1. Central Nervous System-Nervous system that is covered and protected by.

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1 Chapter 28 Head and Spine Trauma Introduction (1 of 2) The nervous system is a compex network of ces that enabes a parts of the body to function. Incudes: Brain Spina cord Severa biion nerve fibers Introduction (2 of 2) The nervous system is we protected. The brain is protected by the. The spina cord is protected by the spina cana. Despite this protection, serious injuries can damage the nervous system. The Nervous System The nervous system contros virtuay a of our body activities incuding refex, vountary, and invountary activities Vountary activities are action that we consciousy perform (ie, passing a dish) Invountary activities are actions that are not under our contro (ie, body functions) Body functions are controed by the nervous system Nervous System 2 Anatomica Parts of the Nervous System: 1. Centra Nervous System-Nervous system that is covered and protected by. 2. Periphera Nervous System-Cabe of nerve fibers that ink the to the various organs of the body 1

2 6 7 to the various organs of the body Anatomy and Physioogy Centra Nervous System Components of the Centra Nervous System (CNS): 1. The brain 2. The cord The Brain The Brain is the controing organ of the body Cerebrum-Largest area of the brain Divided into -fronta, parieta, tempora, and occipita One side contros activities of the opposite side of the body Contros higher functions-senses, motor activities, reasoning, memory, and emotions The Brain Cerebeum- Litte Brain Contros, baance, and coordination of skied movements Brain Stem Most protected part of the CNS Contros functions necessary for ife respirations, digestion, etc. The Brain The Spina Cord Located in spina cana created by the vertebrae of the spine Transmits message between the brain and Made up of fibers that extend from the brain s nerve ces Protective Coverings of the Nervous System 3 Layers of Meninges 1. Dura Mater: outer ayer, tough & fibrous 2. Arachnoid: midde ayer 2

3 1. Dura Mater: outer ayer, tough & fibrous 2. Arachnoid: midde ayer 3. Pia Mater: inner ayer Cerebrospina Fuid: Between and pia mater Brain and spina cord foat in CSF Cear and watery Protective Coverings Cerebrospina Fuid Produced in a chamber inside the brain caed the third ventrice Approximatey 125 to 150 ml of in the brain at one time Primariy acts as a shock absorber Periphera Nervous System PNS Consists of: 12 pair of crania nerves that serve the face and head 31 pair of spina nerves that connect the organs and musces to the spina cord Sensory nerves: senses of the body Motor nerves: causes musces to Connecting nerves: connects sensory and motor nerves Periphera Nervous System Functiona Divisions of the Nervous System Somatic Nervous System functions Autonomic Nervous System invountary functions Divisions of the Autonomic Nervous System 1.Sympathetic Nervous System 2.Parasympathetic Nervous System 3

4 Parasympathetic Nervous System Sympathetic Nervous System Body s response to and prepares body for threatening situations Caed Fight or Fight phenomenon Bood vesses constrict, heart rate rises, sweating occurs, pupis diate Parasympathetic Nervous System Non ife threatening functions of the body House keeping functions heart and respiratory rate Activities of the Nervous Systems Vountary activity requires conscious effort Invountary activity requires no conscious effort Refex activity impuse sent directy from the nerve to the motor nerve. Sensory and Connecting Nerves The connecting nerves in the spina cord form a refex arc. If a sensory nerve in this arc detects an irritating stimuus, it wi the brain and send a direct message to a motor nerve. The Sku (1 of 2) Composed of two groups of bones: the cranium, which protects the brain, and the facia bones The Sku (2 of 2) Cranium is composed of brain tissue, 10% bood suppy, and 10% CSF Four major bones make up the cranium: occiput, tempes, parieta regions, and fronta region Face is composed of 14 bones 4

5 regions, and fronta region Face is composed of 14 bones The Spina Coumn Body s centra supporting structure Has 33 bones Divided into five sections: Cervica Thoracic Lumbar Sacra Coccygea Spina Coumn Head Injuries Traumatic insut to the head that may resut in injury to soft tissue, bony structures, or the brain Account for more than of a traumatic deaths Fata injuries invariaby invove the brain. Be aert to the fact that the patient may have sustained additiona trauma. Head Injuries Cosed injuries The brain has been injured but there is no opening into the brain. Open injuries Often caused by trauma May be beeding and exposed brain tissue Types of Head Injuries acerations Sku fractures Brain injuries Medica conditions 5

6 Brain injuries Medica conditions Compications of head injuries Scap Lacerations Scap has a rich bood suppy and can ead to shock. There may be more serious, deeper injuries. Severe acerations can ead to de-goving injury Fod skin faps back down onto scap. Contro beeding by direct pressure. Scap De-Goving Sku Fractures Indicates significant force; may be open or cosed depending on whether there is an overying aceration of the scap Signs incude: Obvious deformity Visibe crack in the sku eyes Batte s sign Raccoon Eyes Batte s Sign Linear Sku Fracture Most common sku fx Often shows no signs Depressed Sku Fracture High energy impact Most commony on the fronta and parieta bones Fragments may be driven into Basiar Sku Fracture High-energy trauma Usuay foowing diffuse impact to the head Signs incude drainage from the ears, raccoon eyes, and Batte s sign 6

7 Signs incude drainage from the ears, raccoon eyes, and Batte s sign Open Sku Fracture Resut when severe forces are appied to the head Often associated with trauma to mutipe body systems tissue may be exposed to the environment Traumatic Brain Injury (1 of 4) Most serious of a head injuries Two broad categories: primary (direct) injury and secondary (indirect) injury Primary brain injury resuts from impact to the head. Secondary brain injury increases the severity of the primary injury. Traumatic Brain Injury (2 of 4) Secondary injury may be caused by: Hypoxia Hypotension Cerebra edema Intracrania Increased intracrania pressure Cerebra ischemia Infection Traumatic Brain Injury (3 of 4) The brain can be injured directy by a penetrating object or indirecty as a resut of externa forces. A injury can resut from striking a windshied. Initia impact injures front part of brain Head faing back against headrest injures rear part of brain Traumatic Brain Injury (4 of 4) Cerebra edema (sweing of the brain) may not deveop unti severa foowing the initia injury. 7

8 Cerebra edema (sweing of the brain) may not deveop unti severa foowing the initia injury. Intracrania Pressure (ICP) Accumuations of bood within the sku or sweing of the brain can rapidy ead to an increase in ICP. Increased ICP squeezes the brain against bony prominences within the cranium Since the sku is rigid the brain Intracrania Pressure Signs of increased intracrania pressure Abnorma respiratory patterns Decreased puse rate, headache, nausea, vomiting, decreased aertness,, suggish or nonreactive pupis, decerebrate posturing, and increased or widened bood pressure refex Intracrania Beeding Laceration or rupture of bood vesse in brain Epidura hematoma: Accumuation of bood between the sku and mater Subdura hematoma: Accumuation of bood beneath the dura mater but outside the brain Intracerebra hematoma: Beeding within the brain tissue itsef Intracrania Pressure (1 of 3) Epidura hematoma Accumuation of bood between the sku and dura mater Neary aways the resut of a bow to the head Produced by a inear fracture of the thin tempora bone Intracrania Pressure (2 of 3) Subdura hematoma Accumuation of bood beneath the mater but outside the brain Occurs after fas or injuries invoving strong deceeration forces 8

9 Occurs after fas or injuries invoving strong deceeration forces Intracrania Pressure (3 of 3) Intracerebra hematoma Beeding within the tissue itsef Can occur foowing a penetrating injury to the head or because of rapid deceeration forces Subarachnoid Hemorrhage Subarachnoid hemorrhage Beeding occurs into the subarachnoid space, where the circuates. Resuts in boody CSF and signs of meningea irritation Common causes incude trauma or rupture of an aneurysm. Concussion (1 of 2) Brain can sustain when sku is struck There wi be beeding and sweing. Beeding wi increase the pressure within the sku. Considered a mid TBI Concussion (2 of 2) Temporary oss or ateration in brain function May resut in unconsciousness, confusion, or amnesia About of patients do not experience a oss of consciousness Assume that a patient with signs or symptoms of concussion has a more serious injury unti proven otherwise. S/S of Concussion Dizziness Weakness changes Nausea and vomiting Deay of motor functions Inappropriate emotiona responses 9

10 Deay of motor functions Inappropriate emotiona responses Ringing in the ears Surred speech Inabiity to focus Lack of coordination Temporary headache Disorientation Contusion More serious than a concussion Invoves physica to brain tissue May sustain ong-asting and even permanent damage A patient may exhibit any or a of the signs of brain injury. Other Brain Injuries Brain injuries are not aways caused by trauma. Medica conditions may cause spontaneous beeding in the brain. Signs and symptoms of injuries are the same as those of traumatic injuries. There is no mechanism of injury. Compications of Head Injury Cerebra edema Convusions and seizures Vomiting Leakage of fuid Assessing Head Injuries Common causes: -Motor vehice crashes -Direct bows - from heights -Assaut -Sports Injuries Evauate and monitor eve of consciousness 10

11 Sports Injuries Evauate and monitor eve of consciousness Types of Head Injuries Cosed: Sku is intact Major concern is sweing Open: Sku is penetrated or fractured Causes ess sweing Causes damage to brain tissue Signs and Symptoms (1 of 4) Lacerations, contusions, hematomas to scap Soft areas or upon papation Visibe sku fractures or deformities Ecchymosis around eyes and behind the ear Cear or pink CSF eakage Signs and Symptoms (2 of 4) Faiure of pupis to respond to ight Unequa pupis Loss of sensation and/or motor function Period of Amnesia Seizures Signs and Symptoms (3 of 4) Numbness or tinging in the extremities Irreguar respirations Dizziness Visua compaints or abnorma behavior Nausea or vomiting Signs and Symptoms (4 of 4) Vita Signs of a cosed head injury (Cushing s triad): BP Sowing Puse 11

12 BP Sowing Puse Irreguar respirations An isoated head injury wi NOT produce S/S of hypovoemic shock. If S/S of hypovoemic shock exists, ook esewhere! Leve of Consciousness Change in eve of consciousness is the singe most important observation. Use the scae or Gasgow Coma Scae (depending on oca protocos) Reassess Every 15 minutes if patient is stabe. Every 5 minutes if patient is unstabe. Change in Pupi Size Unequa pupi size may indicate increased pressure on one side of the brain. Care of Head Injuries (1 of 2) Estabish an adequate airway. Use jaw thrust maneuver Do not hyperventiate the patient Provide high concentration of oxygen Contro beeding not drainage Assess the patient s eve of consciousness. Care of Head Injuries (2 of 2) Be prepared for vomiting Contro spine Move patient as itte as possibe If patient is combative, contact Paramedic backup to sedate the patient (if aowed) Rapid transport Spine Injuries Compression injuries occur from a. Motor vehice crashes or other types of trauma can overextend, fex, or rotate the spine. Hyperextension: When spine is pued aong its ength; causes 12

13 or rotate the spine. Hyperextension: When spine is pued aong its ength; causes injuries. Hangings are an exampe. Significant Mechanisms of Injury (MOI) Motor vehice crashes Pedestrian-motor vehice coisions Fas Bunt or trauma Motorcyce crashes Hangings Diving accidents Recreationa accidents Questions to Ask Responsive Patients Does your neck or back hurt? What happened? Where does it hurt? Can you move your and feet? Can you fee me touching your fingers? Your toes? Signs and Symptoms of Spina Injury Pain or tenderness of spine Deformity of spine Tinging in the extremities Loss of sensation or paraysis Injuries to the head Priapism in maes Location of Spina Injuries Paraysis around shouder eve and beow indicates injury at area (Quadripegia) Paraysis around waist and beow indicate injury at the L1 area (Parapegia) 13

14 (Parapegia) Care of Spina Injuries Foow BSI precautions. Manage the airway. -Perform the jaw-thrust maneuver to open the airway. -Consider inserting an oropharyngea airway. -Administer oxygen. Stabiize the spine. When to Immobiize?? The most important indicator of a possibe spina injury is the If the MOI is capabe of causing a spina injury, immobiize the patient When in doubt?????? IMMOBILIZE Appying a Cervica Coar (1 of 2) One EMT-B provides continuous in-ine support of the head. Measure the proper size coar. Appying a Cervica Coar (2 of 2) Pace the chin support snuggy under the chin. Wrap the coar around the neck. Ensure that the coar fits. Stabiization of the Cervica Spine (1 of 2) Hod head firmy with both hands. Support the ower jaw. Move to position. Support head whie partner paces cervica coar. Maintain the position unti patient is secured to a backboard. Stabiization of the Cervica Spine (2 of 2) Do not force the head into a neutra, in-ine position if: Musces spasm increases Numbness, tinging, or weakness deveop There is a compromised airway or breathing 14

15 Numbness, tinging, or weakness deveop There is a compromised airway or breathing Preparation for Transport: Supine Patients (1 of 2) Maintain in-ine stabiization. Have the other team members position the immobiization device. patient. Preparation for Transport: Supine Patients (2 of 2) Secure patient to backboard. Reassess puse, motor, and sensory function in each extremity and continue to do so periodicay. Preparation for Transport: Sitting Patients (1 of 2) Maintain manua in-ine stabiization. Appy a coar. Pace a short board behind patient. Position device around patient. Preparation for Transport: Sitting Patients (2 of 2) Turn patient and ower to ong backboard. Secure short and ong backboards together. Reassess the puse, motor function, and sensation. Preparation for Transport: Standing Patients Stabiize the head and neck and appy a c-coar. Position board patient. Carefuy ower the patient to the ground. Backboards Short backboards Used on patients found in a sitting position Long backboards Provide immobiization Hemet Remova (1 of 7) Is the airway cear and is the patient breathing adequatey? 15

16 Is the airway cear and is the patient breathing adequatey? Can airway be maintained and assisted with hemet in pace? How we does the hemet fit? Can the patient move within the hemet? Can the spine be immobiized in a neutra position with the hemet on? Hemet Remova (2 of 7) A hemet that fits we prevents the head from moving and shoud be eft, as ong as: There are no impending airway or breathing probems It does not interfere with assessment and treatment of the airway You can propery immobiize the spine Hemet Remova (3 of 7) Preferred method Removing a hemet shoud aways be at east a job. You shoud first consut with medica contro about your decision to remove a hemet. Hemet Remova (4 of 7) Open the face shied. Prevent head movement. Partner paces hands. Genty sip hemet off. Hemet Remova (5 of 7) Partner sides hands from occiput to back of head. Remove hemet. Stabiize. Appy cervica coar. Pad as needed. Transport hemet and safety devices Hemet Remova (6 of 7) Aternate method The advantage is that it aows the hemet to be removed with the 16

17 89 90 Aternate method The advantage is that it aows the hemet to be removed with the appication of ess force; therefore, reducing the ikeihood of motion occurring in the neck. The disadvantage is that it is sighty more consuming. Hemet Remova (7 of 7) Aternate method (cont d) Remove the chin strap. Remove the face mask. Pop the jaw pads out of pace. Pace your inside the hemet. Hod the jaw with one hand and the occiput with the other. Insert padding behind the occiput. Pediatric Needs Immobiize a chid in the car, if possibe. Chidren may need extra padding to maintain immobiization. C-coar not possibe with sma chidren 17