head & spine injuries - shenandoah county · lumbar lower back 5 ... signs & symptoms of...
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Shenandoah Co. Fire & Rescue
Injuries to the Head the Head and Spine
December EMS Training
Bill Streett – Training
Section Chief
C.E. Card Information
• BLS Providers
• 2 Cards / Provider
• Category 1
• ALS Providers
• 2 Cards / Provider
• Category 1• Category 1
• Course # Blank
• Topic#’s 01403- 2(A)
01203
• Category 1
• Course # Blank
• Topic #’s 02580
02590
Contentsof the Skull
Bone
Dura mater
Arachnoid
Pia materSubarachnoid space
Subdural space
Intracerebral
Epidural space (potential)
Dura materArachnoid
Skull
Pia mater
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
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.
May occur due to clot or
hemorrhage
Can cause altered mental
status
Brain Injury – Nontraumatic
status
Signs and symptoms similar to
traumatic injury (but no
trauma)
Signs & Symptoms ofHead Injuries
Altered or decreased mental status
Irregular breathing patterns
Mechanism of injury present
Continued…
Contusion, laceration, hematoma,
or deformity to the skull
Blood/fluid from ears or nose
Signs & Symptoms ofHead Injuries
Blood/fluid from ears or nose
Bruising around eyes, behind ears
Continued…
Neurologic changes
Nausea and/or vomiting
Unequal pupil size
Signs & Symptoms ofHead Injuries
Unequal pupil size
Decreased heart rate and
increased blood pressure
Seizures
Emergency Care ofHead Injuries
BSI.
Maintain C-spine stabilization.
Assess and treat ABCs.Assess and treat ABCs.
Perform initial assessment.
Administer high-concentration
oxygen.
Continued…
Complete assessment.
Immobilize spine with cervical
collar.
Emergency Care ofHead Injuries
collar.
Monitor airway, breathing, pulse,
mental status closely.
Continued…
Control bleeding.
Do not apply pressure to open or
depressed skull injury.
Emergency Care ofHead Injuries
depressed skull injury.
Transport immediately.
Reassess vital signs every 5 min.
Mechanisms of Spinal Injury
Motor vehicle crashes
Auto-pedestrian collisions
Falls (especially 3+ times patient’s Falls (especially 3+ times patient’s
height)
Blunt or penetrating trauma
Continued…
Motorcycle crashes
Hangings
Diving accidents
Mechanisms of Spinal Injury
Unconscious trauma patients
Continued…
Types of Spinal Injuries
Compression
Distraction (pulling apart)
Lateral bending
Flexion, rotation, extension
Signs & Symptoms of Spinal Injuries
Paralysis of the extremities
Pain with or without movement
Tenderness along the spine
Continued…
Loss of sensation
Impaired breathing
Signs & Symptoms of Spinal Injuries
“C–3, –4, –5 keep the diaphragm
alive”
Continued…
Deformity along spine (rare)
Posturing
Priapism
Signs & Symptoms of Spinal Injuries
Priapism
Incontinence
Assessing Spinal Injury
Questions to ask:
What happened?
Where does it hurt?
Does your neck or back hurt?Does your neck or back hurt?
Continued…
Questions to ask:
Can you move your hands and
feet?
Can you feel me touching your
Assessing Spinal Injury
Can you feel me touching your
fingers? Toes?
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…
Assess pulse, movement, and
sensation in extremities.
Assess the neck and spine.
Treating Spinal Injury
Administer high-concentration
oxygen.
Continued…
Apply properly sized cervical
spine immobilization device.
Apply and secure patient to
appropriate immobilization device.
Treating Spinal Injury
appropriate immobilization device.
Continued…
If proper size collar is not
available, use rolled towel and
tape.
Pad around child as necessary to
Treating Spinal Injury
Pad around child as necessary to
maintain stabilization.
C-Spine Clearing Protocol (Age > 18)
Standard Trauma Evaluation
Immobilize Pt.NO
YES
NO
Reliable Pt. Hx. / Exam?Alert & Oriented, Not Intoxicated
Low Risk Mechanism of injury? Immobilize
YES
Immobilize Pt.
NO
Immobilze Pt.
YES
Normal
*Document "C-Spine clearingprotocol followed."
Consider NO Immobilization*
Normal sensory/motor exam.?Ability to move
Symmetrical movement of all extremitiesAssess light touch
Spine pain or tenderness?Palpate entire axial spine
May need to log roll
Alert & Oriented, Not IntoxicatedNo Psych. issues, Able to Comm.
No Head Injuries (includes+/- LOC)
Significant or High Risk Mech.
Of Injury• Ejection from vehicle.
• Death in same passenger compartment
• Falls of more than 15’ or three times pt. height
• Vehicle Rollover• Vehicle Rollover
• Vehicle-Pedestrian or Vehicle/Bicycle collision
• Motorcycle collision.
• Unresponsive or Altered Mental Status following collision.
• Penetrating injuries of the head, chest, or abdomen
Short Spine Boards
Vest type
Rigid short spine board
Stabilize head, neck, torso
Used for noncritical, seated patient
Manually stabilize patient’s head in Manually stabilize patient’s head in neutral, inneutral, in--line position.line position.
Assess distal pulse, motor function, and Assess distal pulse, motor function, and sensation (PMS).sensation (PMS).
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.
Evaluate and adjust straps. As needed, Evaluate and adjust straps. As needed, secure patient’s wrists and legs.secure patient’s wrists and legs.
Long Spine Boards
Stabilize head, neck, torso,
pelvis, and extremities.
May be applied in:
Lying, standing, and sitting Lying, standing, and sitting
positions
Conjunction with short spine
boards
Grasp the boardGrasp the boardafter reaching after reaching under the patient’sunder the patient’sshoulders.shoulders.
Unsafe scene
Unstable patient condition
Patient blocks EMT–B’s
access to an unstable
Indications
Rapid Extrication
access to an unstable
patient
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.
Indications to Leave Helmet in Place
Good fit, little movement
No current or expected airway
problemsproblems
Removal would cause further
injury
Continued…
Proper immobilization is able to be
performed
No airway or breathing concerns
Indications to Leave Helmet in Place
No airway or breathing concerns
Continued…
Inability to assess or treat airway
and breathing
Improper fit/movement within
Indications for Removing Helmet
Improper fit/movement within
helmet
Continued…
Stabilize head and helmet. Fingers Stabilize head and helmet. Fingers should be on patient’s mandible.should be on patient’s mandible.
1. List the functions of the
components of the nervous
system.
Review Questions
2. What are some mechanisms of
injury that could cause spinal
injury?
3. List the signs and symptoms of a
spinal injury.
4. What questions should you ask if
Review Questions
4. What questions should you ask if
you suspect a patient has a spinal
injury?
5. Describe the emergency care steps
for a patient with a spinal injury.
6. Explain when you would use a
Review Questions
6. Explain when you would use a
short spine board. A long spine
board.
7. What are the indications for rapid
extrication?
8. What are the indications for
Review Questions
8. What are the indications for
leaving a helmet in place? For
removing a helmet?
9. List the signs and symptoms of
a head injury.
10. Describe the emergency care
Review Questions
10. Describe the emergency care
steps for a patient with a
possible head injury.
What is your general impression of
STREETT SCENESSTREETT SCENES
this patient?
What immediate treatment should be
provided?
How should you monitor changing
STREETT SCENESSTREETT SCENES
levels of responsiveness in a patient
with a head injury?