Head Neck and Spinal Injuries

1. Head Neck and Spinal Injuries April Morgenroth EMT, RN, BSN

2. Skull Cervical Vertebrae (7) mandible Thoracic Vertebrae (12) Lumbar Vertebrae (5) Sacrum Coccyx http://www.illustratorsonline.com/cousins/spinal.gif

3. Central Nervous System Brain Spinal Cord Controls basic essential body functions.

4. The Autonomic Nervous System The autonomic nervous system controls the body’s involuntary functions: digestion, heartbeat, respirations… lildarlinzkidzdolls.homestead.com/

5. Anatomy of the Skull Sutures Cartilaginous joints which allow very little movement. Cranium Ocular Orbits Zygomatic Maxilla Mandible http://www.daviddarling.info/images/skull.jpg

6. Facial Trauma Facial trauma may cause airway compromise . Decreased level of consciousness affects patients ability to protect the airway Assume that a patient with facial trauma may also have other head or spinal injuries. http://www.mothersagainstdogchaining.org/Assets/dillions-injury-face.jpg Injury to the central nervous system can affect the body’s drive to breath.

7. Management of Facial Trauma Establish and/or maintain the airway Patient positioning, airway placement, www.medicswithoutborders.org/images/Opening%2 Have suction available to clear airway of: blood vomit secretions Look forand remove: Loose teeth Foreign Objects Provide breathing support if needed: Bag valve mask Provide supplemental oxygen as indicated Monitor Vital signs and level of consciousness

8. Head Injuries Open vs. Closed Head Injury Open and closed refer to the cranial bones and not the skin. Open Head Injury: A head injury that involves a fracture to the cranium is an open head injury Closed Head Injury: Any head injury where the cranium remains intact is a closed head injury.

9. Basic Cranial Anatomy Skull Dura Mater Arachnoid Layer Pia Mater

10. Traumatic Brain Injury Concussion May have brief loss of consciousness Caused by force that is transferred through the skull to the brain. Short term memory loss. Nausea and vomiting Headache The symptoms are only temporary and there is no actual detectable damage to the brain.

11. Traumatic Brain Injury Contusion (Brain Bruise) A blow to the head causes the brain to hit the skull. In some cases the brain may actually “bounce” back injuring the back of the brain too. http://www.mdusd.k12.ca.us/adulted/ontrack/brain.htm Blood vessels on or in the brain are broken. Symptoms are similar to those of a concussion. Bleeding from a contusion may accumulate to form a hematoma. http://www.pathology.vcu.edu/WirSelfInst/neuro_medStudents/image/2561traumpix/21contgross.jpg

12. Traumatic Brain Injury Hematoma Hematoma: a collection of blood around tissue Epidural Hematoma: blood lies between the skull and the dura Subdural Hematoma: blood lies just below the dura Intracerebral Hematoma: Blood collects inside the brain tissue www.neurosurgery.ufl.edu/Images/3%20hematoma.jpg

13. Monroe Kelly Hypothesis “Closed Box Theory” Tissue Cerebral Spinal Fluid Blood http://www.hypertension-experts.com/Hypertension-bg.jpg Increased Pressure

14. Increased Intracranial Pressure Pressure builds up in the cranium Systemic blood pressure increases to allow perfusion to the head. Brain becomes hypoxic Carbon dioxide builds up and increases brain swelling Respiratory Depression

15. Emergency Care of Traumatic Brain Injury Determine level of consciousness Airway: Establish or maintain airway Breathing: May need to support breathing with oxygen and/or manual ventilations Look for signs of circulation: obtain vital signs Raise the head of a patient with traumatic brain injury to reduce intracranial pressure Obtain IV access Assume that any patient with a traumatic head injury also has a spinal injury.

16. Emergency Care of Traumatic Brain Injury In some cases the physician may be able to make a burr hole into the skull to allow for drainage of pooled fluids in the brain. http://content.answers.com/main/content/wp/en/thumb/f/f1/250px-Plate_20_6_20_extract_300px.jpeg The patient with traumatic brain injury and increased intracranial pressure will need to be transferred to a referral center for advanced care.

17. Spinal Injuries www.spineuniverse.com/.../2563/fracture-BB.gif Fractures www2.kumc.edu/neurosurgery/Spine2.jpg Dislocations http://www.chiro.org/chimages/diagrams/diskslip.jpg Disc Injuries

18. Spinal Injuries Evaluate the patient for possible spinal injury: Substantial force to the upper body. Think Mechanism It is possible to have injury to the spinal column without having injury to the spinal cord.

19. Head and Spine Injuries Assessment Nausea/Vomiting Pupils: dilated, pinpoint, unequal Point Tenderness in the neck or spine Altered Level of consciousness Loss of bladder of bowel control Breathing: may be shallow and slow, rapid, or absent Paralysis and/or altered sensation

20. Head and Spine Injuries Ominous Signs Posturing http://upload.wikimedia.org/wikipedia/en/thumb/2/2a/Decorticate.PNG/450px-Decorticate.PNG Decorticate: flexed extremities, drawn in to toward the core. (increased ICP) http://www.who.int/malaria/docs/images/hbsm_fig6.jpg Decerebrate: Extension of the extremities outward. (Cerebral hypoxia, brainstem injury or herniation)

21. Neurogenic Shock Damage to the brain and spinal cord Loss of Sympathetic Tone: Parasympathetic Nervous System is Unopposed Uncontrolled Vasodilation Low Blood Pressure Hypoperfusion: Shock

22. Emergency Care Level of Consciousness Airway, Breathing, Circulation Spinal Immobilization Evaluate and Treat for Shock Start I.V. Fluid Resuscitation Monitor Lab Values Foley Catheter X-Ray Supportive Care: Monitor for changes Supplemental oxygen Treatment of pain

23. Spinal Immobilization Log roll the patient as a unit maintaining in line stabilization Hold c-spine in line and apply collar Log roll patient back onto the backboard Secure chest, hips, legs, and then head Continue to hold the head until it is secured to the board.

24. Spinal Immobilization Place rolled towels on each side of the head If the patient vomits, tilt the backboard to the side. Tape across the forehead Tape beneath the chin support of the collar to secure the head