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Neurological Injury Management

Neurological Injury Management. Objectives. Review the anatomy and physiology of the nervous system and spinal column Identify the types and mechanisms of head and spine injuries, and describe their features Describe the assessment of head and spine injuries. Neurological Injuries.

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Neurological Injury Management

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  1. Neurological Injury Management

  2. Objectives • Review the anatomy and physiology of the nervous system and spinal column • Identify the types and mechanisms of head and spine injuries, and describe their features • Describe the assessment of head and spine injuries

  3. Neurological Injuries • Responsible for one half of the deaths that occur secondary to trauma • The major cause of long-term disability • Caused most frequently by falls and MVA’s • Can be prevented in part by helmets

  4. Anatomy 101 • Neuron: nerve cell • Peripheral neurons (nerves outside of the brain and spinal cord) are sheathed with a protective fatty coating called myelin • Nerve impulses are transmitted across synapses (junctions)

  5. Anatomy 101 • Central Nervous System: Brain Spinal Cord

  6. Anatomy 101 • Peripheral Nervous System: spinal nerves and their branches

  7. Anatomy 201 • Meninges: protective triple layer cover • Dura mater = outer layer • Arachnoid= middle layer • Pia mater= inner layer • Cerebral spinal fluid circulates within the Arachnoid

  8. Anatomy 201 • Brain: Cerebrum Cerebellum Brainstem

  9. Anatomy 201 • Cranial Nerves: originate at base of the brain • Provide sensory/motor supply to the head & face

  10. Anatomy 201 • Motor nerves - brain to muscle units • Sensory nerves - skin back to brain

  11. Anatomy 301 • Somatic Nervous System: Voluntary

  12. Anatomy 301 • Autonomic Nervous System:Involuntary

  13. Traumatic Brain Injury • Severity depends on the amount of primary and secondary brain injury • Primary Injury:THE INITIAL TRAUMA • Main cause of secondary injury: HYPOXIA

  14. Traumatic BrainInjuries • Categories: Open or Closed Open Closed

  15. Traumatic Brain Injuries • Forces: Shearing and Compressive Shearing Compressive

  16. Types of Traumatic Brain Injury • Concussion:Temporary loss or alteration of part or all of the brain’s abilities to function, without apparent physical damage to the brain

  17. Types of Traumatic Brain Injury • Cerebral Contusion:Bruised Brain • Far more serious than a concussion! • Involves physical injury to the brain • May be long-lasting or permanent

  18. Types of Traumatic Brain Injury • Cerebral Hematoma or Bleed • Subdural • Intracerebral • Epidural

  19. Traumatic Brain InjuryGeneral Signs & Symptoms • Headache • Dizziness • Nausea/vomiting • Amnesia

  20. Traumatic Brain Injury General Signs & Symptoms • Decreasing level of responsiveness • Confusion • Combativeness • Loss of responsiveness

  21. Assessing Traumatic Brain Injuries Level of Responsiveness (LOR) • LOR usually corresponds to the extent of loss of brain function • Progressive deterioration usually indicates serious brain injury

  22. AVPU SCALE A=Alert V=Verbal P= Pain U=Unresponsive Obtain Baseline Monitor Frequently(q. 5-15 minutes) Assessing Traumatic Brain InjuriesLevel of Responsiveness (LOR)

  23. The Progressive Downward Spiral Brain Swelling  Increased Intracranial Pressure (ICP) Hypoxia Further Secondary Injury More Swelling Increased ICP

  24. Signs Of Increasing Intracranial PressureThe General Signs of Head Injury Described PreviouslyPLUS • Change in pupilsize and reactivity to light • Slowing pulse • Rising BP.

  25. Signs Of Increasing Intracranial PressureThe General Signs of Head Injury Described PreviouslyPLUS • Change in respiration • Unilateral weakness • Incontinence • Seizures

  26. Urgent Interventions • Presume C-Spine injury: immobilize neck • Open airway, administer oxygen • Do not hyperventilate • Treat bleeding and shock

  27. Urgent Interventions • Prevent aspiration of vomit/secretions • Transport immediately • Elevate head 6”, Transport head uphill

  28. The Spine • 33 vertebra – 7 cervical 12 thoracic 5 lumber 5 sacral 4 coccygeal

  29. The Spine Typical Vertebra

  30. Bony Spine InjurySigns & Symptoms • Usually produced by compression or bending trauma • Pain at injury site • Localized acute tenderness • Self-splinting or guarding • Deformity – usually not obvious

  31. Bony Spine InjurySigns & Symptoms Compression-Cervical 4

  32. Bony Spine Injury Signs & Symptoms Bending (Flexion) Trauma Cervical 5 on Cervical 6 Vertebra

  33. Spinal Cord Injury • Significance of spine injury depends whether spinal cord injured • Spinal Cord damage more common with neck injury than mid/lower back injury

  34. Spinal Cord Injury • Mechanism: axial compression, hyperextension, hyperflexion, rotation • The higher the cord injury, the more nerve fibers damaged Cervical 5 Thoracic 5

  35. Types of Spinal Cord Injuries • Paraplegia - paralysis of both legs • Quadriplegia - paralysis of both arms and both legs • Hemiplegia - paralysis of an arm and leg on the same side

  36. Spinal Cord Injury Signs and Symptoms • Abnormal sensation • Loss of sensation • Muscle weakness or paralysis

  37. Spinal Cord Injury Signs and Symptoms • Signs of neurogenic shock • Difficulty breathing • Incontinence • Priapism

  38. Emergency Care - Spine • Urgent interventions for obstructed airway, abnormal breathing, bleeding • Stabilize head and neck manually • Care for other injuries

  39. Emergency Care - Spine • Transfer to spine board with proper technique to minimize movement • Immobilize on long spine board with CID; apply cervical collar

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