Trauma to the Head, Neck & Spine

Question 1

Nervous System Overview

Answer 1

• Controls thought, sensations, and motor

functions

Question 2

Central nervous system

Answer 2

– Brain, spinal cord

Question 3

Peripheral nervous system

Answer 3

– Vertebral nerves
– Cranial nerves
– Body’s motor and sensory nerves

Question 4

Anatomy of the Head - what are the bones

Answer 4

• Cranium
• Facial Bones (14)
– Mandible
– Maxillae
– Nasal bones
– Malar (zygomatic)

Question 5

Anatomy of the Spine - Vertebrae - what are the bones

Answer 5

– Cervical (7)
– Thoracic (12)
– Lumbar (5)
– Sacral (5)
– Coccyx (4)

Question 6

Scalp Injuries- characteristics

Answer 6

– Lots of blood vessels

– Profuse bleeding

Question 7

Skull Injuries - types

Answer 7

– Open head injury

– Closed head injury

Question 8

Traumatic Brain Injuries (TBI) - types

Answer 8

– Concussion
– Contusion
• Coup
• Contrecoup
– Laceration
– Hematoma
• Subdural Hematoma
• Epidural Hematoma
• Intracerebral Hematoma

Question 9

Think about it - Trauma to the Head, Neck & Spine

Answer 9

• Does my patient have a serious or potentially serious head injury? Should the patient be transported to a trauma center?
• Do my patient’s complaint and MOI indicate spinal stabilization? Is immobilization warranted?

Question 10

Injuries to the Head & Face

Answer 10

• Cranial injuries with impaled objects
– Stabilize object in place
• Injuries to the face and jaw
– Primary concern: Airway
– When possible, position to allow for drainage from mouth

Question 11

Nontraumatic Brain Injuries

Answer 11

• Many signs of brain injury may be caused by an internal brain event (hemorrhage, blood clot)
• Signs are the same as for traumatic injury, except no evidence of trauma and no MOI.

Question 12

Glasgow Coma Scale (GCS)

Answer 12

• May use GCS in addition to AVPU for ongoing neurological assessment
• Considerations for use of GCS
– Eye opening
– Verbal response
– Motor response
• Do not spend extra time at the scene calculating

Question 13

Wounds to the Neck

Answer 13

• Large, major vessels close to surface create the potential for serious bleeding
• Pressure in large vein is lower than atmospheric pressure
• Great possibility of air embolus being sucked through
• Treatment: stop bleeding, prevent air embolism

Question 14

Treatment: Open Neck Wound

Answer 14

• Ensure open airway
• Place gloved hand over wound
• Apply occlusive dressing
• Apply pressure to stop bleeding
• Bandage dressing in place
• Immobilize spine if MOI suggests cervical injury

Question 15

Injuries to the Spine

Answer 15

• Assume possible cervical-spine injury if MOI exerts great force on upper body or if soft-tissue damage to head, face, or neck
• Spinal cord is a relay between most of body and brain for sending messages
• Neurogenic shock: form of shock resulting from nerve paralysis; causes uncontrolled
dilation of blood vessels

Question 16

Assessment: Spinal Injury - what to consider

Answer 16

• Paralysis of extremities
• Pain without movement
• Pain with movement
• Tenderness anywhere along spine
• Impaired breathing
• Deformity
• Priapism
• Loss of bowel or bladder control

Question 17

Treatment: Spinal Injury

Answer 17

• Provide manual in-line stabilization
• Assess ABC’s
• Rapidly assess head and neck; apply rigid cervical collar
• Rapidly assess for sensory and motor function
• Apply appropriate spinal immobilization device
• Reassess sensory and motor function

Question 18

Steps for Applying a Cervical Collar

Answer 18

• Always maintain manual stabilization
• Use in conjunction with a long
backboard

Question 19

Immobilizing a Seated Patient

Answer 19

• Low priority: Use a short board or vest-immobilization device
• High priority: Maintain manual
stabilization while moving patient

Question 20

Steps for Applying a Long Backboard

Answer 20

• Log roll patient
• Pad voids between board and head/torso
• Secure head last
• If pregnant, tilt board to left after
immobilizing

Question 21

Standing Patient - Steps

Answer 21

• Rapid takedown

– Requires three providers, cervical collar, and long backboard

Question 22

Patient Found Wearing a Helmet - when should it be left in place

Answer 22

• When to leave helmet in place
– Fits snugly, allowing no movement
– Absolutely no impending airway or breathing issues
– Removal would cause further injury
– Proper spinal immobilization can be done with helmet in place

Question 23

Patient Found Wearing a Helmet - when should it be removed

Answer 23

• When to remove helmet
– Interferes with ability to assess and manage airway
– Improperly fitted
– Interferes with immobilization
– Cardiac arrest

Question 24

Chapter Review: Trauma to the Head, Neck & Spine

Answer 24

• The two main divisions of the nervous system are the central nervous system and the peripheral nervous system.
• Maintain a high index of suspicion for head or spine injury whenever there is a relevant mechanism of injury.

Question 25

Chapter Review: Trauma to the Head, Neck & Spine

Answer 25

* Provide cervical spine stabilization before beginning any other patient care when head or spine injury is suspected. * Altered mental status is an early and important indicator of head injury. Monitor and document your patient’s mental status throughout the call.

Question 26

Chapter Review: Trauma to the Head, Neck & Spine

Answer 26

• A traumatic brain injury is any injury that disrupts function of the brain and may include anything from a slight concussion to a severe hematoma. • Always secure the torso to the backboard before the head.

Question 27

Remember: Trauma to the Head, Neck & Spine

Answer 27

• The key components of the nervous system are the brain and the spinal cord. These organs regulate thought, sensations, and motor functions. • The skull, vertebrae, and cerebrospinal fluid efficiently protect the brain and spinal cord.

Question 28

Remember: Trauma to the Head, Neck & Spine

Answer 28

* In a closed head injury, the skull remains intact. This is dangerous, for the skull is a closed container with little room for bleeding or swelling. * Neck wounds are at risk for massive bleeding and air entry, causing emboli.

Question 29

Remember: Trauma to the Head, Neck & Spine

Answer 29

• The spine is injured most often by compression or excessive flexion, by extension, or rotation from falls, by diving injuries, and by motor-vehicle collisions. These injuries can interrupt nervous system control of body functions.

Question 30

Remember: Trauma to the Head, Neck & Spine

Answer 30

• In-line immobilization of 33 spinal bones is the essential component of spinal injury immobilization. • Specific procedures apply to different immobilization and extrication situations. EMTs should be proficient in handling the basics of these procedures.

Question 31

Questions to Consider: Trauma to the Head, Neck & Spine

Answer 31

* Does my patient have a mechanism of injury that would indicate the need for spinal immobilization? * Do my patient’s potential head or spine injuries require prompt transport to a trauma center?

Question 32

Critical Thinking: Trauma to the Head, Neck & Spine

Answer 32

• You are treating a patient with a head injury. He has an altered mental status and a significant MOI to the head. Your partner thinks you should hyperventilate. When should you hyperventilate? What are the signs and symptoms that would indicate this is necessary?

Question 33

sensory nerves - sensed the hot plate motor

Answer 33

.

Question 34

mandible

Answer 34

.

Question 35

7, 12, 5 5 4

Answer 35

of spine

Question 36

concussion

Answer 36

mild closed head injury without detectable damage to the brain.

Question 37

contusion

Answer 37

in brain injuries, a bruised brain is caused when the force of a blow to the head is great enough to rupture blood vessels

Question 38

basalar fractures

Answer 38

battle signs, CSF | 4x4 - halo efect

Question 39

coup / contrecoup

Answer 39

.

Question 40

752 Meninges dura mater - tough mother arachniod space pia mater subdural bleed - th pt is bleeding btwn the dura mater & arachnoid space epidural - outside the dural mater intercerebral

Answer 40

knowing that the brain and spinal cord have covering

Question 41

intracranial pressure | Cushings Triad

Answer 41

increase BP decrease Pulse slow & altered response pupils on the affected side will dilate 1st sign of head trauma -altered mental status 2nd Dialated pupil -pressure on the Then Cushings Traid very high BP exactly opposite than shock

Question 42

PP = Perfusion Pressure B/P - ICP (intercranial pressure) 90 =120-30 90=150-60 Body wants a constant perfusion pressure perfusion pressure wants to stay constant at 90

Answer 42

.

Question 43

biggest problem to head and face injuries

Answer 43

airway injury

Question 44

gcs

Answer 44

used to measure LOC

Question 45

761

Answer 45

assume possible spinal injury if... | injuries to the spine must be considered whenever there is serious trauma to any part of the body

Question 46

Assessment of Spinal Injury

Answer 46

.

Question 47

priapism

Answer 47

.

Question 48

when to leave a helmet in place

Answer 48

review - airway and breathing is the reason you leave it on.