Head Neck and Spinal Injuries

April Morgenroth EMT, RN, BSN

Skull

mandible

Cervical Vertebrae (7)

Thoracic Vertebrae (12)

Lumbar Vertebrae (5)

Coccyx

Sacrum

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Central Nervous System

Brain

Spinal Cord

Controls basic essential body functions.

The Autonomic Nervous SystemThe autonomic nervous system controls the body’s involuntary

functions: digestion, heartbeat, respirations…Sympathetic Nervous System Parasympathetic Nervous System

Fight or Flight

Regulate the body’s response to danger or threat: •Vasoconstriction•Rapid Heartbeat•Deep Respirations•Dilated Pupils

Rest and Digest

The body’s resting state allowing metabolism and energy conservation:•Vasodilation•Increased blood flow to the gut•Slower Heartbeat•Lower Blood Pressure

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Anatomy of the Skull

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Mandible

CraniumSuturesCartilaginous joints which allow very little movement.

ZygomaticMaxilla

Ocular Orbits

Facial Trauma

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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.

Injury to the central nervous system can affect the body’s drive to breath.

Management of Facial Trauma

Establish and/or maintain the airway

Patient positioning, airway placement,

Have suction available to clear airway of:

bloodvomitsecretions

Look for and remove: Loose teethForeign Objects

Provide breathing support if needed: Bag valve mask

Provide supplemental oxygen as indicated

Monitor Vital signs and level of consciousness

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Head InjuriesOpen vs. Closed Head Injury

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.

Open and closed refer to the cranial bones and not the skin.

Basic Cranial Anatomy

Skull

Dura Mater

Arachnoid Layer

Pia Mater

Traumatic Brain InjuryConcussion

The symptoms are only temporary and there is no actual detectable damage to the brain.

Caused by force that is transferred through the skull to the brain.

May have brief loss of consciousness

Short term memory loss.

Nausea and vomiting

Headache

Traumatic Brain InjuryContusion (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.

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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.

Traumatic Brain Injury Hematoma

Hematoma: a collection of blood around tissue

Subdural Hematoma: blood lies just below the dura

Epidural Hematoma: blood lies between the skull and the dura

Intracerebral Hematoma:Blood collects inside the brain tissue

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Monroe Kelly Hypothesis“Closed Box Theory”

TissueBlood Cerebral Spinal

Fluid

Increased Pressure

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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

Emergency Care of Traumatic Brain Injury

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

Determine level of consciousness

Assume that any patient with a traumatic head injury also has a spinal injury.

Obtain IV access

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.

The patient with traumatic brain injury and increased intracranial pressure will need to be transferred to a referral

center for advanced care.

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Spinal Injuries

Fractures

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Dislocations

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Disc Injuries

Spinal Injuries

It is possible to have injury to the spinal column without having injury to the spinal cord.

Evaluate the patient for possible spinal injury:

Think Mechanism

Substantial force to the upper body.

Head and Spine InjuriesAssessment

Pupils: dilated, pinpoint, unequal

Breathing: may be shallow and slow, rapid, or absent

Loss of bladder of bowel control

Point Tenderness in the neck or spine

Nausea/Vomiting

Paralysis and/or altered sensation

Altered Level of consciousness

Head and Spine InjuriesOminous Signs

Posturing

Decorticate: flexed extremities, drawn in to toward the core.(increased ICP)

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Decerebrate: Extension of the extremities outward. (Cerebral hypoxia, brainstem injury or herniation)

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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

Emergency Care

Airway, Breathing, Circulation

Level of Consciousness

Evaluate and Treat for Shock

Start I.V.

Fluid Resuscitation

Spinal Immobilization

Monitor Lab Values

Foley Catheter

Supportive Care:Monitor for changes

Supplemental oxygenTreatment of pain

X-Ray

Spinal Immobilization

Hold c-spine in line and apply collar

Log roll the patient as a unit maintaining in line stabilization

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.

Spinal Immobilization

Place rolled towels on each side of the head

Tape across the forehead

Tape beneath the chin support of the collar to secure the head

If the patient vomits, tilt the backboard to the side.