Download Document

21
Injuries to the Head and
Spine
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
OBJECTIVES DIRECTORY
Objectives for this chapter can be
referenced on page 504 of your textbook.
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
TOPICS
•
•
•
•
Anatomy
Head Injuries
Special Circumstances
Spinal Injuries
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
INTRODUCTION
• Axial skeleton
• Protect and house
– Nervous system
– Brain
– Heart
– Lungs
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
THE CALL
• Environment
– Sunny day in July
– 90 degrees Fahrenheit with high
humidity
• Dispatch
– Called to a public pool for a diving
accident
– Dispatch advises that the patient has
been removed from the water by
bystanders
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
Anatomy
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
Anatomy
• Five regions of the spinal column
– Cervical
– Thoracic
– Lumbar
– Sacral
– Coccygeal
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
Head Injuries
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
Photo: © Edward T. Dickinson, MD
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
• Swelling and
bleeding
• Signs
Closed Head
Injuries
– Altered mental
status
– Weakness,
numbness, or
paralysis
– Posturing
– Pupil changes
– Loss of balance
– Nausea and
vomiting
Photo: © Edward T. Dickinson, MD
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
Closed Head Injury
• Herniation
• Signs of herniation
– Profound altered mental status
– Cushing triad
• Decreasing pulse rate
• Increasing blood pressure
• Abnormal respiratory patterns
– Posturing
– Change in pupil response
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment:
Concussion
• Temporary interruption of brain function
• Signs and symptoms
– Brief loss of consciousness
– Temporary altered mental status
– Amnesia
– Repetitive questioning
– Seizure
– Nausea and vomiting
– Incontinence
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment: Open
Head Injury
• Signs and symptoms
– Obvious deformity or visible fracture
– Pain or tenderness
– Cerebrospinal fluid leakage
– Pupil changes
– Battle sign
– Raccoon eyes
– Signs and symptoms of brain injury
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Emergency Care:
Head Injuries
•
•
•
•
Maintain airway and breathing
Stabilize the head and spine
Reassess
Care for soft tissue injuries
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
Special Circumstances
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment and
Care: Penetrating Wounds
• A penetrating wound to the head is always
a serious emergency
– Allow blood to drain
– Stabilize impaled object
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment and Care:
Face, Ears, Nose, and Throat
• Maintain a patent
airway
• Show empathy
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment and Care:
Soft Tissue Injuries of the Face
•
•
•
•
•
Mouth, tongue, and cheek
Ear
Nose
Jaw
Teeth
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment and
Care: Neck Injuries
• Possibility of
severe bleeding
• Pulmonary
embolism
• Blunt trauma
Photo: © Edward T. Dickinson, MD
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment:
Eye Injuries
•
•
•
•
•
•
•
Tenderness or deformity to the orbits
Soft tissue injury around eye
Foreign objects
Injury to the globe
Pupil reactivity
Double vision
Inability to move eye normally
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Emergency Care:
Eye Injuries
•
•
•
•
•
Dress or cover both eyes
Gentle pressure for bleeding
Do not remove clots
Do not force eye open
Do not flush unless chemicals are present
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment and
Care: Foreign Objects in the Eye
•
•
•
•
Flush with water
Remove objects with sterile gauze
Use lower lashes to remove objects
Cover the eyes
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment and
Care: Impaled Objects in the Eye
• Major threat to vision
• Never remove object
• Stabilize
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment and Care:
Globe Injuries and Extruding Eyeballs
• Globe injury
– Cover with sterile dressing
– Cover both eyes
• Extruding eyeballs
– Do not attempt to replace eyeball
– Cover with moist dressing
– Cover both eyes
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment and
Care: Orbit Injuries
•
•
•
•
Deformity
Difficulty moving eye
Double or impaired vision
Numbness around eye
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment and
Care: Chemical Burns to the Eye
•
•
•
•
Take immediate action
Flush for 30–60 minutes
Personal protection
Remove contact lenses
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment and
Care: Removing a Contact Lens
• Open the eyelid
• Press down and forward on the edges of
lens
• Slide lens out of the eye
• Remove and place lens in safe keeping
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
THE RESPONSE
• 18-year-old boy lying on concrete
deck of pool
• Patient does not appear to be moving
• Bystanders state that he dove into
shallow end of pool
• Patient had to be assisted out of pool
• Your partner takes manual
stabilization of spine
• Patient is wet and shivering
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
THE RESPONSE
• Responsive and answers questions
• Airway is patent; breathing normal;
rapid radial pulse
• Alert and oriented with no loss of
consciousness
• Vital signs
– Pulse: 116
– Respirations: 24
– BP: 118/76
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
THE RESPONSE
• Secondary assessment reveals
tenderness to posterior neck, good
distal circulation, and sensory and
motor function in all extremities
• He states that he struck his head
after diving in
• He had a difficult time swimming
after diving in
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
Spinal Injuries
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
Spinal Injuries
• Secondary injury
– Swelling, compression, hypoxic tissue
– Unstable fractures
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
Spinal Injuries
• Assume spinal injury
• Mechanism of injury
• Spinal precautions
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Patient Assessment: Spinal
Cord Injury
• Signs and symptoms
– Pain, tenderness, or pain with movement
– Numbness or tingling in arms or legs
– Paralysis or difficulty moving
– Loss of sensation
– Incontinence
– Priapism
– Deformity of the spine
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Emergency Care:
Spinal Cord Injury
•
•
•
•
Treat immediate life threats
Take spinal precautions
Assess for signs of spinal injury
Immobilize the patient
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Emergency Care:
Spinal Cord Injury
• Spinal immobilization
– Maintain neutral position
– Assess extremities for
• Circulation, sensation,
and movement
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Emergency
Care: Spinal
Cord Injury
• Cervical collars
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Emergency Care:
Spinal Cord Injury
• Long backboard immobilization
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR
Emergency
Care:
Spinal Cord
Injury
• Log roll
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Emergency
Care: Seated Patient
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
EMR Emergency Care: Seated Patient
• Rapid extrication
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
Helmet Removal
• Stabilize helmet.
• Loosen and remove chin strap.
• Transfer manual stabilization to a second
rescuer.
• Second rescuer will place his hands on
patient’s jaw and back of head.
continued
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
Helmet Removal (cont.)
• Remove the helmet at a slow and steady
pace.
• Adjust stabilization.
• Remove the helmet completely.
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
TRANSITION
• EMTs arrive, and you summarize the
mechanism of injury and assessment
findings
• They fully immobilize the patient with
your assistance
• You complete your call
documentation
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
REVIEW
• Define the following terms:
– Axial skeleton
– Cerebrospinal fluid
– Vertebrae
– Articulation
– Posturing
– Foramen magnum
– Herniation
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
REVIEW
• Define the following terms:
– Cushing triad
– Concussion
– Battle sign
– Raccoon eyes
– Orbit
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
STOP, REVIEW, REMEMBER
• Which of the following bones is part of
the axial skeleton?
a.
b.
c.
d.
Skull
Pelvis
Femur
Radius
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
STOP, REVIEW, REMEMBER
• There are _____ bones that make up
the spinal column.
a.
b.
c.
d.
22
33
37
11
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
STOP, REVIEW, REMEMBER
• A large laceration to the scalp that has
an associated fracture of the skull
would be considered a(n):
a.
b.
c.
d.
open head injury.
contusion.
abrasion.
closed head injury.
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
STOP, REVIEW, REMEMBER
• When treating an extruded eyeball, you
should:
a.
b.
c.
d.
replace it in the socket.
apply direct pressure.
wrap the eyeball in a dry dressing.
never replace it in the socket.
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.
REVIEW
• Discussion
1. Discuss the difference between open and
closed head injuries.
2. List the signs and symptoms of a closed
head injury.
3. List the signs and symptoms of a spinal
cord injury.
©2014 Pearson Education, Inc.
EMR Complete: A Worktext, 2nd Ed.