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

Anatomy ReviewAnatomy Review

NervousNervousSystemSystem

Skull and Facial Bones

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 InjuriesHead Injuries

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.

Spinal InjurySpinal InjurySpinal InjurySpinal Injury

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…

Mechanisms Mechanisms ofof

Spinal InjurySpinal Injury

WhiplashWhiplash

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?

Assess sensation in all extremities.Assess sensation in all extremities.

Assess motor function.Assess motor function.

Assess strength Assess strength –– feet.feet.

Assess strength Assess strength –– hands.hands.

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

Apply aCervical SpineImmobilizationImmobilization

Device

Stabilize and measure.Stabilize and measure.

Choose correct collar size.Choose correct collar size.

Prepare collar.Prepare collar.

Slide collar under chin.Slide collar under chin.

Secure collar; maintain inSecure collar; maintain in--line position.line position.

Use of ShortSpine Boards:Spine Boards:Seated Patient

Short Spine Boards

Vest type

Rigid short spine board

Stabilize head, neck, torso

Used for noncritical, seated patient

Select immobilization device.Select immobilization device.

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).

Apply the appropriately sized extrication Apply the appropriately sized extrication collar.collar.

Position the device behind patient.Position the device behind patient.

Secure device to patient’s torso.Secure device to patient’s torso.

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.

Use of LongSpine Boards:Supine PatientSupine Patient

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

Maintain stabilization; apply collar.Maintain stabilization; apply collar.

Prepare and position device.Prepare and position device.

Move patient onto board. Apply padding Move patient onto board. Apply padding to voids.to voids.

Secure the body, then the patient’s head.Secure the body, then the patient’s head.

Reassess PMS.Reassess PMS.

Use of LongSpine Boards:

Standing PatientStanding Patient

Maintain stabilization; apply collar.Maintain stabilization; apply collar.

Position boardPosition boardand EMTand EMT––Bs.Bs.

Grasp the boardGrasp the boardafter reaching after reaching under the patient’sunder the patient’sshoulders.shoulders.

Carefully Carefully lower patient; lower patient; then secure then secure the board.the board.

Rapid ExtricationRapid Extrication

Unsafe scene

Unstable patient condition

Patient blocks EMT–B’s

access to an unstable

Indications

Rapid Extrication

access to an unstable

patient

Manually stabilize; apply collar.Manually stabilize; apply collar.

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.

Rotate patient and reposition hands.Rotate patient and reposition hands.

Lower patient to board.Lower patient to board.

Move patient into position on board.Move patient into position on board.

Secure patient and transport.Secure patient and transport.

Helmet RemovalHelmet RemovalHelmet RemovalHelmet Removal

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…

Inability to immobilize spine

Cardiac arrest

Indications for Removing Helmet

Stabilize head and helmet. Fingers Stabilize head and helmet. Fingers should be on patient’s mandible.should be on patient’s mandible.

Second EMTSecond EMT––B loosens strap.B loosens strap.

Transfer stabilization to second EMTTransfer stabilization to second EMT––B.B.

Carefully remove the helmet.Carefully remove the helmet.

Prevent head from falling once helmet Prevent head from falling once helmet is removed.is removed.

Begin routine stabilization and Begin routine stabilization and immobilization.immobilization.

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?

Sample DocumentationSample Documentation