Chapter 12
Head and Spinal Injuries
Head Injuries
• Scalp wounds
• Skull fracture
• Brain injuries
Scalp Wounds
• Associated with heavy bleeding
• The scalp has a rich blood supply.
• The vessels do not constrict.
• The brain obtains its blood supply
from arteries in the neck.
Care for Scalp Wounds
• Control bleeding by using direct
pressure over wound.
• If skull fracture is suspected, apply
pressure around the edges of the
wound.
• Keep head and shoulders slightly
elevated if spinal injury is not
suspected.
• Seek medical care.
Skull Fracture
• A skull fracture is a break or
crack in the cranium.
• May be open or closed
Recognizing a Skull Fracture
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Pain at point of injury
Deformity of the skull
Bleeding from ears and nose
Cerebrospinal fluid leaking from ear or
nose
Discoloration around eyes
Discoloration behind ear
Heavy scalp bleeding if the skin is broken
Penetrating wound
Care for a Skull Fracture
• Monitor breathing and provide appropriate
care.
• Stabilize the victim’s neck to prevent
movement.
• Elevate the victim’s head and shoulders
to help control bleeding.
• Cover the wounds with a sterile dressing.
• Apply pressure around the edges of the
wound.
Brain Injuries
• When the head is struck with force, the brain
bounces against the inside of the skull.
• Swelling of brain tissue compresses the
brain, which interferes with brain functioning.
• Three types of commonly occurring brain
injuries:
• Concussion
• Contusion
• Hematoma
Recognizing Brain Injury (1 of 2)
• Confused facial expression
• Slow to answer questions or follow
instructions
• Easily distracted and unable to follow
through with normal activities
• Unaware of time, date, and place
• Making disjointed statements
• Stumbling, unable to walk a straight line
Recognizing Brain Injury (2 of 2)
• Distraught
• Asking a question that has already
been answered or inability to
memorize a series of three words
• Coma, unresponsiveness
Care for Brain Injury (1 of 2)
• Seek immediate medical care.
• Suspect a spinal injury in an unresponsive
victim until proven otherwise.
• Stabilize the victim’s head and neck.
• Monitor the victim’s breathing.
• Control scalp bleeding with sterile
dressings.
• Roll the victim onto his or her side to help
drain vomit.
Care for Brain Injury (2 of 2)
• If spinal injury is not suspected, keep the
victim in a slightly head-elevated position.
• If victim is unresponsive, roll him or her
onto the left side.
• The victim’s level of responsiveness is
one of the best indicators of neurologic
function.
• Using the mnemonic AVPU is
especially helpful with small children.
Eye Injuries
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Penetrating eye injuries
Blows to the eye
Cut of the eye or lid
Chemical in the eyes
Eye avulsion
Loose objects in the eye
Light burns to the eye
Penetrating Eye Injuries
• Penetrating eye injuries are
severe injuries that result a sharp
object penetrates the eye.
• Suspect penetration any time you
see a lid laceration or cut.
Care for Penetrating Eye
Injuries
• Seek
immediate
medical care.
• Stabilize the
object.
Blows to the Eye
• Blows to the eye range in severity
from minor or sight threatening.
• A shiner or black eye occurs when
some of the blood vessels around
the eye rupture.
• A blunt object can break the bone
around the eyeball.
Care for Blows to the Eye
• Apply ice for about
15 minutes.
• Do not apply
pressure on the
eye.
• Seek medical care
if there is pain or
reduced vision.
Cuts of the Eye or Lid
• The signs of a cut eyeball or lid
include the following:
• Cut appearance of the cornea
or sclera.
• Inner liquid filling of the eye
may come out through the
wound.
• Lid is cut.
Care for Cuts of the Eye or Lid
• If eyeball is cut, do
not apply pressure.
• If eyelid is cut,
apply gentle
pressure.
• Bandage both eyes
lightly.
• Seek medical care.
Chemical in the Eyes
• Chemicals in the eyes can threaten
sight.
• Alkalis cause greater damage than
acids because they penetrate deeper
and continue to burn longer.
• Damage can occur in 1 to 5 minutes.
Care for Chemical in the Eye
• Hold the eye open.
• Flush the eye with
water for at least 20
minutes.
• Loosely bandage
both eyes with cold,
wet dressings.
• Seek medical care.
Eye Avulsion
• A blow to the eye can avulse it
(knock it out) from its socket.
• This is a serious injury.
Care for Eye Avulsion
• Cover the eye loosely.
• Protect injured eye with a paper cup or
doughnut-shaped pad.
• Cover the undamaged eye with a patch.
• Seek immediate medical care.
Loose Objects in the Eye
• Loose objects in the eye are the
most frequent eye injury and can be
very painful.
• Tearing is common because it is the
body’s way of trying to remove the
object.
Care for Loose Objects in
the Eye
• Lift the upper lid over the lower lid.
• Try flushing the object out with water.
• Examine the lower lid by pulling it down
gently.
• If you see the object, remove it with
moistened sterile gauze.
Light Burns to the Eye
• Burns can result if a person looks at a
source of ultraviolet light such as
sunlight, bright snow, or tanning lamps.
• Severe pain occurs 1 to 6 hours after
exposure.
Care for Light Burns to the Eye
• Cover both eyes with cold, wet packs.
• Tell the victim not to rub the eyes.
• Have the victim rest in a darkened
room.
• Give pain medication, if needed.
• Seek medical care.
Ear Injuries
• Most ear problems are not life-threatening.
• Except for disk batteries and live insects,
few foreign bodies must be extracted
immediately.
• First aiders should seek medical care for
the victim because attempts to remove a
foreign body can rupture the eardrum or
lacerate the ear canal.
Nose Injuries
• Nosebleeds
• Broken nose
• Objects in the nose
Nosebleeds
• Anterior nosebleeds
• From front of nose
• Most common, easier to care for
• Posterior nosebleeds
• From back of nose
• More serious, require medical care
Care for Nosebleeds
• Pinch the soft parts of
the nose together.
• Press firmly toward the
face, for 5 to 10
minutes.
• Keep the head higher
than the heart.
• Apply ice over nose.
• Seek medical care if
needed.
Recognizing a Broken Nose
• Pain, swelling, and a possible
crooked appearance.
• Bleeding and difficulty breathing
through nostrils
• Black eyes appearing 1 to 2 days
after injury.
Care for a Broken Nose
• Seek medical care.
• If bleeding is present, give care as
for a nosebleed.
• Apply an ice pack to the nose for
15 minutes.
• Do not try to straighten a crooked
nose.
Objects in the Nose
• A foreign object in the nose is
a problem mainly among
small children.
Care for Objects in the Nose
• Try to induce sneezing by having
the victim sniff pepper.
• Have the victim blow gently while
you put compression on the
opposite nostril.
• Use tweezers to pull out an object
that is visible.
• Seek medical care if the object
cannot be removed.
Dental Injuries
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Objects caught between the teeth
Bitten lip or tongue
Loosened tooth
Broken tooth
Toothache
Objects Caught Between
the Teeth
• The main method of detecting a
problem is if the victim says that
something is caught between the
teeth.
• The object may or may not be
seen.
Care for Objects Caught
Between the Teeth
• Try to remove the object with
dental floss.
• If unsuccessful, seek dental
care.
Recognizing a Bitten Lip or
Tongue
• Signs of a bitten lip or tongue include:
• Immediate pain when it happens
• Blood may be seen
Care for a Bitten Lip or Tongue
• Apply direct pressure with
sterile gauze.
• Apply ice or cold pack.
• If bleeding does not stop,
seek medical care.
Loosened Tooth
• Trauma can cause teeth to
become loosened in their sockets.
• Applying pressure on either side of
each tooth can determine
looseness.
• Any tooth movement indicates a
possibly loose tooth.
Care for a Loosened Tooth
• Have the victim bite down on a
piece of gauze to keep the tooth
in place.
• Consult a dentist or an oral
surgeon.
Knocked-out Tooth
• A majority of the teeth knocked out
each year in the United States could
be saved with proper treatment.
• Time is critical for successful
reimplantation.
• Steps must be taken to prevent the
tooth from becoming dehydrated.
Care for a Knocked-Out Tooth
• Have victim rinse
mouth.
• Place gauze in
socket.
• Find the tooth.
• Keep tooth moist.
• Take the victim
and the tooth to a
dentist.
Broken Tooth
• The front teeth are frequently broken
by falls or direct blows.
• Such damage is not unusual in the
victims of violent acts or motor
vehicle crashes.
• It is also common in children,
especially those with an overbite.
Care for a Broken Tooth
• Gently clean dirt and blood with a
sterile gauze pad and water.
• Apply an ice pack to the face to
the area of the injury.
• If you suspect a jaw fracture,
stabilize the jaw.
• Seek immediate dental care.
Toothache
• The most common reason for
toothaches is dental decay.
• Victims frequently complain of
pain limited to one area.
• Pain can also affect the ear,
eye, neck, or the opposite side
of the jaw.
Recognizing a Toothache
• The tooth will be sensitive to
heat and cold.
• Identify the diseased tooth by
tapping the area with a spoon
handle or similar object.
• A diseased tooth will hurt.
Care for a Toothache
• Rinse mouth with warm water.
• Use dental floss to remove any food
caught in teeth.
• If you suspect a cavity, paint the tooth
with clove oil to help suppress pain.
• Give the victim pain medication if
needed.
• Seek dental care immediately.
Spinal Injuries
• The spine is a column of vertebrae stacked on
one another from the tailbone to the base of the
skull.
• The spinal cord consists of long tracts of nerves
that join the brain with the other body organs.
• If a broken vertebrae pinches spinal nerves,
paralysis can result.
• All unresponsive victims should be treated as
though they have a spinal injury.
• Suspect a spinal injury in all head-injury victims.
Recognizing Spinal Injuries
• Painful movement or paralysis of
arms and legs
• Numbness, tingling, weakness,
burning sensation in arms and legs
• Loss of bladder or bowel control
• Deformity of neck
Care for Spinal Injuries
• Monitor breathing.
• For an unresponsive victim, open the airway and
check for breathing.
• Stabilize the victim to prevent movement by using
one of the following methods:
• Grasp the victim’s head over the ears and hold
the head and neck still until EMS arrives.
• Kneel with the victim’s head between your knees
or place objects on each side of the victim’s head
to prevent it from rolling side to side.