Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
CHAPTER 29
Injuries to the Head and Spine
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy ReviewAnatomy Review
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
NervousNervousSystemSystem
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Skull and Facial Bones
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Contentsof the Skull
BoneDura materArachnoidPia mater
Subarachnoid spaceSubdural space
Intracerebral
Epidural space (potential)
Dura materArachnoid
Skull
Pia mater
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Spinal ColumnSpinal Column
Division Corresponding AnatomyNumber of Vertebrae
Cervical Neck 7
Thoracic Thorax, ribs, upper back 12
Lumbar Lower back 5
Sacral Back wall of pelvis 5
Coccyx Tailbone 4
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Head InjuriesHead Injuries
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Head Injuries – Overview
Scalp injuries may bleed profusely.
Injuries to the skull may cause damage to the brain and may have an open or closed wound.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
May occur due to clot or hemorrhage
Can cause altered mental status
Signs and symptoms similar to traumatic injury (but no trauma)
Brain Injury – Nontraumatic
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Signs & Symptoms ofHead Injuries
Altered or decreased mental status
Irregular breathing patterns
Mechanism of injury present
Continued…
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Contusion, laceration, hematoma, or deformity to the skull
Blood/fluid from ears or nose
Bruising around eyes, behind ears
Continued…
Signs & Symptoms ofHead Injuries
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Neurologic changes
Nausea and/or vomiting
Unequal pupil size
Decreased heart rate and increased blood pressure
Seizures
Signs & Symptoms ofHead Injuries
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Emergency Care ofHead Injuries
BSI.
Maintain C-spine stabilization.
Assess and treat ABCs.
Perform initial assessment.
Administer high-concentration oxygen.
Continued…
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Complete assessment.
Immobilize spine with cervical collar.
Monitor airway, breathing, pulse, mental status closely.
Continued…
Emergency Care ofHead Injuries
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Control bleeding.
Do not apply pressure to open or depressed skull injury.
Transport immediately.
Reassess vital signs every 5 min.
Emergency Care ofHead Injuries
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Spinal InjurySpinal Injury
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanisms of Spinal Injury
Motor vehicle crashes
Auto-pedestrian collisions
Falls (especially 3+ times patient’s height)
Blunt or penetrating trauma
Continued…
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Motorcycle crashes
Hangings
Diving accidents
Unconscious trauma patients
Continued…
Mechanisms of Spinal Injury
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanisms ofMechanisms ofSpinal InjurySpinal Injury
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WhiplashWhiplash
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Types of Spinal Injuries
Compression
Distraction (pulling apart)
Lateral bending
Flexion, rotation, extension
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Signs & Symptoms of Spinal Injuries
Paralysis of the extremities
Pain with or without movement
Tenderness along the spine
Continued…
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Loss of sensation
Impaired breathing
“C–3, –4, –5 keep the diaphragm alive”
Continued…
Signs & Symptoms of Spinal Injuries
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Deformity along spine (rare)
Posturing
Priapism
Incontinence
Signs & Symptoms of Spinal Injuries
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Assessing Spinal Injury
Questions to ask:
What happened?
Where does it hurt?
Does your neck or back hurt?
Continued…
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Questions to ask:
Can you move your hands and feet?
Can you feel me touching your fingers? Toes?
Assessing Spinal Injury
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Assess sensation in all extremities.Assess sensation in all extremities.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Assess motor function.Assess motor function.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Assess strength Assess strength –– feet. feet.
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Assess strength Assess strength –– hands. hands.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Treating Spinal Injury
Take BSI precautions.
Instruct the patient not to move.
Stabilize cervical spine & ABCs.
Evaluate mechanism of injury.
Evaluate hand grip and foot strength.
Continued…
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Assess pulse, movement, and sensation in extremities.
Assess the neck and spine.
Administer high-concentration oxygen.
Continued…
Treating Spinal Injury
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Apply properly sized cervical spine immobilization device.
Apply and secure patient to appropriate immobilization device.
Continued…
Treating Spinal Injury
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
If proper size collar is not available, use rolled towel and tape.
Pad around child as necessary to maintain stabilization.
Treating Spinal Injury
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
SpinalSpinalImmobilizationImmobilization
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Applying aCervical SpineImmobilization
Device
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Stabilize and measure.Stabilize and measure.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Choose correct collar size.Choose correct collar size.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Prepare collar.Prepare collar.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Slide collar under chin.Slide collar under chin.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Secure collar; maintain in-line position.Secure collar; maintain in-line position.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Use of ShortSpine Boards:Seated Patient
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Short Spine Boards
Vest type
Rigid short spine board
Stabilize head, neck, torso
Used for noncritical, seated patient
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Select immobilization device.Select immobilization device.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Manually stabilize patient’s head in Manually stabilize patient’s head in neutral, in-line position.neutral, in-line position.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Assess distal pulse, motor function, and Assess distal pulse, motor function, and sensation (PMS).sensation (PMS).
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Apply the appropriately sized extrication Apply the appropriately sized extrication collar.collar.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Position the device behind patient.Position the device behind patient.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Secure device to patient’s torso.Secure device to patient’s torso.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Evaluate and pad behind patient’s head Evaluate and pad behind patient’s head as necessary. Secure patient’s head to as necessary. Secure patient’s head to device.device.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Evaluate and adjust straps. As needed, Evaluate and adjust straps. As needed, secure patient’s wrists and legs.secure patient’s wrists and legs.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Use of LongSpine Boards:Supine Patient
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Long Spine Boards
Stabilize head, neck, torso, pelvis, and extremities.
May be applied in:
Lying, standing, and sitting positions
Conjunction with short spine boards
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Maintain stabilization; apply collar.Maintain stabilization; apply collar.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Prepare and position device.Prepare and position device.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Move patient onto board. Apply padding Move patient onto board. Apply padding to voids.to voids.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Secure the body, then the patient’s head.Secure the body, then the patient’s head.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Reassess PMS.Reassess PMS.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Use of LongSpine Boards:
Standing Patient
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Maintain stabilization; apply collar.Maintain stabilization; apply collar.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Position boardPosition boardand EMTand EMT––Bs.Bs.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Grasp the boardGrasp the boardafter reaching after reaching under the patient’sunder the patient’sshoulders.shoulders.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Carefully Carefully lower patient; lower patient; then secure then secure the board.the board.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Rapid ExtricationRapid Extrication
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Unsafe scene
Unstable patient condition
Patient blocks EMT–B’s access to an unstable patient
Indications
Rapid Extrication
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Manually stabilize; apply collar.Manually stabilize; apply collar.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
After putting end of board next to patient, After putting end of board next to patient, position hands on legs/pelvis and position hands on legs/pelvis and chest/arms.chest/arms.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Rotate patient and reposition hands.Rotate patient and reposition hands.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Lower patient to board.Lower patient to board.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Move patient into position on board.Move patient into position on board.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Secure patient and transport.Secure patient and transport.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Helmet RemovalHelmet Removal
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Indications to Leave Helmet in Place
Good fit, little movement
No current or expected airway problems
Removal would cause further injury
Continued…
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Proper immobilization is able to be performed
No airway or breathing concerns
Continued…
Indications to Leave Helmet in Place
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Inability to assess or treat airway and breathing
Improper fit/movement within helmet
Continued…
Indications for Removing Helmet
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Inability to immobilize spine
Cardiac arrest
Indications for Removing Helmet
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Stabilize head and helmet. Fingers Stabilize head and helmet. Fingers should be on patient’s mandible.should be on patient’s mandible.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Second EMTSecond EMT––B loosens strap.B loosens strap.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Transfer stabilization to second EMTTransfer stabilization to second EMT––B.B.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Carefully remove the helmet.Carefully remove the helmet.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Prevent head from falling once helmet Prevent head from falling once helmet is removed.is removed.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Begin routine stabilization and Begin routine stabilization and immobilization.immobilization.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
1. List the functions of the components of the nervous system.
2. What are some mechanisms of injury that could cause spinal injury?
Review Questions
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
3. List the signs and symptoms of a spinal injury.
4. What questions should you ask if you suspect a patient has a spinal injury?
Review Questions
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
5. Describe the emergency care steps for a patient with a spinal injury.
6. Explain when you would use a short spine board. A long spine board.
Review Questions
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
7. What are the indications for rapid extrication?
8. What are the indications for leaving a helmet in place? For removing a helmet?
Review Questions
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
9. List the signs and symptoms of
a head injury.
10. Describe the emergency care steps for a patient with a possible head injury.
Review Questions
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
What is your general impression of this patient?
What immediate treatment should be provided?
STREET SCENESSTREET SCENES
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
How should you monitor changing levels of responsiveness in a patient with a head injury?
STREET SCENESSTREET SCENES
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Sample DocumentationSample Documentation