30: Head and Spine Injuries
Cognitive Objectives
(1 of 5)
5-4.1
State the components of the nervous system.
5-4.2
List the functions of the central nervous system.
5-4.3
Define the structure of the skeletal system as it
relates to the nervous system.
5-4.4
Relate mechanism of injury to potential injuries of
the head and spine.
5-4.5
Describe the implications of not properly caring
for potential spine injuries.
5-4.6
State the signs and symptoms of a potential
spine injury.
Cognitive Objectives
(2 of 5)
5-4.7
Describe the method of determining if a
responsive patient may have a spine injury.
5-4.8
Relate the airway emergency medical care
techniques to the patient with a suspected spine
injury.
5-4.9
Describe how to stabilize the cervical spine.
5-4.10 Discuss indications for sizing and using a
cervical spine immobilization device.
5-4.11 Establish the relationship between airway
management and the patient with head and
spine injuries.
Cognitive Objectives
(3 of 5)
5-4.12
Describe a method for sizing a cervical spine
immobilization device.
5-4.13
Describe how to log roll a patient with a
suspected spine injury.
5-4.14
Describe how to secure a patient to a long
spine board.
5-4.15
List instances when a short spine board should
be used.
5-4.16
Describe how to immobilize a patient using a
short spine board.
Cognitive Objectives
(4 of 5)
5-4.17
Describe the indications for the use of rapid
extrication.
5-4.18
List the steps in performing rapid extrication.
5-4.19
State the circumstance when a helmet should
be left on the patient.
5-4.20
Discuss the circumstances when a helmet
should be removed.
5-4.21
Identify different types of helmets.
5-4.22
Describe the unique characteristics of sports
helmets.
Cognitive Objectives
(5 of 5)
5-4.23
Explain the preferred methods to remove a
helmet.
5-4.24
Discuss alternative methods for removal of a
helmet.
5-4.25
Describe how the patient’s head is stabilized to
remove the helmet.
5-4.26
Differentiate how the head is stabilized with a
helmet compared to without a helmet.
Affective Objectives
(1 of 2)
5-4.27
Explain the rationale for immobilization of the
entire spine when a cervical spine injury is
suspected.
5-4.28
Explain the rationale for utilizing immobilization
methods apart from the straps on the cots.
5-4.29
Explain the rationale for utilizing a short spine
immobilization device when moving a patient
from the sitting to the supine position.
Affective Objectives
(2 of 2)
5-4.30
Explain the rationale for utilizing rapid
extrication approaches only when they indeed
will make the difference between life and death.
5-4.31
Defend the reasons for leaving a helmet in
place for transport of a patient.
5-4.32
Defend the reasons for removal of a helmet
prior to transport of a patient.
Psychomotor Objectives
(1 of 3)
5-4.33
Demonstrate opening the airway in a patient
with a suspected spinal cord injury.
5-4.34
Demonstrate evaluating a responsive patient
with a suspected spinal cord injury.
5-4.35
Demonstrate stabilization of the cervical spine.
5-4.36
Demonstrate the four-person log roll for a
patient with a suspected spinal cord injury.
5-4.37
Demonstrate how to log roll a patient with a
suspected spinal cord injury using two people.
Psychomotor Objectives
(2 of 3)
5-4.38
Demonstrate securing a patient to a long spine
board.
5-4.39
Demonstrate using the short board
immobilization technique.
5-4.40
Demonstrate the procedure for rapid extrication.
5-4.41
Demonstrate preferred methods for stabilization
of a helmet.
5-4.42
Demonstrate helmet removal techniques.
Psychomotor Objectives
(3 of 3)
5-4.43
Demonstrate alternative methods for
stabilization of a helmet.
5-4.44
Demonstrate completing a prehospital care
report for patients with head and spinal injuries.
Anatomy and Physiology
of the Nervous System
Central Nervous System
Sensory and Connecting Nerves
• The connecting nerves in the spinal cord form a reflex
arc.
• If a sensory nerve in this arc detects an irritating
stimulus, it will bypass the brain and send a direct
message to a motor nerve.
How the Nervous System Works
• The nervous system controls virtually all of our
body activities including reflex, voluntary and
involuntary activities
• Voluntary activities are action that we consciously
perform (ie, passing a dish)
• Involuntary activities are actions that are not under
our control (ie, body functions)
• Body functions are controlled by the autonomic
nervous system
Autonomic Nervous System
• Two components
• Sympathetic nervous system
– Reacts to stress with a flight or fright response.
– Some common responses are dilated pupils,
increased pulse rate, or rising BP.
• Parasympathetic nervous system
– Causes the opposite effect of the sympathetic
nervous system
Spinal Column
Anatomy and Physiology
of the Skeletal System
•
•
•
•
Two layers of bone protect the brain.
Skull is divided into cranium and face.
Injury to the vertebrae can cause paralysis.
Vertebrae are connected by intervertebral disks.
Head Injuries
• Scalp lacerations
• Skull fractures
• Brain injuries
• Medical conditions
• Complications of head injuries
Scalp Lacerations
• Scalp has a rich blood supply.
• There may be more serious, deeper injuries.
Skull Fracture
• Indicates significant force
• Signs
– Obvious deformity
– Visible crack in the skull
– Raccoon eyes
– Battle’s sign
Concussion (1 of 2)
• Brain injury
• Temporary loss or alteration in
brain function
• May result in
unconsciousness, confusion,
or amnesia
Concussion (2 of 2)
• Brain can sustain bruise when
skull is struck.
• There will be bleeding and
swelling.
• Bleeding will increase the
pressure within the skull.
Intracranial Bleeding
• Laceration or rupture
of blood vessel in brain
– Subdural
– Intracerebral
– Epidural
Other Brain Injuries
• Brain injuries are not always caused by
trauma.
• Medical conditions may cause spontaneous
bleeding in the brain.
• Signs and symptoms of nontraumatic injuries
are the same as those of traumatic injuries.
– There is no mechanism of injury.
Complications of Head Injury
•
•
•
•
Cerebral edema
Convulsions and seizures
Vomiting
Leakage of cerebrospinal fluid
Signs and Symptoms (1 of 3)
• Lacerations, contusions, hematomas to scalp
• Soft areas or depression upon palpation
• Visible skull fractures or deformities
• Ecchymosis around eyes and behind the ear
• Clear or pink CSF leakage
Signs and Symptoms (2 of 3)
• Failure of pupils to respond to light
• Unequal pupils
• Loss of sensation and/or motor function
• Period of unconsciousness
• Amnesia
• Seizures
Signs and Symptoms (3 of 3)
•
•
•
•
•
•
Numbness or tingling in the extremities
Irregular respirations
Dizziness
Visual complaints
Combative or abnormal behavior
Nausea or vomiting
Spine Injuries
• Compression injuries occur from a fall.
• Motor vehicle crashes or other types of trauma can
overextend, flex, or rotate the spine.
• Distraction: When spine is pulled along its length;
causes injuries.
– Hangings are an example.
Significant Mechanisms of Injury
•
•
•
•
•
•
•
•
Motor vehicle crashes
Pedestrian-motor vehicle collisions
Falls
Blunt or penetrating trauma
Motorcycle crashes
Hangings
Driving accidents
Recreational accidents
• Your unit is on standby at the All American College
during a gymnastic tournament.
• A bystander comes to you and states a 19-year-old
female gymnast has fallen head first from a
balance beam.
• You find the patient prone on a rubber mat awake
and breathing normal. No threats to life are
observed.
You are the provider
• What is the mechanism of injury?
• What injuries do you suspect?
• What is the next step in the assessment process?
You are the provider
continued
Scene Size-up
•
•
•
•
Observe scene for hazards; take BSI precautions.
Anticipate problems with ABCs.
Pay attention for changes in level of consciousness.
Call for ALS backup as soon as possible when
serious MOI is present.
• Look for a deformed helmet or deformed
windshield.
• You manually stabilize the spine and log roll the
patient.
• You assess the ABCs and place the patient on
oxygen via nonrebreathing mask.
• She said she felt pain in her neck right away and
has tingling in her arms and legs. You begin a rapid
trauma assessment.
You are the provider continued (1
of 2)
• Why did you do a rapid trauma assessment?
• What steps comes next?
You are the provider
continued (2 of 2)
Initial Assessment
• Ask the patient:
– What happened?
– Where does it hurt?
– Does your neck or back hurt?
– Can you move your hands and feet?
– Did you hit your head?
• Confused or slurred speech, repetitive questioning,
or amnesia indicate head injury.
• Ask when patient lost consciousness.
• Stabilize the spine.
ABCs
• Use jaw-thrust maneuver to open airway.
• Vomiting may occur. Suction immediately.
• Move patient as little as possible. Do not remove
c-collar.
• Consider providing positive pressure ventilations.
• A pulse that is too slow can indicate a serious
condition.
• Assess and treat for shock.
Transport Decision
• If patient has problems with ABCs, provide rapid
transport.
• You check for an absence of a distal pulse. Pulse
is normal. Bleeding is not noted.
• You determine that this patient is a low-priority
transport.
You are the provider continued (1 of 3)
• What do you need to be sure to ask during the
SAMPLE history?
• Describe the rest of your emergency care.
You are the provider continued (2 of 3)
• You quickly inspect and palpate the chest for
DCAP-BTLS. This was unremarkable.
• You start the patient on high-flow oxygen.
• You apply a cervical collar and immobilize her to a
long board.
• The patient could vomit. Be ready to reposition the
long board and suction.
You are the provider continued (3 of 3)
Focused History and Physical Exam
• The absence of pain does not rule out a potential
spinal injury.
• Do not ask patients with possible spinal injuries to
move their neck.
Rapid Physical Exam for
Significant Trauma (1 of 2)
• Quickly use DCAP-BTLS.
• Decreased level of consciousness is the most
reliable sign of head injury.
• Expect irregular respirations.
• Look for blood or CSF leaking from ears, nose, or
mouth.
Rapid Physical Exam for
Significant Trauma (2 of 2)
• Look for bruising around eyes, behind ears.
• Evaluate pupils.
• Do not probe scalp lacerations. Do not remove an
impaled object.
Focused Physical Exam
for Nonsignificant Trauma
• Watch for change in level of
consciousness.
• Use Glasgow Coma Scale.
• Pain, tenderness, weakness,
numbness, and tingling are
signs of spinal injury.
• May lose sensation or become
paralyzed
• May become incontinent
Baseline Vital Signs/
SAMPLE History
• Complete set of baseline vital signs is essential.
• Assess pupil size and reactivity to light; continue
to monitor.
• Gather as much history as possible while
preparing for transport.
Interventions (1 of 2)
• Control bleeding.
• Fold torn skin flaps back
down onto the skin bed.
• Do not apply excessive
pressure.
• If dressing becomes
soaked, place a second
dressing over it.
Interventions (2 of 2)
• Once bleeding has been controlled, secure with a
soft self-adhering roller bandage.
• Monitor and treat for shock.
• Protect airway from vomiting.
• Provide immediate transport.
Detailed Physical Exam
• Perform if time permits.
• Can help identify subtle or covert injuries
Ongoing Assessment
• Focus on reassessing ABCs, interventions, vital signs.
• Communication and documentation
– Hospital may prepare better with info from your
assessment.
– Document changes in level of consciousness.
– Include history.
– Document vital signs every 5 minutes if unstable,
every 15 minutes if stable.
Emergency Medical Care
of Spinal Injuries
• Follow BSI precautions.
• Manage the airway.
– Perform the jaw-thrust maneuver to open the
airway.
– Consider inserting an oropharyngeal airway.
– Administer oxygen.
• Stabilize the cervical spine.
Stabilization of the Cervical Spine (1 of 3)
• Hold head firmly with
both hands.
• Support the lower jaw.
• Move to eyes-forward
position.
Stabilization of the Cervical Spine (2 of 3)
• Support head while
partner places cervical
collar.
• Maintain the position
until patient is secured
to a backboard.
Stabilization of the Cervical Spine (3 of 3)
• Do not force the head into a neutral,
in-line position if:
– Muscles spasm
– Pain increases
– Numbness, tingling, or weakness
develop
– There is a compromised airway or
breathing problems.
Emergency Medical Care
of Head Injuries
• Establish an adequate airway.
• Control bleeding and provide adequate
circulation.
• Assess the patient’s baseline level of
consciousness.