Chapter 21 Head and Spine Injuries BRADY National

Chapter 21 Head and Spine Injuries BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Objectives 21. 1 Correctly identify the major anatomical components of the central nervous system. 21. 2 Define traumatic brain injury. 21. 3 Describe common traumatic injuries involving the head, neck, and back. 21. 4 Describe the signs and symptoms of potential head injuries involving the brain. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Objectives 21. 5 Describe the signs and symptoms of potential spinal injuries. 21. 6 Describe how to properly assess a patient with a suspected neurologic injury, including neck and spine injuries. 21. 7 List the signs and symptoms of increased intracranial pressure. 21. 8 Demonstrate how to properly treat a patient with a head, neck, spine, or back continued injury. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Objectives 21. 9 Demonstrate how to maintain proper spinal alignment while placing a patient onto a long spine board from the following positions: a. lying b. sitting c. standing 21. 10 Describe and demonstrate how to remove a helmet. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Topics l Anatomy and Physiology l Common Mechanisms of Injury l Increased Intracranial Pressure l Coup-Contracoup l Common Injuries l Head and Brain Injuries continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Topics l Spinal Injuries l Patient Assessment l Management l Chapter Summary BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Case Presentation An unresponsive adult male is lying on his side at the base of a large tree. His helmet is cracked in two places and there is blood leaking from his nose and ears. Tracks show he hit the tree straight on. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Anatomy and Physiology l Skeletal = skull and vertebrae l Brain ◦ 3 parts ◦ White and gray matter l Spinal BRADY cord – l Cerebrospinal fluid l Nerve cells l Central and peripheral nervous systems National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Common Mechanisms of Injury l Rapid deceleration (impact related) l Rapid acceleration l Compression l Penetrating or impaled object l Near drowning l Hypothermia or hyperthermia l Electrical injury (includes lightning) BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Common Mechanisms of Injury BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Central Nervous System Injuries l Primary injuries occur from external trauma l Secondary injuries occur from ◦ ◦ Inadequate brain perfusion Increased intracranial pressure Hypoxia Delayed reactions from primary injury l Most BRADY common among young men National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Increased Intracranial Pressure l Skull volume is fixed l Increased blood or swelling ◦ ◦ ◦ BRADY Compresses the brain Reduce cerebral blood flow Cause cerebral hypoxia Reduce brain function May cause death National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Increased Intracranial Pressure BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Coup – Contrecoup Injuries l Brain strikes the inside of the skull ◦ Initial impact = coup ◦ Rebound to opposite side = contrecoup l Caused by rapid deceleration l May have no external signs l Cause intracranial bleeding and swelling l Pediatric/geriatric injuries may be more severe BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Coup – Contrecoup Injuries BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Common Injuries l Closed ◦ Hematomas ◦ Skull, spine, scapula, posterior rib fractures ◦ Epidural and subdural hematomas continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Common Injuries continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Common Injuries l Open ◦ Brain matter or bone fragments exposed ◦ CSF is leaking from a wound or nose or ears ◦ Non CNS injuries BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Head and Brain Injuries l Scalp injuries – soft tissue l Skull fractures l Traumatic brain injury (TBI) l Recurrent traumatic brain injury l Diffuse axonal injury l Concussion continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Head and Brain Injuries l Amnesia ◦ antegrade and retrograde l Cerebral contusion l Epidural and subdural hematoma l Intracerebral hemorrhage BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Spinal Injuries l Include neck/back ◦ Soft tissue injuries ◦ Strains ◦ Fractures l Vertebral injuries ◦ Fractures ◦ Causes/types vary by location ◦ Lower thoracic/lumbar most common continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Spinal Injuries Copyright Philadelphia Cervical Collar Company. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Spinal Injuries l Scapula l Posterior rib l Neurologic injuries ◦ Primary – direct spinal cord involvement ◦ Secondary (indirect) – pressure from blood or swelling (neural ischemia) l Neurogenic shock ◦ Common cause is spinal cord injury BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Case Update You secure the scene, and then you summon assistance. You instruct rescuers to bring a long spine board, a C-collar, oxygen, and a trauma pack, toboggan, a helicopter for transport. The patient’s pulse is 92 and regular. You ensure an open airway. You visually assess the patient’s injuries. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Patient Assessment l Focus on MOI l Standard assessment procedures – ABCDs, SAMPLE, and vitals l Assess mental status (A&O x 4) ◦ Mini-neurologic exam • LOC – AVPU • Pupillary exam • Best motor response BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Patient Assessment BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Patient Assessment l Distal motor/sensation function (CSM) l Stabilize C-spine (manual, c-collar) BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Management l Maintain vitals – correct life-threats ◦ High flow oxygen l Transport avoiding secondary injury ◦ Assume spinal injury with head injury ◦ Immobilize entire spine l Check for medical issues l Treat other injuries ◦ Do not stop flow of CSF l Monitor BRADY - ongoing assessments National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

The C-Collar l Does NOT provide full stabilization! l Should rest on the shoulder and provide firm support under the chin l Head/c-spine should be in neutral position l Do not use if size is incorrect BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Using Towels or Blankets Copyright Mike Halloran BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

The Long Spine Board l Supine position is preferred l Spine should be treated as a single long bone l Lift or roll patient onto the board l Use axial drag for final positioning l Secure torso first, head last l Seated patients may need a short device before transfer to the LSB BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Standing Backboard l Use manual C-spine stabilization l Check CSM, apply C-collar l Position rescuers to support patient and board l Lower patient l Position correctly on board l Secure patient BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Cautions! l Vomiting is common with brain injury patients ◦ Be prepared to tip the board and/or suction l Pediatric patients need a ped’s Ccollar, and may need padding under the shoulders for neutral position BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Cautions! BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Helmet Removal l Remove only if… ◦ It prevents airway/breathing management ◦ It allows patient’s head to move or prevents spinal immobilization ◦ Patient is in cardiac arrest l Ensure C-spine stabilization throughout l Apply C-collar immediately BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Helmet Removal BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Case Disposition You place a C-collar on the patient, and with the assistance of other patrollers carefully log-roll him onto a long spine board. His vital signs remain stable. After securing the patient to the LSB, you load him into a toboggan with his head uphill, and quickly transport him to a nearby landing zone. The patient is then flown to the nearest trauma center. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Chapter Summary l Brain and spinal cord injuries are potentially life altering or life threatening. l Spine injury should be assumed in the setting of serious head injury. l TBI is the leading cause of traumatic death in patients under age 45. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Chapter Summary l “C 3, C 4, C 5, keep the diaphragm alive. ” l The treatment goals for neurologic injuries are preserving the ABCDs, eliminating spinal movement, and limiting neural ischemia. l All patients with a significant MOI or head, neck, and back injuries should be immobilized BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ