Nucleus Propulsus
    7. 7. Anatomy • Other – Foreman • Vertebral Foreman • Intervertebral Foreman • Transverse Foreman – Disc • Annulus Fibrosis • Nucleus Propulsus
    8. 8. Anatomy Other – Foreman • Vertebral Foreman • Intervertebral Foreman • Transverse Foreman – Disc • Annulus Fibrosis • Nucleus Propulsus
    9. 9. Anatomy Other – Foreman • Vertebral Foreman • Intervertebral Foreman • Transverse Foreman – Disc • Annulus Fibrosis • Nucleus Propulsus
    10. 10. Disc
    11. 11. MUSCLES  Splenius Muscle  Trapezius  Sternocleidomastoid  Scalene
    12. 12. BRACHIAL PLEXUS Roots  Trunks  Divisions  Cords  Branches  C5, C6, C7, C8, T1 Upper, Middle, Lower Anterior, Posterior Lateral, Posterior, Medial  Suprascapular  Musculocutaneous  Axillary  Radial  Median  Ulnar
    13. 13. HISTORY  General History Questions  What/how happened?  When?  Location of pain?  Type of pain?  What makes it better/worse? Time of day?  Abnormal sounds/sensations  Did you continue to play?  Rate pain  Previous medical history?  Previous treatments  Medications/Allergies
    14. 14. INSPECTION/OBSERVATION OF THE SPINE  Normal Curvature  Cervical  Thoracic  lumbar Position of the head  Bilateral soft tissue comparison  Level of the shoulders, iliac crests 
    15. 15. SPINE PATHOLOGY Facet Syndrome
    16. 16. PATHOLOGY Cervical Instability
    17. 17. DIVING SPEARING
    18. 18. PATHOLOGY Cervical Fractures
    19. 19. PATHOLOGY Cervical Fractures
    20. 20. PATHOLOGY CERVICAL FRACTURES C4 Fractures and above- likely cause fatality C5 Fractures and belowsurvival rate is higher
    21. 21. CERVICAL STENOSIS
    22. 22. CERVICAL DISC HERNIATION
    23. 23. CERVICAL DISC HERNIATION
    24. 24. CERVICAL DISC RUPTURE
    25. 25. BRACHIAL PLEXUS INJURIES
    26. 26. BRACHIAL PLEXUS INJURIES -Cervical Neuropraxia - stinger or burner -Signs & Symptoms - upper arm paralysis - pain - burning - tingling - can be very transient - can last months
    27. 27. THORACIC OUTLET SYNDROME - Compression of the neuro-vascular structures between the: - scalene - cervical rib - clavicle
    28. 28. LUMBAR SPINE PATHOLOGIES
    29. 29. SPONDYLOLYSIS Fracture of the pars interarticularis of the vertebrae  Most common at L4/5 or L5/S1 
    30. 30. SPONDYLOLYSTHESIS  Fracture of pars interarticularis with associated anterior slippage deformity
    31. 31. Spondylolysis Spondylolisthesis Why does this translated vertebrae not cause significant neurological trauma?
    32. 32. CAUDA EQUINA  Spinal Cord ends at L2, where cauda equina begins.
    33. 33. DISC HERNIATION L4/L5 OR L5/S1 MECH: LIFTING WITH ROTATION, AXIAL LOADING, VALSALVA MANEUVER
    34. 34. Postero-lateral herniation
    35. 35. HEAD INJURIES http://www.youtube.com/watch?v=pyAmP8CowSk&featur
    36. 36. FACTS  Head injuries are the leading cause of death in sports
    37. 37. TYPES OF HEAD INJURIES  MOI  Coup injury Stationary skull being hit by a traveling object  Trauma to the side of the brain that was struck   Contrecoup Moving skull suddenly stopped  Trauma to the side of the brain that was struck as well as the opposite side   Repeated sub-concussive forces Boxing, heading a soccer ball  Cumulative neurological damage   Rotational or shear forces Sudden twisting, acceleration or deceleration force  Cerebral concussion symptoms  Rupture of the vertebral artery 
    38. 38. MILD TRAUMATIC BRAIN INJURY (MTBI)- CONCUSSION Neurological disruption  Temporary Loss of Function  Sx   Headache  Dizziness  Concentration deficits  LOC Heals over time  FUNCTIONAL problem with nerve conduction 
    39. 39. COMPLICATIONS OF CONCUSSIONS  Post-concussion syndrome  Extended duration of cognitive impairments following a concussion Decreased attention span  Impaired memory  Irritability  Headaches  Fatigue  dizziness 
    40. 40. COMPLICATIONS OF CONCUSSIONS CONT.  Second Impact Syndrome  Consequence of returning an athlete to competition too soon following a concussion Second trauma is often a minor blow  Increases cerebral congestion  Loss of autoregulation of brain’s blood supply  vasodilation  Increased intracranial pressure   Rapid onset of symptoms  Following initial concussion symptoms, athlete may collapse into a comatose state  **High morbidity rate**
    41. 41. HEAD TRAUMA  Intracranial hematoma  Rupture of blood vessels supplying the brain  Epidural hematoma Arterial bleeding between the dura mater and the skull  Rapid bleeding and onset of symptoms within hours  Symptoms progress as bleed continues   Subdural hematoma Venous bleeding between brain and dura mater  Slow bleeding and onset of symptoms may not occur for hours, days, weeks  This type of bleed is responsible for most post concussion deaths… WHY? 
    42. 42. SUBDURAL HEMATOMA
    43. 43. ZYGOMATIC (COMPLEX) FRACTURE  Etiology  MOI  = direct blow Signs and Symptoms  Deformity, or bony discrepancy  Nosebleed  Diplopia  Numbness in cheek
    44. 44. FACIAL LACERATIONS MOI: Direct blow  S&S: LOTS of blood 
    45. 45. NASAL INJURIES  Fractures and Chondral separations  MOI: Direct Blow  S&S: Profuse Bleeding, Deformity, Swelling  Care for nosebleed?
    46. 46. FACIAL INJURIES (CONT)  Auricular Hematoma  Cauliflower Ear Orbital Hematoma  Orbital Fracture   Blow-out Fracture  S&S: Diplopia, downward displacement of the eye, inability to look up Corneal Abrasion  Hyphema   Blood in anterior chamber  MAJOR
    47. 47. EVALUATION OF HEAD INJURIES IN CONSCIOUS ATHLETE  An athlete goes down on the field, and you suspect a head/neck injury  Stabilize head  ALWAYS SUSPECT A NECK INJURY WITH A HEAD INJURY!!!  Take a thorough history  Location of symptoms Cervical pain  Head pain   Flexion mechanisms are most likely to cause catastrophic injury (spearing)  In flexed position, the curve is straightened, and the ability for the c-spine to dissipate forces is lost LOC  History of concussion  Complaints of weakness/fatigue 
    48. 48. EVALUATION OF HEAD INJURIES IN CONSCIOUS ATHLETE  Inspection  Do  you remove the helmet in football/hockey? Inspect  Cervical vertebrae  Mastoid process Battle’s sign – swelling/bleeding over mastoid process may indicate a skull fracture  Racoon eyes – skull or nasal fracture  Skull and scalp  Nystagmus   Cyclical eye movement indicates pressure on motor nerves or disruption of inner ear
    49. 49. Battle Sign Raccoon Eyes
    50. 50. EVALUATION OF HEAD INJURIES IN CONSCIOUS ATHLETE  Inspection (cont’d)  Pupil size  PEARL   Racoon eyes   Bruising around orbit may indicate a skull or nasal fracture Nose and ears   Pupils equal and reactive to light  May indicate pressure on cranial N III (oculomotor) Leakage of blood and cerebral spinal flluid General     Vacant Stare Delayed verbal and motor response Inability to focus attention Disorientation   Slurred Speech Heightened emotions
    51. 51. ON FIELD MANAGEMENT OF HEAD AND NECK INJURIES  Equipment considerations  In general, do not remove the helmet during prehospital care when  Athlete is breathing  With the helmet on rescuers can still Access an airway with the facemask removed  Place a cervical collar on  Adequately secure head to spine board  Take x-rays 
    52. 52. ON FIELD MANAGEMENT OF HEAD AND NECK INJURIES  Equipment considerations (cont’d)  When do you remove the helmet and shoulder pads? Improperly fitting helmet  Unable to remove facemask  Unable to access airway   Considerations Defibrillation  intubation 
    53. 53. EVALUATION OF HEAD/NECK INJURIES IN UNCONSCIOUS ATHLETE Airway  Breathing  Log roll into supine position  Remove facemask  Jaw thrust maneuver to open airway  Rescue breathing/CPR  http://www.csmfoundation.org/Educational_Materials.html
    54. 54. RETURN TO PLAY CRITERIA  Complete resolution of  Neurological symptoms  Motor weakness  Paresthesia  Numbness  Cognitive function  Standardized Testing

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