Trauma to the Head, Neck & Spine Flashcards Preview

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Nervous System Overview

• Controls thought, sensations, and motor


Central nervous system

– Brain, spinal cord


Peripheral nervous system

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


Anatomy of the Head - what are the bones

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


Anatomy of the Spine - Vertebrae - what are the bones

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


Scalp Injuries- characteristics

– Lots of blood vessels
– Profuse bleeding


Skull Injuries - types

– Open head injury
– Closed head injury


Traumatic Brain Injuries (TBI) - types

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


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

• 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?


Injuries to the Head & Face

• 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


Nontraumatic Brain Injuries

• 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.


Glasgow Coma Scale (GCS)

• 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


Wounds to the Neck

• 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


Treatment: Open Neck Wound

• 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


Injuries to the Spine

• 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


Assessment: Spinal Injury - what to consider

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


Treatment: Spinal Injury

• 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


Steps for Applying a Cervical Collar

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


Immobilizing a Seated Patient

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


Steps for Applying a Long Backboard

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


Standing Patient - Steps

• Rapid takedown
– Requires three providers, cervical collar, and long backboard


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

• 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


Patient Found Wearing a Helmet - when should it be removed

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


Chapter Review: Trauma to the Head, Neck & Spine

• 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.


Chapter Review: Trauma to the Head, Neck & Spine

• 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.


Chapter Review: Trauma to the Head, Neck & Spine

• 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.


Remember: Trauma to the Head, Neck & Spine

• 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


Remember: Trauma to the Head, Neck & Spine

• 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.


Remember: Trauma to the Head, Neck & Spine

• 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.


Remember: Trauma to the Head, Neck & Spine

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