Flashcards in Ch 14: Head and Spine Injuries Deck (42):
Arterial bleeding between the skull and dura mater
Signs and Symptoms of Epidural Hematoma
-Yoyo-ing of LOC with rapid decline
-Pupils become sluggish, dilated or non-reactive
-Motor function impaired on one side
Venous bleeding in the subdural space
Signs and Symptoms of Subdural Hematoma
-Signs of trauma to the head
-Deficits in motor function
Damage to the blood vessels in the brain itself
Signs and Symptoms of Intracerebral Hematoma
-More than one contusion
-Specific neurological findings depend on the location and size of the hematoma
Types of Spine Injuries
-Fracture the vertebrae
-Sprain the ligaments
-In severe injuries the vertebrae may shift and compress or sever the spinal cord, causing paralysis or even death
Types of MOI's that can lead to spinal injury
-Motor vehicle crash or ejection from vehicle
-Fall from a height greater than the individuals
-Occurrence of a broken helmet
-Blunt force to the head or trunk
-Injuries that penetrate the head or trunk
-Unconsciousness of an unknown cause
Care for Head and Spine Injuries
H+S injuries can become life threatening when patient stops breathing, so care will also include support of the respiratory, circulatory and nervous systems.
-Minimize movement of the head and spine
-Maintain an open airway
-Control external bleeding
-Provide ongoing survey and care
-Instruct the patient to remain still and minimize movement
-Place your hands on both sides of the patients head.
-Slowly rotate the head until the chin is in line with the middle of the chest.
-Maintain manual stabilization and continue care
-Do not remove your hands from the patient until they are immobilized on a spine board
-The head is in anatomically correct, neutral position to prevent further damage.
-Apply a cervical collar and use in conjunction with manual in line stabilization
Signs and Symptoms of Head and Spine Injuries
Changes in the level of consciousness
-Severe pain or pressure in the head, neck or back
-Tingling or loss of sensation in the extremities
-Partial or complete loss of movement of any body part
-Unusual bumps or depressions on the head, neck or back
-Blood or other fluids draining from the ears, nose, mouth or open wounds
-Profuse external bleeding of the head, neck or back
-Open wounds to the scalp
-Sudden impaired breathing or vision
-Unusual or unequal pupil size
-Nausea or vomiting
-Loss of balance
-Specific changes in blood pressure and pulse
-Bruising of the head especially around the eyes
Do not align the head when:
-The head is severely angled to one side
-Patient complains of pain, pressure or muscle spasms in the neck when you begin to align
-When you feel resistance when attempting to move the head
Support the patients head in the position found, except when the patient's airway cannot be maintained
Sizing a Cervical Collar
-Patient's head is in neutral position
-Apply manual stabilization, making sure fingertips to not extend beyond patient's earlobe.
-The distance between the top of patient's trapezius to an imaginary horizontal line at the jaw is the approximate length you have to achieve.
-Match this length to the appropriate size of collar
-Assemble the chin piece
-Angle the collar for placement and position the bottom
-Position the front of the collar under the chin while maintaining alignment
-Secure the collar
-Maintain in line stabilization
Immobilizing the Patient
-Equipment: Backboard, large towel or blanket, straps or folded triangular bandage
-Log roll patient onto the backboard, checking the back for DCAP-BLS-TIC before placing them on the spine board.
-Babies and children may require padding under their body to line it up with their head.
-Ensure that they are in the correct position, pulling them straight down then straight up to align them
-Secure the body to the spine board
-Secure the head
-Fill in any spaces
Procedure of Securing Patient to Spine Board
-Make sure they are in proper alignment, pull them down, then up to realign
-Strap the torso from above the right shoulder to below the left hip, then again from the left shoulder to the right hip in a criss cross fashion
-Secure the hips above the point where the torso straps are secured, in criss cross fashion to just below the thigh.
-Secure the legs straight across at the thigh and at the ankles
-Secure the head with headblocks and a velcro straps at the chin and forehead
Applying a KED
My Baby Looks Hot Tonight
Strap Order: Middle Bottom Legs Head Top
-The freeing of a patient or object from an entanglement or difficulty
In what way do you maintain an open airway in a suspected head/spine injury?
The Jaw Thrust
what maneuver is used to roll a patient with a suspected head/spine injury?
The Log Roll Method
How do you perform a log roll technique?
Responder 1: Maintain in line stabilization of the head and neck, calls when to turn.
Responders 2, 3 and 4 line up on the same side of the patient and wait for direction from responder 1
while maintaining in line stabilization, gently roll the patient to one side, then gently roll them back. The hardest part is maintaining alignment of the head and neck without twisting.
This is not used on patients with fractures of the femur or pelvis.
Procedure of taking off a motorcycle helmet:
-Responder 1: applies stabilization
-Responder 2: holds stabilization from below helmet area while responder 1 removes helmet, readjusting support grip as helmet is removed
-Once helmet is removed, patients head is gently brought level with the body and a cervical collar is applied
When do we take off sports helmets?
-It limits access to the airway
-The helmet does not securely hold the head in place
-The helmet prevents immobilization of the patient for transport
Signs and symptoms of a skull fracture
-Visible damage to the scalp
-Deformity of the skull or face
-Pain or swelling
-Fluid form the nose, ears, mouth or head wound
-Unusual pupil size
Brain Damage: Signs and Symptoms
-Changes in LOC
-Paralysis or flaccidity
-Unequal facial movement
-Disturbance in vision or pupils
-Ringing in the ears or disturbances in hearing
-Loss of balance
-Pulse that becomes rapid and weak
-High blood pressure with slow pulse
When the brain initially strikes the skull in an acceleration injury
The second point of contact when the brain hits the back of the skull in an acceleration injury.
A complex injury affecting the brain that usually does not result in permanent physical damage to the brain tissue.
anyone suspected of a concussion should be examined by a physician
Concussion: Signs and Symptoms
-Inability to recall what happened just before and after the injury
-Irritability, uncooperativeness, combativeness
-Inability to answer questions or follow commands
-Nausea and or vomiting
-Ringing in the ears
-Brief loss of consciousness
Penetrating wounds of the head
Leave the object in place and stabilize it with bulky dressings.
Controlling bleeding of the head
Avoid putting direct pressure to a head in jury that may involve a skull fracture. If you feel a depression, spongy area or bone fragments, control bleeding with pressure on the area around the wound.
Care for Cheek injuries
-Examine the inside and outside of the cheek
-Control bleeding by placing several folded dressings inside the mouth against the cheek and then secure with a pressure bandage.
Care for imbedded objects in the cheek
-The object may become dislodged and obstruct the airway
-remove the object by pulling it the same way it entered
-if it is too difficult or painful, leave in place and stabilize with bulky dressings
-if the object has passed all the way through and has become imbedded, you may have to remove it to control bleeding and airway management.
Care for Epistaxis
-Have the patient sit with their head slightly forward, pinching the nostrils together
-Apply an ice pack to the bridge of the nose or put pressure on the upper lip just beneath the nose.
Obtain more advanced medical care if the bleeding cannot be controlled within 10-15 minutes, it stops then reoccurs, or the patient says the bleeding is the result of high blood pressure.
Place patient on their side if they lose consciousness to let the blood drain from their nose.
Examining the eye for injuries
Orbits: bruising, swelling, lacerations, tenderness, depression and deformity
Eyelids: bruising, swelling and lacerations
Mucous membranes: Redness, pus, foreign objects
Globes: Abnormal coloring, laceration, and foreign objects.
Pupils: Size, shape, equality, reactive to light
Eye movement: Eyes can move in all directions
Care for an Injured Eye
-Do not flush the eye unless it is a chemical injury
-Do not put salves or medicines in the eye
-Do not remove blood or thrombus from eye
-Only force the lid open to flush chemicals
-Do not allow patient to walk without help
-Do not allow patient to eat or drink
-Never panic and reassure the patient constantly
-Transport in supine.
Signs and Symptoms Foreign Objects in Eye
Signs and Symptoms:
-Abnormal Sensitivity to Light
Care for Objects in Eye:
Upper, Lower, Embedded
-Do not allow patient to rub eye
Removal should be done by higher care, but if necessary:
-Hold lids apart and flush with clean water (follow protocol)
Under Upper Lid:
-Draw upper lid over lower lid (unless patient wearing makeup), drawing the lashes of the lower lid across the undersurface of the upper.
-Grab the upper lashes and turn the lid up with a cotton swab.
-Use a corner of sterile gauze to remove object.
Under lower lid:
-Pull down lower lid to expose inner surface
-Use a corner of sterile gauze to remove object.
-Do not remove
-Fold a triangular bandage into a donut shape and carefully place on eye with object in center.
-Using rolled gauze, secure the donut in place, leaving the object uncovered. Make sure to cover undamaged eye so that patient is less likely to move.
Signs and Symptoms
-Double or decreased vision
-Numbness above brow or over cheek
-Massive discharge from Nose
-Fractures of lower orbit cause paralysis of upward gaze.
-Patient requires hospitalization and surgery
-No injury to eyeball, place cold packs over area to reduce inflammation.
-Injury to eye, do not apply cold pack
Signs and Symptoms
-Swelling or drooping (Edema)
*If eyelid has trauma, chances are eyeball has trauma