Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

CHAPTER 29

Injuries to the Head and Spine

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Anatomy ReviewAnatomy Review

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NervousNervousSystemSystem

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Skull and Facial Bones

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Contentsof the Skull

BoneDura materArachnoidPia mater

Subarachnoid spaceSubdural space

Intracerebral

Epidural space (potential)

Dura materArachnoid

Skull

Pia mater

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Spinal ColumnSpinal Column

Division Corresponding AnatomyNumber of Vertebrae

Cervical Neck 7

Thoracic Thorax, ribs, upper back 12

Lumbar Lower back 5

Sacral Back wall of pelvis 5

Coccyx Tailbone 4

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Head InjuriesHead Injuries

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Head Injuries – Overview

Scalp injuries may bleed profusely.

Injuries to the skull may cause damage to the brain and may have an open or closed wound.

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May occur due to clot or hemorrhage

Can cause altered mental status

Signs and symptoms similar to traumatic injury (but no trauma)

Brain Injury – Nontraumatic

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Signs & Symptoms ofHead Injuries

Altered or decreased mental status

Irregular breathing patterns

Mechanism of injury present

Continued…

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Contusion, laceration, hematoma, or deformity to the skull

Blood/fluid from ears or nose

Bruising around eyes, behind ears

Continued…

Signs & Symptoms ofHead Injuries

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Neurologic changes

Nausea and/or vomiting

Unequal pupil size

Decreased heart rate and increased blood pressure

Seizures

Signs & Symptoms ofHead Injuries

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Emergency Care ofHead Injuries

BSI.

Maintain C-spine stabilization.

Assess and treat ABCs.

Perform initial assessment.

Administer high-concentration oxygen.

Continued…

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Complete assessment.

Immobilize spine with cervical collar.

Monitor airway, breathing, pulse, mental status closely.

Continued…

Emergency Care ofHead Injuries

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Control bleeding.

Do not apply pressure to open or depressed skull injury.

Transport immediately.

Reassess vital signs every 5 min.

Emergency Care ofHead Injuries

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Spinal InjurySpinal Injury

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Mechanisms of Spinal Injury

Motor vehicle crashes

Auto-pedestrian collisions

Falls (especially 3+ times patient’s height)

Blunt or penetrating trauma

Continued…

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Motorcycle crashes

Hangings

Diving accidents

Unconscious trauma patients

Continued…

Mechanisms of Spinal Injury

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Mechanisms ofMechanisms ofSpinal InjurySpinal Injury

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WhiplashWhiplash

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Types of Spinal Injuries

Compression

Distraction (pulling apart)

Lateral bending

Flexion, rotation, extension

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Signs & Symptoms of Spinal Injuries

Paralysis of the extremities

Pain with or without movement

Tenderness along the spine

Continued…

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Loss of sensation

Impaired breathing

“C–3, –4, –5 keep the diaphragm alive”

Continued…

Signs & Symptoms of Spinal Injuries

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Deformity along spine (rare)

Posturing

Priapism

Incontinence

Signs & Symptoms of Spinal Injuries

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Assessing Spinal Injury

Questions to ask:

What happened?

Where does it hurt?

Does your neck or back hurt?

Continued…

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Questions to ask:

Can you move your hands and feet?

Can you feel me touching your fingers? Toes?

Assessing Spinal Injury

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Assess sensation in all extremities.Assess sensation in all extremities.

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Assess motor function.Assess motor function.

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Assess strength Assess strength –– feet. feet.

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Assess strength Assess strength –– hands. hands.

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Treating Spinal Injury

Take BSI precautions.

Instruct the patient not to move.

Stabilize cervical spine & ABCs.

Evaluate mechanism of injury.

Evaluate hand grip and foot strength.

Continued…

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Assess pulse, movement, and sensation in extremities.

Assess the neck and spine.

Administer high-concentration oxygen.

Continued…

Treating Spinal Injury

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Apply properly sized cervical spine immobilization device.

Apply and secure patient to appropriate immobilization device.

Continued…

Treating Spinal Injury

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If proper size collar is not available, use rolled towel and tape.

Pad around child as necessary to maintain stabilization.

Treating Spinal Injury

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SpinalSpinalImmobilizationImmobilization

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Applying aCervical SpineImmobilization

Device

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Stabilize and measure.Stabilize and measure.

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Choose correct collar size.Choose correct collar size.

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Prepare collar.Prepare collar.

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Slide collar under chin.Slide collar under chin.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Secure collar; maintain in-line position.Secure collar; maintain in-line position.

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Use of ShortSpine Boards:Seated Patient

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Short Spine Boards

Vest type

Rigid short spine board

Stabilize head, neck, torso

Used for noncritical, seated patient

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Select immobilization device.Select immobilization device.

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Manually stabilize patient’s head in Manually stabilize patient’s head in neutral, in-line position.neutral, in-line position.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Assess distal pulse, motor function, and Assess distal pulse, motor function, and sensation (PMS).sensation (PMS).

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Apply the appropriately sized extrication Apply the appropriately sized extrication collar.collar.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Position the device behind patient.Position the device behind patient.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Secure device to patient’s torso.Secure device to patient’s torso.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Evaluate and pad behind patient’s head Evaluate and pad behind patient’s head as necessary. Secure patient’s head to as necessary. Secure patient’s head to device.device.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Evaluate and adjust straps. As needed, Evaluate and adjust straps. As needed, secure patient’s wrists and legs.secure patient’s wrists and legs.

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Use of LongSpine Boards:Supine Patient

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Long Spine Boards

Stabilize head, neck, torso, pelvis, and extremities.

May be applied in:

Lying, standing, and sitting positions

Conjunction with short spine boards

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Maintain stabilization; apply collar.Maintain stabilization; apply collar.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Prepare and position device.Prepare and position device.

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Move patient onto board. Apply padding Move patient onto board. Apply padding to voids.to voids.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Secure the body, then the patient’s head.Secure the body, then the patient’s head.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Reassess PMS.Reassess PMS.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Use of LongSpine Boards:

Standing Patient

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Maintain stabilization; apply collar.Maintain stabilization; apply collar.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Position boardPosition boardand EMTand EMT––Bs.Bs.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Grasp the boardGrasp the boardafter reaching after reaching under the patient’sunder the patient’sshoulders.shoulders.

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Carefully Carefully lower patient; lower patient; then secure then secure the board.the board.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Rapid ExtricationRapid Extrication

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Unsafe scene

Unstable patient condition

Patient blocks EMT–B’s access to an unstable patient

Indications

Rapid Extrication

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Manually stabilize; apply collar.Manually stabilize; apply collar.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

After putting end of board next to patient, After putting end of board next to patient, position hands on legs/pelvis and position hands on legs/pelvis and chest/arms.chest/arms.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Rotate patient and reposition hands.Rotate patient and reposition hands.

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Lower patient to board.Lower patient to board.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Move patient into position on board.Move patient into position on board.

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Secure patient and transport.Secure patient and transport.

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Helmet RemovalHelmet Removal

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Indications to Leave Helmet in Place

Good fit, little movement

No current or expected airway problems

Removal would cause further injury

Continued…

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Proper immobilization is able to be performed

No airway or breathing concerns

Continued…

Indications to Leave Helmet in Place

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Inability to assess or treat airway and breathing

Improper fit/movement within helmet

Continued…

Indications for Removing Helmet

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Inability to immobilize spine

Cardiac arrest

Indications for Removing Helmet

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Stabilize head and helmet. Fingers Stabilize head and helmet. Fingers should be on patient’s mandible.should be on patient’s mandible.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Second EMTSecond EMT––B loosens strap.B loosens strap.

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Transfer stabilization to second EMTTransfer stabilization to second EMT––B.B.

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Carefully remove the helmet.Carefully remove the helmet.

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Prevent head from falling once helmet Prevent head from falling once helmet is removed.is removed.

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Begin routine stabilization and Begin routine stabilization and immobilization.immobilization.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

1. List the functions of the components of the nervous system.

2. What are some mechanisms of injury that could cause spinal injury?

Review Questions

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

3. List the signs and symptoms of a spinal injury.

4. What questions should you ask if you suspect a patient has a spinal injury?

Review Questions

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

5. Describe the emergency care steps for a patient with a spinal injury.

6. Explain when you would use a short spine board. A long spine board.

Review Questions

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

7. What are the indications for rapid extrication?

8. What are the indications for leaving a helmet in place? For removing a helmet?

Review Questions

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

9. List the signs and symptoms of

a head injury.

10. Describe the emergency care steps for a patient with a possible head injury.

Review Questions

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

What is your general impression of this patient?

What immediate treatment should be provided?

STREET SCENESSTREET SCENES

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How should you monitor changing levels of responsiveness in a patient with a head injury?

STREET SCENESSTREET SCENES

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Sample DocumentationSample Documentation