SPM 100 Skills Lab 4 Notes:
C-spine Immobilization, Hemorrhage Control and
Splinting Extremities
Brain Injuries
Direct Injuries: open head, lacerated, punctured or broken bones or foreign object (impaled).
Indirect Injuries: either closed or open; shock impact to the brain transferred from the skull.
(concussions and contusions) (epidural/sbudoural hematomas)
Signs of Brain injuries and skull fractures:
Visible bone fragments
Irregular breathing pattern
Altered mental Status
Temperature increase
Deep laceration or Bruising
Blurred or multiple-image vision
Any severe pain
Impaired hearing / Equilibrium problems
“Battle’s signs” (bruising behind ears)
Forceful or Projectile vomiting - repeated
Pupils unequal or non-reactive
Posturing*
“Raccoon eyes” (Bilateral Black eyes)
Paralysis or disability on one side of the body
Open eye appears to be depressed
Bleeding/Clear fluid from the ears and/or nose
Personality changes
Seizures
Increased blood pressure and
Deteriorating Vital signs
decreased pulses (Cushing’s syndrome) Unitlateral Dilated pupil – non-reactive
*Posturing – flexing arms and wrist and extending legs and feet (decorticate posture) or extending arms with the shoulders rotated inward and
wrist flexed, legs extended (decerebrated posture); may be spontaneous or in response to painful stimulus.
Emergency Care for Brain Injuries and Skull Fractures
Universal precautions
Keep patient at rest
Assume spinal injury
Speak to conscious patients
Monitor patient (vital signs, pulse oximeter Monitor/manage for shock
every 5 minutes)
Vomiting
Apply C-collar
Early Neurosurgical Consultation
Oxygen
Control Bleeding / Dress & Bandage wound
Glosgow Coma Scale:
Eye Opening
ADULT
Opens spontaneously
Opens eyes to verbal command
Opens eyes to pain
Does not open eyes
CHILD/ADOLESCENT
Spontaneous
To voice
To pain
None
INFANT
Spontaneous
To voice
To pain
None
4
3
2
1
Alert and oriented
Converses but disoriented
Speaking but nonsensical
Moans or makes unintelligible sounds
No response
Oriented
Confused
Inappropriate
Garbled
None
Babbles, easily consoled
Irritable, difficult to console
Cries to pain
Moans to pain
None
5
4
3
2
1
Follows commands
Localizes pain
Movement or withdrawal to pain
Abnormal flexion (decorticate)
Abnormal extension (decerebate)
No response
Obeys commands
Localizes pain
Withdraws to pain
Flexion (decorticate)
Extension (decerebrate)
None
Normal movement
Withdraws to touch
Withdraws to pain only
Flexion (decorticate)
Extension (decerebrate)
None
6
5
4
3
2
1
Total Score:
3-15
Verbal Response
Motor Response
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SPM 100 Skills Lab 4 Notes:
The GCS helps the health care professional assess and determine what intervention to apply to
the head injury. Moderate: GCS 9-12. Severe: GSC < 8. (For GSC < 8 – intubate)
Spinal Injuries
Signs of Spinal Injuries:
Paralysis to the extremities
Pain with or without movement
Tenderness anywhere along the spine
Impaired Breathing
Deformity (rare)
Priapism
Posturing
Loss of bowel or bladder control
Severe spinal shock (neurogenic shock HR & BP)
Soft tissue injuries
Emergency Care for Spinal Injuries
Manual in-line c-spine immobilization
Assess ABC’s
Apply C-collar
Assess sensory and motor function in extremities
Oxygen
Spinal Immobilization
1. Place head in neutral, in-line position and maintain manual immobilization of head.
Assess pulses, motor, and sensory functions.
2. Stabilize the head by applying appropriate size rigid cervical collar (c-collar).
3. Log roll patient by having someone maintain cervical immobilization while others are
placed at shoulder, waist, and knees. Reach across the patient and turn toward you as a
unit. The person holding immobilization is in-control.
4. Place patient on a spine board and secure.
Hemorrhage (Bleeding)
Hemorrhage is the major cause of shock (hypoperfusion). Hemorrhage and Bleeding is
classified as either external or internal. Blood and open wounds pose a high risk of infection to
the health care provider, always use universal precautions (mask, gloves, gowns & eye
protection).
Arterial Bleeding - rapid and profuse, spurting with heart beat
Venous Bleeding – steady flow, dark red; Venous pressure may be lower than atmosphere
pressure, large veins may actually suck in debris or air bubble (neck). This may cause abnormal
heart rhythms, brain damage and lung injury.
Capillary Bleeding – slow and oozing (minor and easily controlled)
Patient assessment and care always begins with the ABC’s. Always control severe external
bleeding in the initial assessment.
Several Major Methods of controlling External Bleeding:
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SPM 100 Skills Lab 4 Notes:
Direct Pressure – most common and effective way to control bleeding; apply direct pressure
over the wound until bleeding is controlled then apply bandage – May take 3-5 minutes.
Elevation – elevate the injury above the level of the heart, helps to reduce blood pressure slowing
bleeding; avoid using if you suspect musculoskeletal injury, spinal injury
Pressure Points – used when direct pressure and elevation fail to stop external bleeding; it is a
site where a large artery lies close to the surface of the body and directly over a bone. Brachial
artery is used for bleeding from the upper extremities. Femoral artery is used for bleeding from
the lower extremities.
Tourniquet – LAST RESORT; ONLY FOR LIFE-THREATENING. Note the time of
application.
Splinting
Care for all painful, swollen, or deformed extremities is splinting. Splinting is used to
immobilize adjacent joints and bone ends around injury. For splinting to be effective it must
minimize the movement of the injury and decrease pain. Splinting also helps prevent further
injury or soft tissue damage. Realignment of a deformed extremity aids in restoring circulation
(no pulse).
Three Basic Splints:
1. Rigid splint – extremity to be moved into anatomical position; provide the best
support; Ex: cardboard, wood and pneumatic.
2. Formable splint – cane be molded to different angles; commonly used for
immobilizing joints.
3. Traction splint – for femur fractures
Before applying a splint, expose the injury. You need to assess the injury and then decide the
best device to use. Always assess pulses and sensations distal to the injury. Always splint the
injury to stabilize the injury site and adjacent joint and then reassess pulse.
A hazard to splinting can be getting too wrapped up in the splinting process and neglecting the
patients ABC’s. Always continue to assess the airway, breathing and circulation.
References: O’Keefe, M., Limmer, D., Grant, H. & etc. (1998) Emergency Care (5 th edition); New Jersey; Brady/Prentice Hall.
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