Ch. 13-Head and Spine Injuries

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Ch. 13-Head and Spine Injuries
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13.1 Types of Head Injury

• Injury to the Scalp
• Injury to the Brain
• Injury to the Skull (skull fracture)

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Signs of increased pressure inside the skull

• Decreasing mental status or altered
  responsiveness.
• Combativeness and erratic behavior.
• Nausea and/or vomiting.
• Pupils that are not equal or reactive to light.
• Double vision or other visual disturbances.
• Headache, sometimes severe.
• Loss of memory, confusion, or disorientation.
• Weakness or loss of balance.
• Seizures.
• Evidence of trauma to the head.
• Slow heart rate.
• Irregular breathing pattern.

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First Aid Care for Brain Injury

• 1. Suspect spine injury in any victim with
  suspected
• brain injury stabilize the head and neck as
  described
• later in this chapter.
• 2. Establish and monitor the victims ABCDs
  ensure
• the airway is open, provide rescue breathing if
  the
• breathing is inadequate.
• 3. Anticipate vomiting be prepared to keep the
  victims
• head and neck stabilized as you roll the victim
• on his or her side to prevent aspiration.
• 4. Treat the victim for shock keep the victim
  warm,
• but do not elevate the legs.

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Vocabulary

• Coup-contrecoup- A mechanism of brain injury in
  which the head comes to a sudden stop but the
  brain continues to move back and forth inside the
  skull

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Injury to the Skull (Skull Fracture)

• Four basic types
• 1. DepressedAn object strikes the skull, leaving
  an obvious depression or deformity bone
  fragments are often driven into the membranes or
  the brain itself by the force of the impact.
• 2. LinearThe most common type of skull fracture,
  a linear fracture causes a thin-line crack in the
  skull. Linear fractures are the least serious and
  the most difficult to detect.
• 3. ComminutedA comminuted fracture appears at
  the point of impact, with multiple cracks
  radiating from the center (it looks like a
  cracked eggshell).
• 4. BasilarA basilar skull fracture occurs when
  there
• is a break in the base of the skull it is often
  the result
• of a linear fracture that extends to the floor of
• the skull.

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Victim Assessment

• 1. Obtain a history that includes the mechanism
  of injury, whether the victims level of
  consciousness has deteriorated, and whether the
  victim has been moved.
• 2. If possible, have someone stabilize the head,
  neck, and spine in a neutral in-line position.
  Complete a primary survey to detect and correct
  any life-threatening problems.
• 3. Check the head look for depressions,
  fractures, lacerations, deformities, bruising,
  and other obvious problems.
• 4. Maintain in-line stabilization, check the neck
  and spine for lacerations, bruises, swelling,
  protrusions, or other obvious deformities ask
  the victim if there is pain, or muscle spasm.
• 5. Check the arms and legs for paralysis,
  weakness, or loss of sensation.

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PROGRESS CHECK

• 1. Bleeding from a scalp laceration, as from any
  other soft-tissue injury, is best controlled with
  _________.
• (direct pressure/indirect pressure/compression
  bandages)
• 2. Coup-contrecoup injury occurs when the head
  suddenly stops but the brain ____________.
• (begins bleeding/keeps moving/leaks fluid)
• 3. ____________ skull fracture occurs when an
  object strikes the skull and leaves an obvious
  deformity. (Depressed/Linear/Comminuted)
• 4. ____________ skull fracture resembles a
  cracked egg.
• (Linear/Comminuted/Depressed)
• 5. ____________ skull fracture is the most
  common. (Comminuted/Linear/Basilar)

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Signs and Symptoms of Skull Fracture

• Contusions, lacerations, or hematomas to the
  scalp
• Deformity of the skull
• Blood or cerebrospinal fluid (clear fluid)
  leaking from the ears, nose or mouth
• Bruising around the eyes in the absence of trauma
  to the eyes (raccoon eyes) is a very late sign
• Bruising behind the ears, or mastoid process
  (Battles sign) is a very late sign
• Damage to the skull visible through lacerations
  in the scalp
• Pain, tenderness, or swelling at the site of
  injury

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Signs and Symptoms of ClosedHead Injuries

• Altered or decreasing mental statusthe best
  indicator of a brain injury
• Irregular breathing pattern
• Obvious signs of a mechanism of
  injurycontusions, lacerations, or hematomas to
  the scalp or deformity to the skull
• Blood or cerebrospinal fluid leaking from the
  ears or nose
• Bruising around the eyes (raccoon eyes)
• Bruising behind the ears, or mastoid process
  (Battles sign)
• Loss of movement or sensation
• Nausea and/or vomiting vomiting may be forceful
  or repeated
• Unequal pupil size (dilated) that does not react
  to light (fixed) with altered mental status
• Possible seizures
• Unresponsiveness

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Signs and Symptoms of Open Head Injuries

• Obvious results of the mechanism of
  injurycontusions, lacerations, or hematomas to
  the scalp
• Deformity to the skull or obvious penetrating
  injury
• A soft area or depression detected during
  palpation
• Brain tissue exposed through an open wound
• Bleeding from an open bone injury

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PROGRESS CHECK

• 1. The most serious complication of head injury
  is ____________ to the brain. (contusion/laceratio
  n/lack of oxygen)
• 2. During assessment, check for scalp and skull
  wounds by ____________.
• (visually examining/probing/separating the edges
  of the wound)
• 3. During assessment, check the arms and legs for
  paralysis and ____________. (pulse/fractures/loss
  of sensation)
• 4. In closed head injury, the _________ is not
  broken. (scalp/skull/tough tissue)
• 5. Raccoon eyes, a classic sign of skull
  fracture, involves bruising around the
  ____________. (ears/eyes/mastoid process)
• 6. Head injury is indicated by blood or
  ______________ dripping from the ears, nose, or
  mouth. (lymph fluid/cerebrospinal fluid/mucus)

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13.3 First Aid Care for Head Injury

• 1. The top priority is establishing and
  maintaining an open airway with adequate
  oxygenation
• 2. Control bleeding face and scalp wounds may
  bleed heavily, but such bleeding is usually easy
  to control with direct pressure.
• 3. Never try to remove a penetrating object
• 4. If the victim sustained a medical or
  nontraumatic injury, place the victim on the left
  side elevate the head slightly, keep the victim
  warm, but avoid overheating
• 5. While waiting for emergency personnel to
  arrive
• Dress any facial and scalp wounds that have not
  been dressed.
• Continue to monitor vital signs.
• Stay alert to the possibility of vomiting or
  seizures work quickly to prevent aspiration.
• Continually monitor the airway and the victims
• neurological status.

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Vocabulary

• Raccoon eyes- Bruising around the eyes in the
  absence of trauma to the eyes a very late sign
  of skull fracture
• Battles sign- Bruising behind the ears (mastoid
  process) a very late sign of skull fracture
• Distraction- The sudden pulling apart of the
  spine that stretches and tears the cord, as in
  hanging

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PROGRESS CHECK

• 1. The top priority in treating victims of head
  injury is establishing and maintaining
  ____________.
• (an open airway/circulation/hemorrhage control)
• 2. Use the modified ____________ technique to
  open the airway.
• (head-tilt/chin-lift/jaw-thrust)
• 3. If there is blood or fluid dripping from the
  ear, ____________.
• (control it with pressure/pack the ear with
  gauze/cover the ear loosely with gauze to absorb
  the flow)
• 4. If you suspect a fracture beneath a bleeding
  scalp wound, ____________. (do not apply
  pressure/apply pressure/use a compression
  bandage)
• 5. _________ any object protruding from the head.
• (Remove/Cut off/Stabilize and leave in place)

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13.4 Injuries to the Spine

• Compression (the weight of the body is driven
  against the head, as in falls)
• Excessive flexion, extension, or rotation
• Lateral bending
• Distraction (a sudden pulling apart of the
  spine that stretches and tears the spinal cord,
  as in hangings)

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Complications of Spinal Injury

• Inadequate Breathing Effort
• Paralysis

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Victim Assessment

• 1. Note the mechanism of injuryespecially the
• type of movement and amount of force that was
• involved in the injury
• 2. Ask Does your neck or back hurt? What
  happened? Where does it hurt? Can you move? Can
  you feel?
• 3. Inspect the back for contusions, deformities,
  lacerations, punctures, penetrations, and
  swelling
• 4. Palpate gently for areas of tenderness or
  deformity
• 5. Assess equality of strength in the victims
  extremities

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To assess an unresponsive victim

• 1. Note the mechanism of injury. If the mechanism
• of injury suggests spinal injury and the victim
  is
• unconscious, assume spinal injury has occurred.
• 2. Inspect for contusions, deformities,
  lacerations,
• punctures, penetrations, or swelling palpate for
• areas of deformity.
• 3. Ask others at the scene about the mechanism of
• injury and the victims mental status before you
• arrived on the scene.

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PROGRESS CHECK

• 1. The vertebrae most likely to be injured are
  the
• ____________. (thoracic/lumbar/cervical)
• 2. One mechanism of spinal injury is distraction,
  or _____________ of the vertebrae.
  (compression/pulling apart/rotation)
• 3. The first step in assessment of spinal injury
  victims is to note the ____________.
• (mental status/loss of motor
  function/mechanism of injury)
• 4. If the victim is ____________ and the
  mechanism of injury suggests it, suspect spinal
  injury.
• (paralyzed/unconscious/in pain)

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13.5 Signs and Symptoms of Spinal Injury

• Tenderness in the area of the injury
  lacerations, cuts, punctures, or bruises over or
  around the spine indicate forceful injury.
• Pain associated with movement suspect spinal
  injury if the victim complains of pain when
  moving an apparently uninjured neck, shoulder, or
  leg.
• Pain independent of movement or palpation along
  the spinal column or in the lower legs.
• Obvious deformity of the spine upon palpation
  (not a usual sign).
• Soft-tissue injuries associated with trauma in
  the head and neck (causing cervical spine
  injury) shoulders, back, or abdomen (causing
  thoracic or lumbar injury) or the legs (causing
  lumbar or sacral injury).
• Numbness, weakness, or tingling in the arms or
  legs.
• Loss of sensation, weakness, or paralysis in the
  arms or legs
• Urinary or fecal incontinence.
• Impaired breathing

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PROGRESS CHECK

• 1. The ability to walk or move the arms and legs
  does not rule out ____________.
  (priapism/deformity/spinal injury)
• 2. The most reliable sign of spinal injury in a
  conscious victim is ____________.
• (priapism/incontinence/paralysis of the
  extremities
• 3. Breathing that involves little or no chest
  movement indicates that the victim is breathing
  with only the ____________. (abdomen/diaphragm/mou
  th)

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13.6 First Aid Care for Spinal Injury

• 1. Establish and maintain in-line stabilization.
• 2. Establish and maintain an open airway and
  adequate ventilation.

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Helmet Removal

• 1. Take the victims eyeglasses off before you
  attempt to remove the helmet.
• 2. One First Aider should stabilize the helmet by
  placing hands on each side of the helmet, fingers
  on the mandible (lower jaw) to prevent movement.
• 3. A second First Aider should loosen the chin
  strap.
• 4. The second First Aider should place one hand
  on the mandible at the angle of the jaw, and the
  other hand at the back of the head.
• 5. The First Aider holding the helmet should pull
  the sides of the helmet apart (to provide
  clearance for the ears), gently slip the helmet
  halfway off the victims head, then stop.
• 6. The First Aider who is maintaining
  stabilization of the neck should reposition,
  sliding the hand under the victims head to
  secure the head from falling back after the
  helmet is completely removed.
• 7. The first First Aider should remove the helmet
  completely.
• 8. The victim should then be immobilized as
  described on pages 243244.

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PROGRESS CHECK

• 1. The general rule for management of spinal
  injury is to ____________ the spine, head, torso,
  and pelvis. (reduce/straighten/immobilize)
• 2. The first priority in caring for spinal injury
  is to ensure adequate ____________.
• (air supply/circulation/immobilization)