May 2011 CE. Site code # E Head & Spinal Cord Trauma

Size: px

Start display at page:

Download "May 2011 CE. Site code # E Head & Spinal Cord Trauma"

Aldous Hensley
5 years ago
Views:

May 2011 CE Site code # 107200E-1211 Head & Spinal Cord Trauma Objectives by Mike Higgins, FF/PM Grayslake Fire Dept Program

1 May 2011 CE Site code # E-1211 Head & Spinal Cord Trauma Objectives by Mike Higgins, FF/PM Grayslake Fire Dept Program by Sharon Hopkins, RN, BSN, EMT-P To view on the Advocate Condell website visit: 1

2 Date of CE presentation: May 2011 Topic: Head & Spinal Cord Trauma Behavioral Objectives: Upon successful completion of this module, the EMS provider will be able to: 1. List risky behaviors contributing to brain and spinal cord injuries. 2. Describe typical injury patterns related to specific mechanisms of injury. 3. Describe the anatomy of the brain. 4. List contents of the skull. 5. Describe the mechanisms for the development of secondary brain injury. 6. Describe the pathophysiology of traumatic brain injuries including pressures related to brain blood flow. 7. Explain the normal anatomy and physiology of the spinal column and spinal cord. 8. Describe the pathophysiology of traumatic spinal cord injuries. 9. Describe components of a neurological assessment in the field. 10. List signs and symptoms of spinal cord injuries. 11. Describe the pathophysiology of neurogenic shock. 12. Describe prehospital treatment based on Region X SOP s of the patient with a head or spinal cord injury. 13. Review ventilation rates of the stable and unstable patients with head and/or spinal cord injuries. 14. Review the Region X Infield Spinal Clearance SOP. 15. Review measurement of fitting a cervical collar. 16. Review the procedure for demonstrating the standing backboard takedown procedure. 17. Demonstrate the proper measurement and placement of a cervical collar. 18. Demonstrate the standing take down with the back board. 19. Actively participate in case scenario discussion. 20. Successfully complete the post quiz with a score of 80% or better. References Bledsoe, B., Porter, R., Cherry, R. Paramedic Care Principles & Practices Third Edition. Brady Campbell, J.E. International Trauma Life Support for Prehospital Care Providers, 6th Edition. Brady Region X SOP March 2007; amended January 1,

3 Anatomy of the Skull Brain PAD to remember layers of meninges from inner to outer: P pia A arachnoid D - dura Lobes of the Cerebrum Cerebellum Brainstem 3

4 Activity by Lobe Frontal lobe behind forehead Emotions, reasoning, movement, planning, parts of speech, purposeful acts, creativity, judgment, problem solving, planning Parietal lobe behind frontal lobe, above temporal lobe, top of back of head Connected with processing of nerve impulses related to senses (touch, pain, taste, pressure, temperature), language formation Temporal lobe either side of brain above ears Right mainly involved with visual memory (pictures, faces) Left mainly involved with verbal memory (words, names) Hearing, memory, meaning, language. Role in emotions and learning. Interpretation and processing of auditory stimuli Occipital lobe back of brain Responsible for vision Involved with ability to recognize objects Cerebellum little brain lower part of brain next to occipital area and brain stem Controls movement, balance, posture, coordination, equilibrium, motor control, muscle tone, coordination of voluntary motor movement Brain stem base of brain Plays role in attention, arousal, consciousness. Sends and relays information. All information passes through this area to the brain or to the body Controls involuntary activities heart beat, digestion, breathing, blood pressure. Cushing s Reflex Protective response to preserve blood flow to the brain: B/P will increase Systolic B/P dramatically increasing as diastolic B/P stays same or increases Widening pulse pressure Heart rate will decrease Effort to lower elevating blood pressure Respirations may be irregular Note: vital signs move opposite to shock 4

Signs & Symptoms Head Injury Syndromes of Incomplete Spinal Cord Injury Central Cord Syndrome Most common injury associated with hyperextension.

5 Signs & Symptoms Head Injury Syndromes of Incomplete Spinal Cord Injury Central Cord Syndrome Most common injury associated with hyperextension. It is an inverse paraplegia: impairment of arms and hands and to a lesser extent, legs. Usual weakness in arms and legs are spared. Variable sensory loss. Anterior Cord Syndrome Most often associated with acute disk herniation or ischemia from an arterial occlusion. Below the injury lose motor function, pain sensation, and temperature sensation. Left intact is touch, proprioception (sense of position in space), and vibration. Brown-Sequard Syndrome Most commonly associated with penetrating trauma and spinal cord tumors. The spinal cord suffers a lateral insult. Ipsilateral (same side) loss of motor function, proprioception (sense of position in space), vibration, and light touch. Contralaterally (opposite side) loss of pain, temperature, and deep touch sensations. 5

Dermatomes of the Body Divisions of the surface of the skin. Area of skin whose sensory nerves all come from a single spinal nerve root. Spinal roots are in pairs anterior and posterior.

6 Dermatomes of the Body Divisions of the surface of the skin. Area of skin whose sensory nerves all come from a single spinal nerve root. Spinal roots are in pairs anterior and posterior. Anterior/motor root front of root carries impulses from spinal cord to the muscles to stimulate contraction. Posterior/sensory root root in back carries sensory information regarding touch, position, pain, temperature from the body to the spinal cord. Mapping responses following the dermatomes helps pinpoint area of spinal cord damage. Example: Can have neurological complaint in 4 th and 5 th fingers and not rest of fingers. Can have a neurological complaint on the inner thighs but not circumferential. Ventilation Rates for Head/Spinal Injuries Stable Patient Relatively stable patient needing BVM assistance with 100% O 2 Adult 10 breaths/min - 1 breath every 6 seconds Child 20 breaths/min - 1 breath every 3 seconds Infant 25 breaths/min - 1 breath every 2.5 seconds Ventilation Rates for Head/Spinal Injuries Unstable Patient Unstable patient with rapid neurological deterioration ventilate with BVM and 100% O 2 Adult 20 breaths/minute - 1 every 3 seconds Child 30 breaths/minute - 1 every 2 seconds Infant 35 breaths/min - 1 every 1.7 seconds 6

Glasgow Coma Scale There are many references available for the Glasgow Coma Scale. The scale for verbal responses need to be amended based on age of the patient.

7 Glasgow Coma Scale There are many references available for the Glasgow Coma Scale. The scale for verbal responses need to be amended based on age of the patient. Best response to eye opening and best motor response are basically the same in all age categories. Use the following table as a guide to calculate the GCS in the case scenarios in the packet. (GCS) 7

8 Case Studies For Discussion Read your case. Determine your general impression. Be prepared to defend your impression. Determine proper field care. Describe specifics to monitor for in the reassessments. Case Scenario #1 17 y/o patient injured at bike track- fell head first off bike Conscious, confused VS: B/P 92/50, P - 64, R - 14 Arms not moving; Legs move c/o pain to neck Skin warm & dry No allergies; no medications No medical history Last ate 2 hours ago Doesn t remember how he wiped out Reported have lost control speeding around track Upon arrival, bystanders holding c-spine No movement detected in upper extremities; lower ext move spontaneously If belly breathing noted (excessive use of abdominal muscles to breath) what would that indicate? Case Scenario #2 41 y/o male restrained driver T-boned by SUV Unconscious, shallow respirations Vital signs: B/P 146/82, P - 94, R - 32, SpO 2 94% Blood draining from left ear and left nares Diminished breath sounds on left Deformed left arm, left femur GCS: Eye opening none Verbal response moans Motor Withdrawing on left, no movement on right Repeat VS: B/P 168/72, P - 44, R - 16 Pupils: fixed/dilated left, right minimally reactive Raccoon eyes or Battle s signs indicate what? Case Scenario #3 60 y/o female riding her bike - hit pothole and fell off bike Helmet damaged Short loss of consciousness; asking repetitive questions; nauseated; complains of headache and blurred vision Vital signs: B/P132/78, P-98, R-20, SpO 2 99%; Pupils PERL GCS: eye opening spontaneous Verbal slightly confused Motor obeys commands 8

9 Case Scenario #4 5 y/o is vomiting, has headache, was acting bizarre Patient has an altered level of consciousness History of falling off jungle gym earlier today Initial loss of consciousness for few minutes then lucid; alert & oriented B/P 90/46, P - 104, R - 24 Nauseated GCS: Eye opening after calling their name Verbal response talking nonsense Motor response pulling at equipment with right hand, trying to get your hands off him Pupils - right slower to react, midsize Left extremities flaccid Bruise and swelling noted over right forehead above ear Minor scratches to bilateral arms Case Scenario #5 Patient presents to ED with FB stuck in head Awake, talking, following commands How do you immobilize this impaled object? Case Scenario #6 45 y/o male passenger - MVC involving a deer Patient unconscious Facial trauma evident Gurgling respirations Radial and carotid pulses noted regular and normal Vital signs: B/P 92/62, P-74, R-18 Pupils: right reactive, left non-reactive GCS: Eyes eyelids move when body touched Verbal silent Motor flexes right arm to pain, left arm straightens to pain Repeat VS: B/P 88/50, P-62, R-28 irregular File: CE, EMS; CE packets; 2011; May Head and Spinal Cord Injuries 9

10 10

11 Pre-Quiz Paramedic And Basic Level From May 2011 CE Material Head and Spinal Cord Trauma Name Date 1. Describe typical injury patterns for: - T-bone/lateral impacts - Rear impacts - Rollover - ATV s - Falls from heights landing on feet 2. Indicate the typical function associated with the lobes of the brain - Frontal lobe - Temporal lobe - Parietal lobe - Occipital lobe 3. Describe vital sign changes indicating increasing intracranial pressure (ICP) (Cushing s reflex): Blood pressure Pulse rate Changes of systolic B/P related to diastolic B/P 4. What are components of completing a neurological ( neuro ) exam in the field? 5. Describe vital sign changes for neurogenic shock: Blood pressure Pulse rate Skin parameters 11

12 Pre-quiz May 2011 Head & spinal cord Trauma 6. What are the ventilation rates for the following age groups if they are stable with head injuries and require assisted ventilation? Adult - per minute or one every seconds Child - per minute or one every seconds Infant - per minute or one every seconds 7. What are the ventilation rates for the following age groups if they are unstable with head injuries and require assisted ventilation? Adult - per minute or one every seconds Child - per minute or one every seconds Infant - per minute or one every seconds 8. What are the 3 components evaluated for in-field spinal clearance? What is documented if you have cleared the patient s c-spine in the field and not immobilized them? 9. What are the land marks used for proper measurement when sizing for use of the cervical collar? 10.Calculate the GCS for the following patient: Eyes open to verbal Speaking nonsense, words understandable but not to the current conversation Right arm has purposeful movement; no movement in left extremities Total GCS: File: CE, EMS; CE Packets; Quizzes ; 2011 ; Pre quiz May Head & Spinal Cord Trauma 12

Chapter 32. Objectives. Objectives 01/09/2013. Spinal Column and Spinal Cord Trauma

Chapter 32. Objectives. Objectives 01/09/2013. Spinal Column and Spinal Cord Trauma Chapter 32 Spinal Column and Spinal Cord Trauma Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1.