Chapter 12 Head and Spinal Injuries

Chapter 12Head and Spinal Injuries

Head Injuries

Any head injury is potentially serious.•Scalp wounds•Skull fractures•Brain injuries

Scalp Wounds

Scalp wounds bleed profusely because the scalp has many blood vessels.

Caring for Scalp Wounds (1 of 3)

• Apply direct pressure with a dry, sterile dressing.

• If dressing becomes blood filled, add another dressing on top.


• If skull fracture is suspected:• Apply pressure

around edges of wound and over broad area rather than on center of wound.


• Keep head and shoulders slightly elevated if spinal injury is not suspected.

• Seek medical care.

Skull Fracture

• A skull fracture is a break or crack in the cranium.

• May be open or closed• Difficult to determine without

X-ray or CT scan

Signs and Symptoms of a Skull Fracture (1 of 2)

• Pain at point of injury• Deformity of skull• Bleeding from ears

and nose• Cerebrospinal fluid

(CSF) leaking from ear or nose

• Discoloration around eyes

Courtesy of Rhonda Beck.

Signs and Symptoms of a Skull Fracture (2 of 2)

• Discoloration behind ear

• Heavy scalp bleeding if the skin is broken

• Penetrating wound © Scott Camazine/Photo Researchers, Inc.

Care for a Skull Fracture• Monitor breathing and begin

cardiopulmonary resuscitation (CPR) if necessary.

• Stabilize victim’s neck.• Elevate victim’s head and shoulders if no

spinal injury is suspected.• Cover wounds with a sterile dressing.• Apply pressure around edges of wound.

Brain Injuries (1 of 2)

• Injury to the brain causes most short- and long-term problems.

• Mishandling a victim could result in permanent damage or death.

• The brain will swell from bleeding when it is injured, and swelling can interfere with brain functioning.

Brain Injuries (2 of 2)

Brain injuries can be caused by:•A penetrating foreign object•Bony fragments from a skull fracture•The brain striking the inside of the skull

• Deceleration injury occurs when a person’s head hits a stationary object.

• Acceleration injury occurs when a person has been hit by a moving object.

Traumatic Brain InjuriesConcussions (1 of 4)

• Occur when a blow to the head alters the function of the brain

• Recovery can last from several minutes to months.

• Some symptoms may represent a blood clot pushing the brain against the skull.


Seek immediate medical care if:• Loss of consciousness• Persistent, worsening headache• Weakness, numbness, decreased

coordination• Vomiting or nausea• Slurred speech• Very drowsy or cannot be awakened• Increasingly confused, restless, or agitated


Seek immediate medical care if (cont’d):• Unusual behavior• One pupil is larger than the other.• Convulsions or seizures• Inability to recognize people or places• A child will not stop crying and cannot be

consoled.• A child will not nurse or eat.


Helmets should not be removed unless:•airway obstruction is suspected.•the helmet is so loose that you cannot stabilize the spine.

Other Traumatic Brain Injuries• Contusion: direct blow to the head • Coup-contrecoup: blow to the head that

causes a contusion at site of impact and hits brain to opposite side of head

• Diffuse axonal: shaking or strong rotation of the head that causes a tearing injury

• Penetration: a bullet, knife, or other sharp object enters the brain

Acquired Brain InjuriesDeveloped during or after birth and are not the result of injuries •Infection•Stroke•Tumors•Anoxia

Further Care of Brain Injuries (1 of 2)

Further care required if: • Headache lasts more than 1 or 2 days. • Nausea lasts more than 2 hours. • Vomiting occurs hours after initial episodes of

vomiting have stopped. • Victim cannot respond or appears confused

or disoriented after waking him or her every 2 hours.

Further Care of Brain Injuries (2 of 2)

Further care required if (cont’d):• Victim sees double, the eyes do not move

together, or one pupil appears larger than the other.

• The arms and legs are not as mobile. • Walking is unsteady.• Speech is slurred or victim cannot talk.• Victim suffers seizures or convulsions.

Eye Injuries

The eyes are easily damaged by trauma and should be examined by an ophthalmologist or other physician as soon as possible after injury.

Penetrating Eye Injuries

Penetrating eye injuries are severe injuries that result when a sharp object penetrates the eye.

Care for Penetrating Eye Injuries (1 of 2)

• Seek immediate medical care.

• Stabilize the object. • Use bulky dressings

or clean cloths. • Place a protective

paper cup or piece of cardboard folded into a cone over the affected eye.

Care for Penetrating Eye Injuries (2 of 2)

• For short objects:• Surround the eye without touching the

object with roller gauze bandage or cloths held in place with a roller bandage.

Blows to the Eye (1 of 2)

• Range in severity• A black eye occurs when blood vessels

around the eye rupture.

Blows to the Eye (2 of 2)

A fist, a ball, or other blunt object can break the bone.•Symptoms:

• Double vision• Inability to look upward

Care for Blows to the Eye• Apply an ice or cold pack for about

15 minutes. • Do not apply pressure to the eye. • Seek medical care immediately if

there is double vision, pain, or reduced vision.

Cuts of the Eye or LidThe signs of a cut eyeball or lid include the following:

• Cut appearance of the cornea or sclera

• Inner liquid filling of the eye may come out through the wound.

• Lid is cut.

Care for Cuts of the Eye or Lid

• If eyeball is cut, do not apply pressure.

• Apply a sterile or clean dressing with gentle pressure if only the eyelid is cut.

• Bandage both eyes lightly.

• Seek medical care.

Chemicals in the Eyes (1 of 2)

• Chemicals in the eyes can threaten sight.

• Alkalis cause greater damage than acids.

• Damage can occur in 1 to 5 minutes.

Chemicals in the Eyes (2 of 2)

Common alkalis:• Drain cleaners• Cleaning agents• Ammonia• Cement• Plaster• Caustic soda

Common acids:• Hydrochloric acid• Nitric acid• Sulfuric acid (battery

acid)• Acetic acid

Care for Chemicals in the Eyes• Keep eye open wide. • Flush with water.

• Warm water• At least 20 minutes • From the nose side • Victim should roll eye. • Loosely bandage eyes

with cold, wet dressings.

• Seek immediate medical care.

Eye Avulsion

• An eye avulsion is when the eye is knocked out of its socket.

• This is a very serious injury.

Care for Eye Avulsion• Cover eye loosely with sterile dressing

moistened with clean water. • Do not try to push eyeball back in

socket. • Protect the injured eye. • Cover undamaged eye. • Seek medical care immediately.

Loose Objects in the Eye

Loose objects in the eye are the most frequent eye injury and can be very painful.

Care for Loose Objects in the Eye (1 of 2)

• Lift upper lid over lower lid and blink. • Flush out object with warm water.• Examine lower lid by pulling it down gently.

• Remove object with moistened sterile gauze or clean cloth.

Care for Loose Objects in the Eye (2 of 2)

• Examine underside of upper lid. • Grasp lashes of upper lid. • Place matchstick or cotton-tipped swab

across upper lid. • Roll lid upward over stick or swab.• Remove visible object with moistened

sterile gauze or clean cloth.

Light Burns to the Eye

• Burns can result if a person looks at a source of ultraviolet light.

• Severe pain occurs 1 to 6 hours after exposure.

Care for Light Burns to the Eye

• Cover both eyes with cold, wet packs.• Do not rub the eyes.• Rest in a darkened room.• Do not allow light to reach burned eyes. • Give pain medication, if needed. • Seek medical care.

Ear Injuries• Most ear problems are not life-threatening. • Only disk batteries and live insects must

be removed immediately. • First aiders should seek medical care for

the victim.

Insect Removal

• Shine a light into the ear. • Place several drops of light mineral oil

or vegetable oil into the ear. • Carefully irrigate the ear with warm

water when the insect is near the opening.

• Suck out the insect with a bulb syringe. • Seek medical care if the insect cannot

be removed.

Objects in Ears

• If an object is visible near the ear canal opening, cautiously remove the object with tweezers.

• Small objects can sometimes be removed by irrigating with warm water.

• Do not irrigate vegetable matter.

Nosebleeds• Anterior nosebleeds (from front of nose):

• Most common• Blood flows from one nostril.

• Posterior nosebleeds (from back of nose):• Involve massive bleeding• Blood usually flows backward into the mouth

or down the back of the throat. • Requires medical care

Care for Anterior Nosebleeds• Keep head higher

than level of the heart.

• Sit and lean slightly forward.

• Pinch the soft parts of the nose together.

• Continue compressing for 5 to 10 minutes.

• Apply ice pack to the nose and cheeks.

If Bleeding Continues (1 of 2)

• Gently blow the nose to clear blood clots. • Spray a decongestant spray into nostril.• Pinch the nose again for 10 minutes.

If Bleeding Continues (2 of 2)

Seek medical care if:• The nosebleed continues.• Bleeding cannot be stopped or keeps

reappearing. • Bleeding is rapid or blood loss is large.• Weakness or fainting is present. • Blood begins to go down back of throat rather

than out front of nose.

Care After a Nosebleed• Sneeze through an open mouth. • Avoid too much physical activity. • Elevate head when lying down. • Keep nostrils moist; apply petroleum

jelly just inside the nostrils for 1 week. • Increase humidity in bedroom during

winter months.• Avoid picking or rubbing the nose.

Recognizing a Broken Nose

• Pain, swelling, and a possible crooked appearance

• Bleeding and difficulty breathing through the nostrils

• Black eyes appearing 1 to 2 days after injury

Care of a Broken Nose

• Seek medical care.• Give care for a nosebleed if

necessary.• Apply ice pack to nose for 15-

minute intervals.• Do not try to straighten a crooked

nose.

Care for Objects in the Nose• Induce sneezing.• Have victim gently blow the nose

while gently compressing one nostril.

• Use tweezers to pull out visible objects.

• Seek medical care if the object cannot be removed.

Dental Injuries

An object might be caught between the teeth if the victim says there is something caught between his or her teeth even if it is difficult to see.

Care for Objects Caught Between the Teeth

• Try to remove object with dental floss.

• Do not try to remove object with a sharp or pointed instrument.

• If unsuccessful, seek dental care.

Recognizing a Bitten Lip or Tongue

Signs of a bitten lip or tongue include:• Immediate pain when it happens• Blood may be seen.

Care for a Bitten Lip or Tongue

• Apply direct pressure with sterile gauze or a clean cloth.

• Clean area with a cloth.• Apply ice pack or have victim suck on

a popsicle or ice chips if there is swelling.

• If bleeding does not stop, seek medical care.

Loosened Tooth

Trauma can cause teeth to become loosened. Any tooth movement indicates a possible loose tooth.

Care for a Loosened Tooth

• Have victim bite down on a piece of gauze.

• Consult a dentist or an oral surgeon.

Knocked-Out Tooth• A knocked-out tooth is a dental

emergency. • Time is crucial. • Prevent the tooth from drying and

protect the ligament fibers from damage.

Care for a Knocked-Out Tooth• Rinse mouth.• Put a rolled gauze

pad in the socket. • Find tooth, and

handle by the crown.

• A tooth can often be reimplanted if it is replaced within 30 minutes after injury.

Transporting a Knocked-Out Tooth

• Do not transport a tooth dry. • Use victim’s saliva for less than an hour. • Use whole milk for 3 hours. • The best medium is Hank’s solution. • A tooth may be kept in an older victim’s

mouth for transportation.

Care for a Knocked-out Toothin a Remote Location

• Try to replace the tooth into the socket. • Apply pressure on the tooth so that the

top is even with the adjacent teeth. • Do not use this method for children or

others who may swallow the tooth.

Broken Tooth

• Front teeth are frequently broken by falls or direct blows.

Care for a Broken Tooth• Rinse the mouth with warm water. • Apply an ice pack on the face in

the area of the injured tooth. • Stabilize the jaw if a jaw fracture is

suspected. • Seek immediate dental care.

Toothache• The most common reason is

dental decay.• Victims frequently complain of

pain limited to one area. • Pain can also affect the ear,

eye, neck, or opposite side of the jaw.

Care for a Toothache• Rinse mouth with warm water.• Use dental floss to remove any food.• Paint the tooth using a small cotton

swab with oil of cloves or Orajel if you suspect a cavity.

• Give acetaminophen or ibuprofen.• Seek dental care.

Spinal Injuries (1 of 2)

• The spine is a column of vertebrae stacked from the tailbone to the base of the skull.• Consists of long tracts of nerves that join the

brain with all other body organs and parts• If a broken vertebra pinches spinal nerves,

paralysis can result.

Spinal Injuries (2 of 2)

• Suspect spinal injury whenever significant cause of injury occurs.

Signs and Symptoms of a Spinal Injury

• Pain radiating into the arms or legs • Neck or back pain • Numbness, tingling, weakness,

burning, or lessened sensation in the arms or legs

• Loss of bowel or bladder control • Paralysis of the arms or legs• Deformity

Questions to Ask a Responsive Victim (1 of 3)

• Is there pain?• Can you wiggle your

fingers?• Can you feel

pressure on your finger?


• Can you squeeze my hand?

• Can you wiggle your toes?


• Squeeze victim’s toes.

• Can you push your foot against my hand?

Treating an Unresponsive Victim (1 of 2)

• Look for cuts, bruises, and deformities.

• Pinch victim’s hand.

• Pinch victim’s foot.

Treating an Unresponsive Victim (2 of 2)

• Use the Babinski test. • Ask bystanders what happened. • Assume victim has a spinal injury until proven

otherwise.

Care for Spinal Injuries• Monitor breathing. • Stabilize the victim.

• Grasp head over ears. • Hold head and neck

until EMS arrives.• Kneel with head

between your knees.• Place objects on each

side of head to prevent rolling.

Education

Chapter 12 Head and Spinal Injuries