Head and Head and Spinal TraumaSpinal Trauma
RIFLES RIFLES LIFESAVERSLIFESAVERS
Central Nervous Central Nervous System System The brain and spinal cord The brain and spinal cord
comprise the central nervous comprise the central nervous system (CNS)system (CNS)
The CNS is protected by bony The CNS is protected by bony structures, i.e., the skull and structures, i.e., the skull and spinal vertebraespinal vertebrae
Injuries of the CNS and its Injuries of the CNS and its protective structures can cause protective structures can cause death or paralysisdeath or paralysis
Principles of CNS Principles of CNS Injury CareInjury Care Observe principles of TCCCObserve principles of TCCC
– Care Under FireCare Under Fire– Tactical Field CareTactical Field Care– Casualty Evacuation CareCasualty Evacuation Care
Follow the ABCsFollow the ABCs Spine immobilization to avoid Spine immobilization to avoid
further injury to spinal cordfurther injury to spinal cord
Open Head InjuriesOpen Head Injuries
Due to penetrating or Due to penetrating or blunt traumablunt trauma
Signs and symptomsSigns and symptoms– Usually unconsciousUsually unconscious– Open skull fractureOpen skull fracture– Exposed brain tissueExposed brain tissue– Pupillary changesPupillary changes
Open head injuries are Open head injuries are usually catastrophic usually catastrophic and result in deathand result in death
Gunshot Wound to Gunshot Wound to HeadHead
Missile tract Missile tract with with fragments fragments and bloodand blood
Open Facial InjuriesOpen Facial Injuries
Brain may not be Brain may not be involved in facial involved in facial traumatrauma
Maintain a clear Maintain a clear airwayairway
Bleeding may be Bleeding may be profuseprofuse– STOP THE BLEEDING!STOP THE BLEEDING!
Apply cervical spine Apply cervical spine immobilization if immobilization if blunt traumablunt trauma
Impalement InjuriesImpalement Injuries
DO NOT REMOVE DO NOT REMOVE OBJECT OR EXERT OBJECT OR EXERT ANY FORCE UPON IT!ANY FORCE UPON IT!– Severe bleeding may Severe bleeding may
occur causing shockoccur causing shock Check pulses distal to Check pulses distal to
impaled objectimpaled object Immobilize the objectImmobilize the object Apply bulky support Apply bulky support
bandages to hold in bandages to hold in placeplace
Closed Head InjuriesClosed Head Injuries
Due to blunt traumaDue to blunt trauma Skull may be fracturedSkull may be fractured Severe brain injury Severe brain injury
may be present in may be present in absence of skull absence of skull fracturefracture
Underlying brain Underlying brain injury may be more injury may be more severe than severe than immediately apparentimmediately apparent
Signs and Symptoms Signs and Symptoms of Closed Head Injuriesof Closed Head Injuries
Deformity of headDeformity of head Blood or clear fluid Blood or clear fluid
from nose or earsfrom nose or ears ““Raccoon eyes”Raccoon eyes” Bruising behind earsBruising behind ears Pupillary changesPupillary changes Confusion or Confusion or
unconsciousnessunconsciousness HeadacheHeadache
Assessment of Head Assessment of Head InjuriesInjuries
Level of consciousness using AVPU scaleLevel of consciousness using AVPU scale– Alert: Converses spontaneously and Alert: Converses spontaneously and
appropriatelyappropriately– Verbal: Responds to verbal stimuliVerbal: Responds to verbal stimuli– Painful: Responds to painful stimuliPainful: Responds to painful stimuli– Unresponsive: Unresponsive to any stimuliUnresponsive: Unresponsive to any stimuli
Pupil sizePupil size– Pupils should be equal and constrict Pupils should be equal and constrict
vigorously to light stimulusvigorously to light stimulus Motor functionMotor function
– Strength should be normal and equal in all Strength should be normal and equal in all extremitiesextremities
PosturingPosturing
Occurs with severe brain injury Occurs with severe brain injury when patient is near deathwhen patient is near death
Treatment of Head Treatment of Head InjuriesInjuries
Remember ABCsRemember ABCs Apply cervical collar Apply cervical collar
if appropriateif appropriate Dress the head Dress the head
wound to control wound to control bleedingbleeding
Elevate head of Elevate head of litter to decrease litter to decrease pressure on brainpressure on brain
Evacuate to Evacuate to surgical assetssurgical assets
Spinal Cord InjuriesSpinal Cord Injuries
May occur with neck or back May occur with neck or back traumatrauma
Associated with blunt head Associated with blunt head trauma, especially when casualty trauma, especially when casualty is unconsciousis unconscious
Can occur with penetrating trauma Can occur with penetrating trauma of vertebral columnof vertebral column
Improper handling may cause Improper handling may cause further injuryfurther injury
Mechanisms Mechanisms of Spinal of Spinal InjuryInjury
HyperextensioHyperextensionn
HyperflexionHyperflexion CompressionCompression RotationRotation Lateral StressLateral Stress DistractionDistraction
Signs and Symptoms Signs and Symptoms of Spinal Cord Injuriesof Spinal Cord Injuries Neck or back painNeck or back pain Penetrating injury of neck or backPenetrating injury of neck or back Tenderness to palpation of spineTenderness to palpation of spine Loss of strength in extremitiesLoss of strength in extremities Loss of feeling in extremitiesLoss of feeling in extremities ParalysisParalysis IncontinenceIncontinence
Assessment of Spinal Assessment of Spinal Cord InjuriesCord Injuries Observe principles of TCCCObserve principles of TCCC
– ““The best medicine on any battlefield The best medicine on any battlefield is fire superiority”is fire superiority”
Follow the ABCsFollow the ABCs Maintain high index of suspicion Maintain high index of suspicion
for spinal cord injury in for spinal cord injury in appropriate settingappropriate setting
Secure and maintain spinal Secure and maintain spinal immobilization throughout immobilization throughout evacuationevacuation
Spinal ImmobilizationSpinal Immobilization
Immobilize the Immobilize the casualty’s head and casualty’s head and neck manuallyneck manually
Apply a cervical collar, if Apply a cervical collar, if available, or improvise available, or improvise oneone
Secure patient to short Secure patient to short spine board if extracting spine board if extracting from a vehiclefrom a vehicle
Secure head and neck Secure head and neck to spine board for to spine board for extractionextraction
Spinal ImmobilizationSpinal Immobilization
Transfer patient Transfer patient to long spine to long spine board as soon as board as soon as feasiblefeasible
Logroll in unisonLogroll in unison Stabilize head Stabilize head
and neck with and neck with sandbags or sandbags or rolled blanketsrolled blankets
Long Spine BoardLong Spine Board
Secure casualty to long spine Secure casualty to long spine board with straps across board with straps across forehead, chest, hips, thighs, and forehead, chest, hips, thighs, and lower legslower legs
Questions?Questions?