INJURIES TO THE HEAD AND SPINE

1. LESSON 19 INJURIES TO THE HEAD AND SPINE

2. Introduction • May be life-threatening or cause permanent damage • Trauma to head, neck, torso may result in serious injury • Injuries without immediate obvious signs and symptoms may involve potentially life-threatening problem • Any head injury may also injure spine

3. Common Mechanisms of Head and Spinal Injuries • Motor vehicle crashes and pedestrian-vehicle collisions • Falls • Diving • Skiing and other sports injuries • Forceful blunt or penetrating trauma to head, neck or torso • Hanging incidents

4. Suspect a Head or Spinal Injury • With any unresponsive trauma patient • When wounds or other injuries suggest large forces involved • Observe patient carefully during the primary assessment

5. Head Injuries

6. Injuries to the Head • May be open or closed • Scalpbleeding may be profuse  can cause shock in infants and young children • Closed injuries may involve swelling or depression at site of skull fracture • Bleeding inside skull may occur with any head injury

7. General Signs and Symptoms of Head Injuries • Lump or deformity in head, neck or back • Changing levels of responsiveness • Difficulty breathing or shallow breathing • Drowsiness • Confusion • Dizziness • Unequal pupils

8. General Signs and Symptoms of Head Injuries (continued) • Headache • Clear fluid from nose or ears • Stiff neck • Inability to move any body part • Tingling, numbness or lack of feeling in feet or hands • Pain or tenderness • Loss of bladder or bowel control

9. Suspect Spinal Injury in Any Trauma Patient with Risk Factors • Patient 65 and older • Child older than 2 with trauma of head or neck • Motor vehicle or bicycle crash involving driver, passenger or pedestrian • Falls from more than the person’s standing height • Patient feels tingling in hands or feet, pain in back or neck, or muscle weakness or lack of feeling in torso or arms

10. Suspect Spinal Injury in Any Trauma Patient with Risk Factors (continued) • Patient is intoxicated or not alert • Any painful injury, particularly of head, neck or back • An unresponsive patient with unknown mechanism of injury

11. Assessing Head and Spinal Injuries • Assessment of patient with head injury should also look for spinal injury • Perform standard assessment • Take great care when moving or repositioning patient  unless necessary, do not move patient • Maintain manual spinal motion restriction

12. Assessing an Unresponsive Patient • If no life-threatening condition, perform limited physical examination for other injuries • Do not move patient unless necessary • Check for serious injuries • Stabilize head and neck in position found

13. Assessing an Unresponsive Patient (continued) • Ask those at scene: • What happened • Patient’s mental status before becoming unresponsive

14. Assessing a Responsive Patient • If nature of injuries suggests potential spinal injury, carefully assess for spinal injury during physical examination • Explain the need to hold the head still • Ask patient not to move more than you ask during the examination • If 2 responders, one should manually stabilize head and neck

15. Assessing a Responsive Patient (continued) • Ask: • Does your neck or back hurt? • What happened? • Where does it hurt? • Can you move your hands and feet? • Can you feel me touching your fingers? • Can you feel me touching your toes?

16. Physical Examination • When checking torso, observe patient for impaired breathing or loss of bladder or bowel control • When assessing extremities, compare strength from one side of the body to the other • Assess both feet and both hands at the same time • Assess all extremities for pulse, movement and feeling

17. Physical Examination (continued) • Don’t assume patient without symptoms has no spinal injury; consider forces involved • When in doubt, keep head immobile while waiting for additional EMS

18. Skill: Assessing Head and Spinal Injuries

19. Check patient’s head

20. Check neck for deformity, swelling and pain

21. Check sensation in feet

22. Ask patient to point toes

23. Ask patient to push against your hands with feet

24. Check sensation in hands

25. Ask patient to make a fist and curl it in

26. Ask patient to squeeze your hands

27. Brain Injuries

28. Brain Injuries • Can occur with blow to head with/without open wound • Brain injury likely with skull fracture • Brain swelling or bleeding may occur

29. Signs and Symptoms of a Brain Injury • Severe or persistent headache • Altered mental status (confusion, unresponsiveness) • Lack of coordination, movement problems

30. Signs and Symptoms of a Brain Injury (continued) • Weakness, numbness, loss of sensation, paralysis • Nausea and vomiting • Seizures • Unequal pupils • Problems with vision or speech • Airway or breathing problems or irregularities

31. Assessing Brain Injury • Signs and symptoms may occur hours or even days after trauma • Do not assume patient with head injury does not have brain injury if signs and symptoms are not immediately apparent

32. Concussion • Brain injury involving temporary impairment • Usually no head wound or signs and symptoms of more serious head injury • Patient may have been “knocked out” but regained consciousness quickly

33. Signs and Symptomsof Concussion • Temporary confusion • Memory loss about event • Brief loss of responsiveness • Mild or moderate altered mental status • Unusual behavior • Headache

34. Medical Evaluation • Concussion patient may recover quickly • Difficult to determine injury severity • More serious signs and symptoms may occur over time • Patients with suspected brain injuries require medical evaluation

35. Emergency Care for Head Injuries • Perform standard patient care • Use the jaw thrust to open airway • Follow local protocol for oxygen • Manually stabilize the head and neck • Don’t let patient move • Closely monitor mental status

36. Emergency Care forHead Injuries (continued) • Control bleeding  but no direct pressure on skull fracture • Dress and bandage open wounds • Monitor vital signs • Expect vomiting • Provide additional care for skull fracture

37. Skull Fracture • Check for possible skull fracture before applying direct pressure to scalp bleeding – direct pressure could push bone fragments into brain • Skull fracture is life-threatening

38. Deformed area Depressed or spongy area Blood or fluid from ears or nose Eyelids swollen shut or becoming discolored (bruising) Signs and Symptoms of Skull Fracture

39. Signs and Symptomsof Skull Fracture (continued) • Bruising under eyes (raccoon eyes) • Bruising behind ears (Battle’s sign) • Unequal pupils • An object impaled in skull

40. Emergency Care for Skull Fractures • Care as for any head and spinal injury • Don’t clean wound, press on it or remove impaled object • Cover wound with sterile dressing

41. Emergency Care forSkull Fractures (continued) • If bleeding, apply pressure only around edges of wound with ring dressing • Do not move patient unnecessarily

42. Spinal Injuries

43. Fracture of neck or back always serious – possible damage to spinal cord Spinal Injuries

44. Effects of nerve damage depend on nature and location of injury Movement of head or neck could make injury worse Spinal Injuries (continued)

45. Emergency Care for Spinal Injuries • Perform standard patient care • Give general care as for any head or spinal injury • Use constant manual spinal motion restriction until patient secured to backboard with head stabilized

46. Emergency Care forSpinal Injuries (continued) • Support head in position found

47. Emergency Care forSpinal Injuries (continued) • Maintain airway and provide needed ventilation without moving head • To position patient for ventilations or CPR, keep head in line with body • Follow local protocol for oxygen

48. Positioning a Spinal Patient • Move patient only if necessary • Roll vomiting patient to one side to drain mouth • Roll face down patient onto back for ventilations or CPR • Use log roll to turn patient • If alone, move vomiting patient into HAINES recovery position

49. Removing a Helmet

50. Removing a Helmet • Remove helmet only to care for life-threatening condition • Remove helmet, following local protocol, only when faceguard prevents giving ventilations • With many helmets, faceguard can be removed or pivoted so helmet is left on for ventilations • For athletic helmets, first unsnap and remove jaw pads