Download Neurological Injuries - toggenburg ski patrol

Neurological Injury
Management
Objectives



Review the anatomy and physiology of
the nervous system and spinal column
Identify the types and mechanisms of
head and spine injuries, and describe
their features
Describe the assessment of head and
spine injuries
Neurological Injuries




Responsible for one half of the deaths that
occur secondary to trauma
The major cause of long-term disability
Caused most frequently by falls and MVA’s
Can be prevented in part by helmets
Anatomy 101
Neuron: nerve cell
 Peripheral neurons (nerves outside of
the brain and spinal cord) are
sheathed with a protective fatty
coating called myelin
 Nerve impulses are transmitted across
synapses (junctions)

Anatomy 101
Central Nervous System:
Brain
Spinal Cord

Anatomy 101

Peripheral Nervous
System:
spinal nerves and
their branches
Anatomy 201
Meninges: protective triple layer cover
 Dura mater = outer layer
 Arachnoid = middle layer
 Pia mater = inner layer
 Cerebral spinal fluid circulates within
the Arachnoid

Anatomy 201

Brain:
Cerebrum
Cerebellum
Brainstem
Anatomy 201
Cranial Nerves:
originate at base of
the brain
 Provide
sensory/motor supply
to the head & face

Anatomy 201
Motor nerves brain to muscle
units
 Sensory nerves skin back to brain

Anatomy 301

Somatic Nervous System: Voluntary
Anatomy 301

Autonomic Nervous System:
Involuntary
Traumatic
Brain
Injury



Severity depends on the amount of primary
and secondary brain injury
Primary Injury: THE INITIAL TRAUMA
Main cause of secondary injury: HYPOXIA
Traumatic Brain
Injuries

Categories: Open or Closed
Open
Closed
Traumatic Brain
Injuries

Forces: Shearing and Compressive
Shearing
Compressive
Types of Traumatic
Brain Injury

Concussion: Temporary
loss or alteration of part
or all of the brain’s
abilities to function,
without apparent
physical damage
to the brain
Types of Traumatic
Brain Injury




Cerebral Contusion: Bruised Brain
Far more serious
than a concussion!
Involves physical
injury to the brain
May be long-lasting
or permanent
Types of Traumatic
Brain Injury

Cerebral Hematoma
or Bleed
 Subdural
 Intracerebral
 Epidural
Traumatic Brain Injury
General Signs & Symptoms




Headache
Dizziness
Nausea/vomiting
Amnesia
Traumatic Brain Injury
General Signs & Symptoms




Decreasing level of
responsiveness
Confusion
Combativeness
Loss of
responsiveness
Assessing Traumatic Brain
Injuries
Level of Responsiveness (LOR)
LOR usually corresponds to the
extent of loss of brain function
 Progressive deterioration
usually indicates serious brain
injury

Assessing Traumatic Brain
Injuries
Level of Responsiveness (LOR)
AVPU SCALE
A = Alert
V = Verbal
P = Pain
U = Unresponsive
Obtain Baseline
Monitor Frequently
(q. 5-15 minutes)
The Progressive Downward Spiral
Brain Swelling

Increased Intracranial Pressure (ICP)

Hypoxia

Further Secondary Injury

More Swelling

Increased ICP
Signs Of Increasing
Intracranial Pressure
The General Signs of Head
Injury Described Previously
PLUS



Change in pupil
size and reactivity
to light
Slowing pulse
Rising BP.
Signs Of Increasing
Intracranial Pressure
The General Signs of Head
Injury Described Previously
PLUS




Change in respiration
Unilateral weakness
Incontinence
Seizures
Urgent
Interventions



Presume C-Spine injury: immobilize neck
Open airway, administer oxygen
 Do not hyperventilate
Treat bleeding and shock
Urgent
Interventions

Prevent aspiration of vomit/secretions
Transport immediately

Elevate head 6”, Transport head uphill

The Spine

33 vertebra –
7 cervical
12 thoracic
5 lumber
5 sacral
4 coccygeal
The Spine
Typical Vertebra
Bony Spine Injury
Signs & Symptoms





Usually produced by compression
or bending trauma
Pain at injury site
Localized acute tenderness
Self-splinting or guarding
Deformity – usually not obvious
Bony Spine Injury
Signs & Symptoms
Compression-Cervical 4
Bony Spine Injury
Signs & Symptoms
Bending (Flexion) Trauma
Cervical 5 on Cervical 6 Vertebra
Spinal Cord Injury
Significance of spine injury
depends whether spinal cord
injured
 Spinal Cord damage more
common with neck injury
than mid/lower back injury

Spinal Cord Injury


Mechanism: axial compression,
hyperextension, hyperflexion, rotation
The higher the cord injury, the more
nerve fibers damaged
Cervical 5
Thoracic 5
Types of Spinal
Cord Injuries
Paraplegia - paralysis of both legs
 Quadriplegia - paralysis of both arms
and both legs
 Hemiplegia - paralysis of an arm and
leg on the same side

Spinal Cord Injury
Signs and Symptoms
Abnormal sensation
 Loss of sensation
 Muscle weakness
or paralysis

Spinal Cord Injury
Signs and Symptoms
Signs of neurogenic
shock
 Difficulty breathing
 Incontinence
 Priapism

Emergency Care - Spine
Urgent interventions for
obstructed airway, abnormal
breathing, bleeding
 Stabilize head and neck manually
 Care for other injuries

Emergency Care - Spine
Transfer to spine board with
proper technique to minimize
movement
 Immobilize on long spine board
with CID; apply cervical collar
