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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.