Head and Spinal Injuries

1
Chapter 12

• Head and Spinal Injuries

2
Head Injuries

• Scalp wounds
• Skull fracture
• Brain injuries

3
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.

4
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.

5
Skull Fracture

• A skull fracture is a break or crack in the
  cranium.
• May be open or closed

6
Recognizing a Skull Fracture

• 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

7
Care for a Skull Fracture

• Monitor breathing and provide appropriate care.
• Stabilize the victims neck to prevent movement.
• Elevate the victims head and shoulders to help
  control bleeding.
• Cover the wounds with a sterile dressing.
• Apply pressure around the edges of the wound.

8
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

9
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

10
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

11
Care for Brain Injury (1 of 2)

• Seek immediate medical care.
• Suspect a spinal injury in an unresponsive victim
  until proven otherwise.
• Stabilize the victims head and neck.
• Monitor the victims breathing.
• Control scalp bleeding with sterile dressings.
• Roll the victim onto his or her side to help
  drain vomit.

12
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 victims level of responsiveness is one of
  the best indicators of neurologic function.
• Using the mnemonic AVPU is especially helpful
  with small children.

13
Eye Injuries

• 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

14
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.

15
Care for Penetrating Eye Injuries

• Seek immediate medical care.
• Stabilize the object.

16
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.

17
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.

18
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.

19
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.

20
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.

21
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.

22
Eye Avulsion

• A blow to the eye can avulse it (knock it out)
  from its socket.
• This is a serious injury.

23
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.

24
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 bodys way of
  trying to remove the object.

25
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.

26
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.

27
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.

28
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.

29
Nose Injuries

• Nosebleeds
• Broken nose
• Objects in the nose

30
Nosebleeds

• Anterior nosebleeds
• From front of nose
• Most common, easier to care for
• Posterior nosebleeds
• From back of nose
• More serious, require medical care

31
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.

32
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.

33
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.

34
Objects in the Nose

• A foreign object in the nose is a problem mainly
  among small children.

35
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.

36
Dental Injuries

• Objects caught between the teeth
• Bitten lip or tongue
• Loosened tooth
• Broken tooth
• Toothache

37
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.

38
Care for Objects Caught Between the Teeth

• Try to remove the object with dental floss.
• If unsuccessful, seek dental care.

39
Recognizing a Bitten Lip or Tongue

• Signs of a bitten lip or tongue include
• Immediate pain when it happens
• Blood may be seen

40
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.

41
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.

42
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.

43
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.

44
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.

45
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.

46
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.

47
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.

48
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.

49
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.

50
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.

51
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

52
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 victims head over the ears and hold
  the head and neck still until EMS arrives.
• Kneel with the victims head between your knees
  or place objects on each side of the victims
  head to prevent it from rolling side to side.