Central nervoussystem lesson3


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Central nervoussystem lesson3

  1. 1. Emergency Services, LLC / Copyright 20131TREATING BRAIN INJURIES (continued from Lesson 2)• Specific management– Secure Airway and provide good oxygenation.Secure Airway and provide good oxygenation.• If GCS is less than eight, intubate.If GCS is less than eight, intubate.– Spinal immobilization (collar, padded head-immobilizationSpinal immobilization (collar, padded head-immobilizationdevice)device)– Record baseline vitals and Glasgow Coma Score.Record baseline vitals and Glasgow Coma Score.– Two large-bore I.V. catheters (en-route)Two large-bore I.V. catheters (en-route)– Rapid transport to facility able to deal with critical head-injured patients• Remember the Golden Hour!Hands-On:Central Nervous System Training, Lesson 3
  2. 2. Emergency Services, LLC / Copyright 20132TYPES OF SPINAL TRAUMA• Hyperextension/Hyperflexion– Excessive posterior or anterior movement of the head.Examples are:• Face into windshield in MVA• Elderly person falling to floor• Football tackle• Dive into shallow water• Rider thrown from horse or motorcycle.Hands-On:Central Nervous System Training, Lesson 3
  3. 3. Emergency Services, LLC / Copyright 20133TYPES OF SPINAL TRAUMA• Compression– The weight of the head or pelvis is driven into stationaryneck or torso. Examples are:• Dive into shallow water• Fall of greater than 10-20 feet onto head or legs.Hands-On:Central Nervous System Training, Lesson 3
  4. 4. Emergency Services, LLC / Copyright 20134TYPES OF SPINAL TRAUMA• Rotation– Excessive rotation of the torso or head and neck, movingone side of the spinal column against the other.Examples are:• Rollover MVC• Motorcycle accident• Sports injuriesHands-On:Central Nervous System Training, Lesson 3
  5. 5. Emergency Services, LLC / Copyright 20135TYPES OF SPINAL TRAUMA• Lateral Stress– Direct lateral force on the spinal column, typicallyshearing one level of the cord from another. Examplesare:• “T-Bone” type MVC• FallsHands-On:Central Nervous System Training, Lesson 3
  6. 6. Emergency Services, LLC / Copyright 20136TYPES OF SPINAL TRAUMA• Distraction– Excessive stretching of the column and cord.Examples are:• Hanging• Child wearing seatbelt inappropriately• Snowmobile or motorcycle under rope or wireHands-On:Central Nervous System Training, Lesson 3
  7. 7. Emergency Services, LLC / Copyright 20137TYPES OF SPINAL TRAUMA• Mechanism of Injury– How important is mechanism of injury in predictingpatient injuries? Very important to the Paramedic/EMT!– The accident will determine the mechanism of injurywhich may suggest the type of injury which in turn maydetermine early patient treatment and handling.Hands-On:Central Nervous System Training, Lesson 3
  8. 8. Emergency Services, LLC / Copyright 20138TYPES OF ACCIDENTS• What type of CNS injuries would you expect inthese examples?Accident: Head-OnInjuries: Hyperextension/hyperflexion,CompressionAccident: T-BoneInjuries: Lateral StressHands-On:Central Nervous System Training, Lesson 3
  9. 9. Emergency Services, LLC / Copyright 20139TYPES OF ACCIDENTSAccident: T-Bone, RolloverInjuries: Lateral Stress, RotationAccident: RolloverInjuries: Rotation– Depending upon the severity and duration of a motor vehicle crash,you might have multiples or combinations of these injuries.Hands-On:Central Nervous System Training, Lesson 3
  10. 10. Emergency Services, LLC / Copyright 201310SPINAL INJURIES• Signs and Symptoms– Mechanism of injury– Pain in neck or back– Neurological signs• Numbness• Tingling• Loss of motor function– Shock– Respiratory distressHands-On:Central Nervous System Training, Lesson 3
  11. 11. Emergency Services, LLC / Copyright 201311SPINAL INJURIES• Treatment for spinal injuries– Most treatment in the pre-hospital setting involvesprevention of further injury, not remedying the currentinjury.• Types of immobilization devices– KED– Long spine board– Short spine board– Vacuum splint (may fail in cold weather!)Hands-On:Central Nervous System Training, Lesson 3
  12. 12. Emergency Services, LLC / Copyright 201312SPINAL INJURIES• Specific TreatmentMost people who sustain a spinal injury have otherinjuries as well!– Remember ABC’s– Oxygen– IV therapy– Immobilization– Medication considerationsHands-On:Central Nervous System Training, Lesson 3
  13. 13. Emergency Services, LLC / Copyright 201313SPINAL INJURIES• Protocols: Will a Spinal Immobilization Rule-Outprotocol be in our future?– Some departments now have the ability not to board apatient if it appears that the patient has no spinal injury orfracture.– Some patients who feel they don’t want to be immobilized,because they feel constrained, claustrophobic, orwhatever, do not have their wishes honored by protocolsthat say all accident patients, even if a spinal injury is not inevidence, must be boarded. Sometimes an internal injurymight be aggravated by immobilization.Hands-On:Central Nervous System Training, Lesson 3
  14. 14. Emergency Services, LLC / Copyright 201314SPINAL INJURIES• Protocols: Will a Spinal Immobilization Rule-Outprotocol be in our future?– Most EMS departments use protocols to protect them fromliability, even if these protocols are not truly sensitive to thewishes of the patient.Hands-On:Central Nervous System Training, Lesson 3