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CHAPTER 29

CHAPTER 29. Injuries to the Head and Spine. Anatomy Review. Nervous System. Skull and Facial Bones. Epidural space (potential). Contents of the Skull. Bone Dura mater Arachnoid Pia mater. Subarachnoid space. Subdural space. Intracerebral. Arachnoid. Dura mater. Skull. Pia mater.

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CHAPTER 29

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  1. CHAPTER 29 Injuries to the Head and Spine

  2. Anatomy Review

  3. NervousSystem

  4. Skull and Facial Bones

  5. Epidural space (potential) Contentsof the Skull Bone Dura mater Arachnoid Pia mater Subarachnoid space Subdural space Intracerebral Arachnoid Dura mater Skull Pia mater

  6. Spinal Column

  7. Head Injuries

  8. Head Injuries – Overview • Scalp injuries may bleed profusely. • Injuries to the skull may cause damage to the brain and may have an open or closed wound.

  9. Brain Injury – Nontraumatic • May occur due to clot or hemorrhage • Can cause altered mental status • Signs and symptoms similar to traumatic injury (but no trauma)

  10. Signs & Symptoms ofHead Injuries • Altered or decreased mental status • Irregular breathing patterns • Mechanism of injury present • Continued…

  11. Signs & Symptoms ofHead Injuries • Contusion, laceration, hematoma, or deformity to the skull • Blood/fluid from ears or nose • Bruising around eyes, behind ears • Continued…

  12. Signs & Symptoms ofHead Injuries • Neurologic changes • Nausea and/or vomiting • Unequal pupil size • Decreased heart rate and increased blood pressure • Seizures

  13. Emergency Care ofHead Injuries • BSI. • Maintain C-spine stabilization. • Assess and treat ABCs. • Perform initial assessment. • Administer high-concentration oxygen. • Continued…

  14. Emergency Care ofHead Injuries • Complete assessment. • Immobilize spine with cervical collar. • Monitor airway, breathing, pulse, mental status closely. • Continued…

  15. Emergency Care ofHead Injuries • Control bleeding. • Do not apply pressure to open or depressed skull injury. • Transport immediately. • Reassess vital signs every 5 min.

  16. Spinal Injury

  17. Mechanisms of Spinal Injury • Motor vehicle crashes • Auto-pedestrian collisions • Falls (especially 3+ times patient’s height) • Blunt or penetrating trauma • Continued…

  18. Mechanisms of Spinal Injury • Motorcycle crashes • Hangings • Diving accidents • Unconscious trauma patients • Continued…

  19. Mechanisms ofSpinal Injury

  20. Whiplash

  21. Types of Spinal Injuries • Compression • Distraction (pulling apart) • Lateral bending • Flexion, rotation, extension

  22. Signs & Symptoms of Spinal Injuries • Paralysis of the extremities • Pain with or without movement • Tenderness along the spine • Continued…

  23. Signs & Symptoms of Spinal Injuries • Loss of sensation • Impaired breathing • “C–3, –4, –5 keep the diaphragm alive” Continued…

  24. Signs & Symptoms of Spinal Injuries • Deformity along spine (rare) • Posturing • Priapism • Incontinence

  25. Assessing Spinal Injury Questions to ask: • What happened? • Where does it hurt? • Does your neck or back hurt? • Continued…

  26. Assessing Spinal Injury Questions to ask: • Can you move your hands and feet? • Can you feel me touching your fingers? Toes?

  27. Assess sensation in all extremities.

  28. Assess motor function.

  29. Assess strength – feet.

  30. Assess strength – hands.

  31. Treating Spinal Injury Take BSI precautions. Instruct the patient not to move. Stabilize cervical spine & ABCs. Evaluate mechanism of injury. Evaluate hand grip and foot strength. Continued…

  32. Treating Spinal Injury Assess pulse, movement, and sensation in extremities. Assess the neck and spine. Administer high-concentration oxygen. Continued…

  33. Treating Spinal Injury Apply properly sized cervical spine immobilization device. Apply and secure patient to appropriate immobilization device. Continued…

  34. Treating Spinal Injury If proper size collar is not available, use rolled towel and tape. Pad around child as necessary to maintain stabilization.

  35. SpinalImmobilization

  36. Applying aCervical SpineImmobilizationDevice

  37. Stabilize and measure.

  38. Choose correct collar size.

  39. Prepare collar.

  40. Slide collar under chin.

  41. Secure collar; maintain in-line position.

  42. Use of ShortSpine Boards: Seated Patient

  43. Short Spine Boards Vest type Rigid short spine board Stabilize head, neck, torso Used for noncritical, seated patient

  44. Select immobilization device.

  45. Manually stabilize patient’s head in neutral, in-line position.

  46. Assess distal pulse, motor function, and sensation (PMS).

  47. Apply the appropriately sized extrication collar.

  48. Position the device behind patient.

  49. Secure device to patient’s torso.

  50. Evaluate and pad behind patient’s head as necessary. Secure patient’s head to device.

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