Chapter 13
First Aid for Colleges
and Universities
10 Edition
Head and Spine
Injuries
Slide Presentation prepared by
Randall Benner, [Link]., NREMT-P
© 2012 Pearson Education, Inc.
Introduction
• Head injuries can involve either injury to the
scalp or injury to the brain itself.
• Any trauma severe enough to injure the brain
can also injure the spine.
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Types of Head Injuries
• Injury to the scalp
– Similar injury patterns as other soft tissue injuries
– Contusions, lacerations, abrasions, avulsions
– Bleeding may be minimal or severe (bleed very
heavily)
• Injured scalp management
– Apply direct pressure with dry sterile dressing.
– Avoid pressure over possible
fracture site.
(apply pressure around the edges
of the wound)
– Consider management
for spinal injury as well.
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Injury to the Brain
• The brain is enclosed in the
skull (a rigid closed container)
• injury to the brain results in swelling of the
brain tissue and bleeding within the skull,
• the closed skull would not allow the brain
to expand with the swelling or bleeding.
• The pressure would increase inside the
skull, and could compress the brain tissue.
• This leads to brain tissue dysfunction and
death.
Types of Injury to the Brain
• Primary injury: torn brain tissue or ruptured brain
vessels from the initial trauma
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Types of Injury to the Brain
• Secondary injury: occurs after the initial injury,
- swelling of brain tissue
- increase in pressure within the skull
- an inadequate blood flow and inadequate
delivery of oxygen to the brain cells (poor
perfusion).
- Establishing and maintaining a good airway and
adequate ventilation
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Types of Injury to the Brain
• coup-contrecoup
- a type of acceleration-deceleration injury
- the head comes to a sudden stop
- the brain continues to move back and forth
inside the skull
- There are two sites of injury: the point of impact
and the point on the opposite side where the
brain hits the skull.
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Signs and Symptoms of a Brain Injury
– Main symptom is altered mental
status
– Nausea and/or vomiting
– Headache, weakness, loss of
balance
– Pupils may be unequal
– Double vision or other visual
disturbances
– Loss of memory, confusion, or
disorientation
– Seizures
– Heart rate slows and breathing
becomes irregular
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Injury to the Skull (Skull Fracture)
• Usually results in minor injury
unless brain is also injured
• Types of skull fractures
– Depressed: depression or
deformity
– Linear: a thin-line crack in the
skull.
– Comminuted: multiple cracks
radiating from the center
– Basilar: a break in the base of
the skull
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Signs and Symptoms of a Skull Fracture
– Pain, tenderness, swelling at injury site
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Assessment, Signs, and Symptoms of Head
Injury
• Closed and open head injuries
– Open head injury causes brain to be exposed
– Closed head injury has no open wound
– Either type of injury may or may not have concurrent
brain damage
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Assessment, Signs, and Symptoms of Head
Injury
• Signs and symptoms of a closed head injury
– Altered mental status is best indicator
– Patient may have seizures
– Soft tissue injuries may be present
– Raccoon’s eyes or Battle’s sign may be present
– Loss of motor/sensory reflexes in half of the body
– Pupillary and vital sign changes
– Nausea, vomiting
– Blood or cerebrospinal fluid leaking from the ears or
nose
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Assessment, Signs, and Symptoms of Head
Injury
• Signs and symptoms of an open head injury
– Evidence of trauma to the head
– Depressed region of the skull
– Exposed brain tissue
– External bleeding
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Assessing Head Injuries
• Assessing a victim with a head
injury
– Determine mechanism of injury.
(how much damage may have
occurred)
– Bring the head inline and Complete
a primary survey
– While keeping spine aligned,
assess the head, pupils, neck,
chest, abdomen, arms, and legs.
– Assess the arms and legs for
paralysis, weakness, or loss of
sensation.
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First Aid Care for Head Injury
• Never remove any penetrating object.
• place the victim on the left side; elevate the head
slightly, keep the victim warm, but avoid
overheating.
• monitor the airway, breathing, pulse, and mental
status for deterioration;
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Injuries to the Spine
• Spinal column and cord injuries
– Column injury is damage to
vertebrae (not show any signs of
neurologic dysfunction)
– Cord injury is damage to spinal
cord itself
– Certain region of column
more likely to be injured
(cervical)
– Mismanagement can result in
permanent disability
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Injuries to the Spine
• Common mechanisms for spinal injuries
– Compression: (the weight of the body is driven
against the head, as with falls)
– Excessive flexion, extension, rotation, lateral bending
– Distraction (pulling apart – as with hangings)
– Damage from bony fragments penetrating in spinal
cord.
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Complications of Spinal Injury
• Inadequate breathing
– Damage to nerves that stimulate the diaphragm (high
in cervical region) results in inability to breathe
• Paralysis
– With spinal cord damage, there may be weakness,
loss of sensation, or paralysis
– Often these symptoms become permanent
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Injuries to the Spine
• Assessment considerations
– Note the mechanism of injury.
– Do not logroll the victim unless necessary.
– Palpate gently for deformity or tenderness.
– Assess motor function of the hands and feet on each
side of the body; both sides should be the same.
• Ask the following questions
– What happened and how did it happen?
– Does your neck or back hurt?
– Can you move your hands and feet?
– Can you feel me pinching your toes and fingers?
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Signs and Symptoms of Spinal Injury
• Suspect spinal injury with any serious injury
• Spinal injury symptoms
– Tenderness or pain in area of injury
– Soft tissue trauma in area of injury
– Numbness, tingling, weakness to extremities
– Urinary or fecal incontinence
– Impaired breathing with high spinal injuries
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First Aid Care for Spinal Injury
• The general rule for management of spinal injury
is to support and immobilize the spine, the head,
the torso, and the pelvis.
– Activate EMS and maintain inline stabilization
(immobilized on a backboard) (stabilize the neck in
the position in which you found it).
– Establish and maintain airway and adequate
breathing.
– Provide rescue breathing, if needed.
– Assess pulses and perform CPR, if needed.
– Control any external hemorrhage.
First Aid Care for Spinal Injury
– Keep helmet in place if the following apply
• Helmet fits well
• No impending airway or breathing problems
• Removal of helmet may further injure the victim
• Helmet does not prevent proper immobilization
• Helmet does not interfere with assessment and
reassessment
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First Aid Care for Spinal Injury
• Helmet Removal
– Remove the helmet if the following apply
• Helmet does not fit well
• The victim is in cardiac arrest
• The helmet interferes with proper assessment of
airway and breathing functions
• The helmet interferes with proper management of
airway and breathing functions
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