Head and Head and Spinal TraumaSpinal Trauma

RIFLES RIFLES LIFESAVERSLIFESAVERS

Central Nervous Central Nervous System System The brain and spinal cord The brain and spinal cord

comprise the central nervous comprise the central nervous system (CNS)system (CNS)

The CNS is protected by bony The CNS is protected by bony structures, i.e., the skull and structures, i.e., the skull and spinal vertebraespinal vertebrae

Injuries of the CNS and its Injuries of the CNS and its protective structures can cause protective structures can cause death or paralysisdeath or paralysis

Principles of CNS Principles of CNS Injury CareInjury Care Observe principles of TCCCObserve principles of TCCC

– Care Under FireCare Under Fire– Tactical Field CareTactical Field Care– Casualty Evacuation CareCasualty Evacuation Care

Follow the ABCsFollow the ABCs Spine immobilization to avoid Spine immobilization to avoid

further injury to spinal cordfurther injury to spinal cord

Open Head InjuriesOpen Head Injuries

Due to penetrating or Due to penetrating or blunt traumablunt trauma

Signs and symptomsSigns and symptoms– Usually unconsciousUsually unconscious– Open skull fractureOpen skull fracture– Exposed brain tissueExposed brain tissue– Pupillary changesPupillary changes

Open head injuries are Open head injuries are usually catastrophic usually catastrophic and result in deathand result in death

Gunshot Wound to Gunshot Wound to HeadHead

Missile tract Missile tract with with fragments fragments and bloodand blood

Open Facial InjuriesOpen Facial Injuries

Brain may not be Brain may not be involved in facial involved in facial traumatrauma

Maintain a clear Maintain a clear airwayairway

Bleeding may be Bleeding may be profuseprofuse– STOP THE BLEEDING!STOP THE BLEEDING!

Apply cervical spine Apply cervical spine immobilization if immobilization if blunt traumablunt trauma

Impalement InjuriesImpalement Injuries

DO NOT REMOVE DO NOT REMOVE OBJECT OR EXERT OBJECT OR EXERT ANY FORCE UPON IT!ANY FORCE UPON IT!– Severe bleeding may Severe bleeding may

occur causing shockoccur causing shock Check pulses distal to Check pulses distal to

impaled objectimpaled object Immobilize the objectImmobilize the object Apply bulky support Apply bulky support

bandages to hold in bandages to hold in placeplace

Closed Head InjuriesClosed Head Injuries

Due to blunt traumaDue to blunt trauma Skull may be fracturedSkull may be fractured Severe brain injury Severe brain injury

may be present in may be present in absence of skull absence of skull fracturefracture

Underlying brain Underlying brain injury may be more injury may be more severe than severe than immediately apparentimmediately apparent

Signs and Symptoms Signs and Symptoms of Closed Head Injuriesof Closed Head Injuries

Deformity of headDeformity of head Blood or clear fluid Blood or clear fluid

from nose or earsfrom nose or ears ““Raccoon eyes”Raccoon eyes” Bruising behind earsBruising behind ears Pupillary changesPupillary changes Confusion or Confusion or

unconsciousnessunconsciousness HeadacheHeadache

Assessment of Head Assessment of Head InjuriesInjuries

Level of consciousness using AVPU scaleLevel of consciousness using AVPU scale– Alert: Converses spontaneously and Alert: Converses spontaneously and

appropriatelyappropriately– Verbal: Responds to verbal stimuliVerbal: Responds to verbal stimuli– Painful: Responds to painful stimuliPainful: Responds to painful stimuli– Unresponsive: Unresponsive to any stimuliUnresponsive: Unresponsive to any stimuli

Pupil sizePupil size– Pupils should be equal and constrict Pupils should be equal and constrict

vigorously to light stimulusvigorously to light stimulus Motor functionMotor function

– Strength should be normal and equal in all Strength should be normal and equal in all extremitiesextremities

PosturingPosturing

Occurs with severe brain injury Occurs with severe brain injury when patient is near deathwhen patient is near death

Treatment of Head Treatment of Head InjuriesInjuries

Remember ABCsRemember ABCs Apply cervical collar Apply cervical collar

if appropriateif appropriate Dress the head Dress the head

wound to control wound to control bleedingbleeding

Elevate head of Elevate head of litter to decrease litter to decrease pressure on brainpressure on brain

Evacuate to Evacuate to surgical assetssurgical assets

Spinal Cord InjuriesSpinal Cord Injuries

May occur with neck or back May occur with neck or back traumatrauma

Associated with blunt head Associated with blunt head trauma, especially when casualty trauma, especially when casualty is unconsciousis unconscious

Can occur with penetrating trauma Can occur with penetrating trauma of vertebral columnof vertebral column

Improper handling may cause Improper handling may cause further injuryfurther injury

Mechanisms Mechanisms of Spinal of Spinal InjuryInjury

HyperextensioHyperextensionn

HyperflexionHyperflexion CompressionCompression RotationRotation Lateral StressLateral Stress DistractionDistraction

Signs and Symptoms Signs and Symptoms of Spinal Cord Injuriesof Spinal Cord Injuries Neck or back painNeck or back pain Penetrating injury of neck or backPenetrating injury of neck or back Tenderness to palpation of spineTenderness to palpation of spine Loss of strength in extremitiesLoss of strength in extremities Loss of feeling in extremitiesLoss of feeling in extremities ParalysisParalysis IncontinenceIncontinence

Assessment of Spinal Assessment of Spinal Cord InjuriesCord Injuries Observe principles of TCCCObserve principles of TCCC

– ““The best medicine on any battlefield The best medicine on any battlefield is fire superiority”is fire superiority”

Follow the ABCsFollow the ABCs Maintain high index of suspicion Maintain high index of suspicion

for spinal cord injury in for spinal cord injury in appropriate settingappropriate setting

Secure and maintain spinal Secure and maintain spinal immobilization throughout immobilization throughout evacuationevacuation

Spinal ImmobilizationSpinal Immobilization

Immobilize the Immobilize the casualty’s head and casualty’s head and neck manuallyneck manually

Apply a cervical collar, if Apply a cervical collar, if available, or improvise available, or improvise oneone

Secure patient to short Secure patient to short spine board if extracting spine board if extracting from a vehiclefrom a vehicle

Secure head and neck Secure head and neck to spine board for to spine board for extractionextraction

Spinal ImmobilizationSpinal Immobilization

Transfer patient Transfer patient to long spine to long spine board as soon as board as soon as feasiblefeasible

Logroll in unisonLogroll in unison Stabilize head Stabilize head

and neck with and neck with sandbags or sandbags or rolled blanketsrolled blankets

Long Spine BoardLong Spine Board

Secure casualty to long spine Secure casualty to long spine board with straps across board with straps across forehead, chest, hips, thighs, and forehead, chest, hips, thighs, and lower legslower legs

Questions?Questions?