Neurological Injury Management Neurological Injury Management

Neurological Injury Neurological Injury Management Management

ObjectivesObjectives

Review the anatomy and physiology of Review the anatomy and physiology of the nervous system and spinal columnthe nervous system and spinal column

Identify the types and mechanisms of Identify the types and mechanisms of head and spine injuries, and describe head and spine injuries, and describe their featurestheir features

Describe the assessment of head and Describe the assessment of head and spine injuriesspine injuries

Neurological InjuriesNeurological Injuries

Responsible for one half of the deaths that Responsible for one half of the deaths that occur secondary to traumaoccur secondary to trauma

The major cause of long-term disabilityThe major cause of long-term disability Caused most frequently by falls and MVA’sCaused most frequently by falls and MVA’s Can be prevented in part by helmetsCan be prevented in part by helmets

Anatomy 101Anatomy 101

NeuronNeuron: : nerve cellnerve cell Peripheral neurons (nerves outside of the Peripheral neurons (nerves outside of the

brain and spinal cord) are sheathed with brain and spinal cord) are sheathed with a protective fatty coating called a protective fatty coating called myelinmyelin

Nerve impulses are transmitted across Nerve impulses are transmitted across synapses synapses (junctions)(junctions)


Central Nervous System: Central Nervous System: Brain Spinal Cord Brain Spinal Cord


Peripheral Nervous Peripheral Nervous System: System: spinal nerves and spinal nerves and their branchestheir branches


Meninges: protective triple layer coverMeninges: protective triple layer cover Dura materDura mater = outer layer = outer layer ArachnoidArachnoid = middle layer= middle layer Pia materPia mater = inner layer= inner layer

Cerebral spinal fluid circulates within Cerebral spinal fluid circulates within the the ArachnoidArachnoid


Brain: Brain: CerebrumCerebrum CerebellumCerebellum BrainstemBrainstem


Cranial NervesCranial Nerves: originate : originate at base of the brainat base of the brain

Provide sensory/motor Provide sensory/motor supply to the supply to the head & facehead & face


Motor nerves - brain Motor nerves - brain to muscle unitsto muscle units

Sensory nerves - skin Sensory nerves - skin back to brainback to brain


Somatic Nervous System: Somatic Nervous System: VoluntaryVoluntary


Autonomic Nervous System:Autonomic Nervous System: InvoluntaryInvoluntary

Traumatic Traumatic Brain Brain InjuryInjury

Severity depends on the amount of primary Severity depends on the amount of primary and secondary brain injuryand secondary brain injury

Primary Injury:Primary Injury: THE INITIAL TRAUMATHE INITIAL TRAUMA Main cause of secondary injuryMain cause of secondary injury: : HYPOXIAHYPOXIA

Traumatic BrainTraumatic BrainInjuriesInjuries

Categories: Open or ClosedCategories: Open or Closed Open Open Closed Closed

Traumatic Brain Traumatic Brain

InjuriesInjuries Forces: Shearing and CompressiveForces: Shearing and Compressive

Shearing Shearing CompressiveCompressive

Types of Traumatic Types of Traumatic Brain InjuryBrain Injury

Concussion:Concussion: Temporary Temporary

loss or alteration of part loss or alteration of part

or all of the brain’s or all of the brain’s

abilities to function, abilities to function,

without apparent without apparent

physical damage physical damage

to the brainto the brain


Cerebral Contusion:Cerebral Contusion: Bruised BrainBruised Brain

Far more serious Far more serious than a concussion!than a concussion! Involves physical Involves physical injury to the braininjury to the brain May be long-lasting May be long-lasting or permanentor permanent


Cerebral HematomaCerebral Hematoma or Bleed or Bleed Subdural Subdural IntracerebralIntracerebral EpiduralEpidural

Traumatic Brain InjuryTraumatic Brain Injury General Signs & SymptomsGeneral Signs & Symptoms

HeadacheHeadache DizzinessDizziness Nausea/vomitingNausea/vomiting AmnesiaAmnesia

Traumatic Brain Injury Traumatic Brain Injury General Signs & SymptomsGeneral Signs & Symptoms

Decreasing level of Decreasing level of responsivenessresponsiveness

ConfusionConfusion CombativenessCombativeness Loss of Loss of responsivenessresponsiveness

Assessing Traumatic Brain Assessing Traumatic Brain Injuries Injuries

Level of Responsiveness (LOR)Level of Responsiveness (LOR)

LOR usually corresponds to the LOR usually corresponds to the extent of loss of brain functionextent of loss of brain function

Progressive deterioration Progressive deterioration usually indicates serious brain usually indicates serious brain injuryinjury

Assessing Traumatic Brain Assessing Traumatic Brain InjuriesInjuries

Level of Responsiveness (LOR)Level of Responsiveness (LOR) AVPU SCALEAVPU SCALE AA == AlertAlert VV == VerbalVerbal PP = Pain= Pain UU == UnresponsiveUnresponsive Obtain BaselineObtain Baseline Monitor FrequentlyMonitor Frequently

(q. 5-15 minutes)(q. 5-15 minutes)

The Progressive Downward SpiralThe Progressive Downward Spiral

Brain Swelling Brain Swelling

Increased Intracranial Pressure (ICP)Increased Intracranial Pressure (ICP)

HypoxiaHypoxia

Further Secondary InjuryFurther Secondary Injury

More SwellingMore Swelling

Increased ICPIncreased ICP

Signs Of Increasing Signs Of Increasing Intracranial PressureIntracranial PressureThe General Signs of Head The General Signs of Head Injury Described PreviouslyInjury Described Previously

PLUSPLUS Change in pupilChange in pupil

size and reactivitysize and reactivity to light to light

Slowing pulseSlowing pulse Rising BP.Rising BP.

Signs Of Increasing Signs Of Increasing Intracranial PressureIntracranial Pressure The General Signs of Head The General Signs of Head Injury Described PreviouslyInjury Described Previously

PLUSPLUS

Change in respirationChange in respiration Unilateral weaknessUnilateral weakness IncontinenceIncontinence SeizuresSeizures

Urgent Urgent InterventionsInterventions

Presume C-Spine injury: immobilize neckPresume C-Spine injury: immobilize neck Open airway, administer oxygenOpen airway, administer oxygen

Do not hyperventilateDo not hyperventilate Treat bleeding and shockTreat bleeding and shock

Urgent Urgent InterventionsInterventions

Prevent aspiration of vomit/secretionsPrevent aspiration of vomit/secretions Transport immediatelyTransport immediately

Elevate head 6”, Transport head uphillElevate head 6”, Transport head uphill

The SpineThe Spine

33 vertebra – 33 vertebra – 7 cervical7 cervical 12 thoracic 12 thoracic 5 lumber5 lumber 5 sacral5 sacral 4 coccygeal4 coccygeal

The SpineThe SpineTypical VertebraTypical Vertebra

Bony Spine InjuryBony Spine Injury Signs & SymptomsSigns & Symptoms

Usually produced by compression Usually produced by compression or bending trauma or bending trauma

Pain at injury sitePain at injury site Localized acute tendernessLocalized acute tenderness Self-splinting or guardingSelf-splinting or guarding Deformity – usually not obviousDeformity – usually not obvious

Bony Spine InjuryBony Spine Injury Signs & SymptomsSigns & Symptoms

Compression-Cervical 4 Compression-Cervical 4

Bony Spine Injury Bony Spine Injury Signs & SymptomsSigns & Symptoms

Bending (Flexion) TraumaBending (Flexion) Trauma Cervical 5 on Cervical 6 VertebraCervical 5 on Cervical 6 Vertebra

Spinal Cord InjurySpinal Cord Injury

Significance of spine injury Significance of spine injury depends whether spinal cord depends whether spinal cord injuredinjured

Spinal Cord damage more Spinal Cord damage more common with neck injury common with neck injury than mid/lower back injurythan mid/lower back injury

Spinal Cord InjurySpinal Cord Injury Mechanism: axial compression, Mechanism: axial compression,

hyperextension, hyperflexion, rotationhyperextension, hyperflexion, rotation The higher the cord injury, the more The higher the cord injury, the more nerve fibers damagednerve fibers damaged Cervical 5 Thoracic 5 Cervical 5 Thoracic 5

Types of Spinal Types of Spinal Cord InjuriesCord Injuries

Paraplegia - paralysis of both legsParaplegia - paralysis of both legs Quadriplegia - paralysis of both armsQuadriplegia - paralysis of both arms

and both legsand both legs Hemiplegia - paralysis of an arm andHemiplegia - paralysis of an arm and

leg on the same sideleg on the same side

Spinal Cord Injury Spinal Cord Injury Signs and SymptomsSigns and Symptoms

Abnormal sensationAbnormal sensation Loss of sensationLoss of sensation Muscle weaknessMuscle weakness

or paralysis or paralysis

Spinal Cord Injury Spinal Cord Injury Signs and SymptomsSigns and Symptoms

Signs of neurogenic Signs of neurogenic shockshock

Difficulty breathingDifficulty breathing IncontinenceIncontinence PriapismPriapism

EmergencyEmergency Care - Spine Care - Spine

Urgent interventions for Urgent interventions for obstructed airway, abnormal obstructed airway, abnormal breathing, bleedingbreathing, bleeding

Stabilize head and neck manuallyStabilize head and neck manually Care for other injuriesCare for other injuries

Emergency Care - SpineEmergency Care - Spine

Transfer to spine board with Transfer to spine board with proper technique to minimize proper technique to minimize movementmovement

Immobilize on long spine board Immobilize on long spine board with CID; apply cervical collarwith CID; apply cervical collar

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Neurological Injury Management Neurological Injury Management