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TRAUMATIC HEAD AND SPINAL
CORD INJURY

MR.JERRY JAMES
NURSING EDUCATOR
INSTITUTE OF HEALTH ANDMANAGEMENT
MECHANISM OF INJURY
Deformation

Acceleration-deceleration
Rotation
CLASSIFICATION OF HEAD INJURY
1.DIRECT HEAD INJURY
2. INDIRECT HEAD INJURY
OPEN HEAD INJURY
CLOSED HEAD INJURY
COUP AND COUNTERCOUP INJURY
CLASSIFICATION BASED ON THE LOCATION
1.SCALP INJURY
 ABRASIONS

 CONTUSIONS
 LACERATION
2.SKULL FRACTURE
a. Linear fracture
b. Depressed skull fracture
c. Diastatic

skull fracture
d. Basilar skull fracture
e. Cranial burst skull fracture
f. Compound skull fractures
2. MENINGEAL INJURIES
3.CEREBRAL INJURIES
1.CONCUSSION
Typical signs.
• Altered level of consciousness
• Amnesia
• headache
2.CONTUSION
Typical signs

• Hemorrhage
• Infarction
• Necrosis
• Edema
• Seizure
• Increased I.C.P
SPINAL CORD INJURY
CLASSIFICATION OF SPINAL CORD
INJURY
1. Hyper flexion
2. Hyperextension
3. Compression injury
4.Rotational injuries
5.Penetrating injury
CLASSIFICATION BY DEGREE OF INJURY
• COMPLETE INJURY
• INCOMPLETE INJURY
INCOMPLETE INJURY
1.Central cord syndrome
• Motor deficits in the upper extremities
• Less impairment in leg movements
• Sensory loss below the site of injury
• Loss of bladder control may occur
2. Anterior cord syndrome
Loss of perception of pain, temperature and motor
function is noted below the level of the lesion
3. Brown sequard syndrome
4. Conus medullaris and Cauda equina syndrome
• Lower extremity dysfunction
• Loss of bladder and anal sphincter

• function
• Male sexual dysfunction
• Loss of achilles reflex
ETIOLOGICAL FACTORS
Road traffic accident
Fall from higher place

Athletic accidents
Blast injuries
Anti coagulant and anti platelet medications

Occupational accidents
penetration
PATHOPHYSIOLIOGY OF BRAIN TRAUMA
Brain suffers traumatic injury
Brain swelling or bleeding increase intra cranial volume

Intra cranial pressure increases
Pressure on blood vessels with in the brain increases

Decreased blood flow to the brain
Cerebral hypoxia and ischemia occur
Herniation of the brain
Brain death
PATHOPHYSIOLOGY OF SPINAL CORD INJURY
Hemorrhage

RBC and platelet

break down of RBC

Aggregation
Free radical formation
Release of nor epinephrine

Serotonine,dopamine

Vasoconstriction
Thrombosis formation

SC blood flow

secondary injury

spinal edema, tissue hypoxi a
CLINICAL MANIFESTATIONS
HEAD TRAUMA
 Altered level of consciousness
 Confusion
 Pupillary abnormalities
 Altered or absent gag and corneal reflex
 Sudden onset of neurological onset
 Changes in vital signs
 Spasticity
 Vertigo
 Seizures

 Ottorhoea
 Rhinorrhoea
 Slurred speech
SPINAL CORD INJURY

Spinal shock and neurogenic shock
Respiratory distress
Bradycardia

Poikilothermism
Low blood pressure
Loss of bowel or bladder control

Loss of sensation, including the ability to feel heat, cold
and touch
Difficulty with balance and walking

Loss of movement
Spinal edema
CERVICAL INJURIES
C-1/C-2 levels will often result in loss of breathing
C3 vertebrae and above : Typically results in loss of
diaphragm function

C4 : Results in significant loss of function at the biceps and
shoulders.
C5 : Results in potential loss of function at the biceps and
shoulders, and complete loss of function at the wrists and
hands.
C6 : Results in limited wrist control, and complete loss of
hand function
C7 and T1 : Results in lack of dexterity in the hands and
fingers, but allows for limited use of arms
THORACIC INJURIES
T1 to T8 : Results in the inability to control the abdominal
muscles
T9 to T12 : Results in partial loss of trunk and abdominal
muscle control.
LUMBOSACRAL INJURIES
Dysfunction of the bowel and bladder

Sexual dysfunction
DIAGNOSTIC FINDINGS
Hisory collection
Physical examination

Neurological examination
Ct and m.R.I
Pet scan

Nerve conduction studies
Transcranial doppler studies
X ray

Blood investigation
‘ASIA’ SCALE
AMERICAN SPINAL INJURY ASSOCIATION SCALE
A. Complete

Complete loss of sensory and motor function

b. incomplete

Sensory function is preserved but no motor function

c. incomplete

Motor function is preserved and muscle grade more
than 3

d. incomplete

Motor function is preserved and muscle grade more
than 3

e. normal

Motor and sensory function are normal
MANAGEMENT
2/2/2 rule
1. Patient die in 2 mins from airway and breathing
compromise and hypovolemic shock
2. Patient die in 2 hrs from hypovolemic shock
3. Patient die in 2 weeks from septic shock
MANGEMENT
Management of trauma patient can be divided in to
2 phase
• Primary phase
• Secondary phase
PRIMARY SURVEY
A - AIRWAY
B- BREATHING’
C- CIRCULATION
D- DISABILITY

E- EXPOSURE
AIRWAY
Assessment
 Can the patient talk
 Is the patient voice normal
 Stridor
 Foreign body
 Bleeding and secretions
 Mandibular or laryngeal fracture
INTERVENTIONS
1. Cervical spine stabilization
2. Sedation

3. Jaw thrust
4. Suction
5. Pulse oximetry

6. Oxygen administration
7. Endotracheal intubation
8. Arterial blood gas analysis
BREATHING
Assessment:

LOOK the movement of the chest
Respiratory rate
Flail chest

Cyanosis
Foreign object
INTERVENTIONS
• Oxygen administration
• Endotracheal intubation
• Arterial blood gas analysis
• Mechanical ventilation
• Inter costal drainage
CIRCULATION
SHOCK
Clinical findings
• Hypotension
• Tachycardia or bradycardia

• Tachypnea
CIRCULATION
ASSESSMENT
• External hemorrhage
• Penetrating trauma
• Blunt trauma
• Head injury
• hypotension
INTERVENTIONS
Intravenous fluids

Massive transfusion
Direct manual pressure
Hyperventilation

Mannitol
Anticonvulsants
positions
DISABILITY
Life threatening disability
• Spinal cord transection
• Intracerebral or intracranial hemorrhage
• Cerebro vascular injury
INTERVENTIONS
• Mobilization
• Neurological assessment
• Glasgow coma scale
DISABILITY ASSESSMENT
‘AVPU’ ASSESSMENT
A- AWAKE
V-VERBAL RESPONSE
P-PAINFUL RESPONSE

U-UNRESPONSIVE
EXPOSURE
Undress the patient and look for injury
Immobilization
Cover the patient with warm blanket
IV fluids
Patient privacy
LIFTING AND HANDLING THE PATIENT
LOG ROLLING
SECONDARY SURVEY
Step 1.
‘SAMPLE HISTORY’
S- signs and symptoms
A- allergies

M- medication currently used
P- past illness
L- last meal
E- events/ environment related injury
NURSING MANAGEMENT
Monitoring for neurological function
Maintaining the airway
Monitoring fluid and electrolyte balance
Promoting adequate nutrition
Preventing injury
Maintaining body temperature
Maintain skin integrity
• Drug management
Methylprednisolone (Medrol)
Atropine and dopamine
Anti coagulants
Sedatives
Analgesics
Osmotic diuretics
Deep vein thrombosis prophylaxis
I.V fluids
SURGICAL MANAGEMENT
• Craniotomy or craniectomy
• Decompression laminectomy
NON SURGICAL MANAGEMENT

• The halo and vest system
• Cervical traction
Traumatic head  and spinal cord injury
Traumatic head  and spinal cord injury

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