Chapter 12

Head and Spinal Injuries

Head Injuries

• Scalp wounds

• Skull fracture

• Brain injuries

Scalp Wounds

• Associated with heavy bleeding

• The scalp has a rich blood supply.

• The vessels do not constrict.

• The brain obtains its blood supply from arteries in the neck.

Care for Scalp Wounds

• Control bleeding by using direct pressure over wound.

• If skull fracture is suspected, apply pressure around the edges of the wound.

• Keep head and shoulders slightly elevated if spinal injury is not suspected.

• Seek medical care.

Skull Fracture

• A skull fracture is a break or crack in the cranium.

• May be open or closed

Recognizing a Skull Fracture• Pain at point of injury• Deformity of the skull• Bleeding from ears and nose• Cerebrospinal fluid leaking from ear or

nose• Discoloration around eyes• Discoloration behind ear• Heavy scalp bleeding if the skin is broken• Penetrating wound

Care for a Skull Fracture• Monitor breathing and provide

appropriate care. • Stabilize the victim’s neck to prevent

movement.• Elevate the victim’s head and shoulders

to help control bleeding.• Cover the wounds with a sterile dressing.• Apply pressure around the edges of the

wound.

Brain Injuries• When the head is struck with force, the brain

bounces against the inside of the skull.• Swelling of brain tissue compresses the

brain, which interferes with brain functioning.• Three types of commonly occurring brain

injuries:• Concussion• Contusion• Hematoma

Recognizing Brain Injury (1 of 2)

• Confused facial expression• Slow to answer questions or follow

instructions• Easily distracted and unable to follow

through with normal activities• Unaware of time, date, and place• Making disjointed statements• Stumbling, unable to walk a straight line

Recognizing Brain Injury (2 of 2)

• Distraught

• Asking a question that has already been answered or inability to memorize a series of three words

• Coma, unresponsiveness

Care for Brain Injury (1 of 2)

• Seek immediate medical care. • Suspect a spinal injury in an unresponsive

victim until proven otherwise. • Stabilize the victim’s head and neck.

• Monitor the victim’s breathing.• Control scalp bleeding with sterile

dressings.• Roll the victim onto his or her side to help

drain vomit.

Care for Brain Injury (2 of 2)

• If spinal injury is not suspected, keep the victim in a slightly head-elevated position. • If victim is unresponsive, roll him or her

onto the left side.• The victim’s level of responsiveness is

one of the best indicators of neurologic function. • Using the mnemonic AVPU is

especially helpful with small children.

Eye Injuries

• Penetrating eye injuries• Blows to the eye• Cut of the eye or lid• Chemical in the eyes• Eye avulsion• Loose objects in the eye• Light burns to the eye

Penetrating Eye Injuries

• Penetrating eye injuries are severe injuries that result a sharp object penetrates the eye.

• Suspect penetration any time you see a lid laceration or cut.

Care for Penetrating Eye Injuries

• Seek immediate medical care.

• Stabilize the object.

Blows to the Eye• Blows to the eye range in severity

from minor or sight threatening.

• A shiner or black eye occurs when some of the blood vessels around the eye rupture.

• A blunt object can break the bone around the eyeball.

Care for Blows to the Eye

• Apply ice for about 15 minutes.

• Do not apply pressure on the eye.

• Seek medical care if there is pain or reduced vision.

Cuts of the Eye or Lid• The signs of a cut eyeball or lid

include the following:

• Cut appearance of the cornea or sclera.

• Inner liquid filling of the eye may come out through the wound.

• Lid is cut.

Care for Cuts of the Eye or Lid

• If eyeball is cut, do not apply pressure.

• If eyelid is cut, apply gentle pressure.

• Bandage both eyes lightly.

• Seek medical care.

Chemical in the Eyes• Chemicals in the eyes can threaten

sight.

• Alkalis cause greater damage than acids because they penetrate deeper and continue to burn longer.

• Damage can occur in 1 to 5 minutes.

Care for Chemical in the Eye• Hold the eye open.

• Flush the eye with water for at least 20 minutes.

• Loosely bandage both eyes with cold, wet dressings.

• Seek medical care.

Eye Avulsion

• A blow to the eye can avulse it (knock it out) from its socket.

• This is a serious injury.

Care for Eye Avulsion

• Cover the eye loosely.

• Protect injured eye with a paper cup or doughnut-shaped pad.

• Cover the undamaged eye with a patch.

• Seek immediate medical care.

Loose Objects in the Eye

• Loose objects in the eye are the most frequent eye injury and can be very painful.

• Tearing is common because it is the body’s way of trying to remove the object.

Care for Loose Objects in the Eye

• Lift the upper lid over the lower lid.

• Try flushing the object out with water.

• Examine the lower lid by pulling it down gently.

• If you see the object, remove it with moistened sterile gauze.

Light Burns to the Eye

• Burns can result if a person looks at a source of ultraviolet light such as sunlight, bright snow, or tanning lamps.

• Severe pain occurs 1 to 6 hours after exposure.

Care for Light Burns to the Eye

• Cover both eyes with cold, wet packs.

• Tell the victim not to rub the eyes.

• Have the victim rest in a darkened room.

• Give pain medication, if needed.

• Seek medical care.

Ear Injuries• Most ear problems are not life-threatening.

• Except for disk batteries and live insects, few foreign bodies must be extracted immediately.

• First aiders should seek medical care for the victim because attempts to remove a foreign body can rupture the eardrum or lacerate the ear canal.

Nose Injuries

• Nosebleeds

• Broken nose

• Objects in the nose

Nosebleeds

• Anterior nosebleeds

• From front of nose

• Most common, easier to care for

• Posterior nosebleeds

• From back of nose

• More serious, require medical care

Care for Nosebleeds• Pinch the soft parts of

the nose together.• Press firmly toward the

face, for 5 to 10 minutes.

• Keep the head higher than the heart.

• Apply ice over nose.• Seek medical care if

needed.

Recognizing a Broken Nose

• Pain, swelling, and a possible crooked appearance.

• Bleeding and difficulty breathing through nostrils

• Black eyes appearing 1 to 2 days after injury.

Care for a Broken Nose

• Seek medical care.

• If bleeding is present, give care as for a nosebleed.

• Apply an ice pack to the nose for 15 minutes.

• Do not try to straighten a crooked nose.

Objects in the Nose

• A foreign object in the nose is a problem mainly among small children.

Care for Objects in the Nose• Try to induce sneezing by having

the victim sniff pepper.• Have the victim blow gently while

you put compression on the opposite nostril.

• Use tweezers to pull out an object that is visible.

• Seek medical care if the object cannot be removed.

Dental Injuries

• Objects caught between the teeth

• Bitten lip or tongue

• Loosened tooth

• Broken tooth

• Toothache

Objects Caught Between the Teeth

• The main method of detecting a problem is if the victim says that something is caught between the teeth.

• The object may or may not be seen.

Care for Objects Caught Between the Teeth

• Try to remove the object with dental floss.

• If unsuccessful, seek dental care.

Recognizing a Bitten Lip or Tongue

• Signs of a bitten lip or tongue include:

• Immediate pain when it happens

• Blood may be seen

Care for a Bitten Lip or Tongue

• Apply direct pressure with sterile gauze.

• Apply ice or cold pack.

• If bleeding does not stop, seek medical care.

Loosened Tooth

• Trauma can cause teeth to become loosened in their sockets.

• Applying pressure on either side of each tooth can determine looseness.

• Any tooth movement indicates a possibly loose tooth.

Care for a Loosened Tooth

• Have the victim bite down on a piece of gauze to keep the tooth in place.

• Consult a dentist or an oral surgeon.

Knocked-out Tooth• A majority of the teeth knocked out

each year in the United States could be saved with proper treatment.

• Time is critical for successful reimplantation.

• Steps must be taken to prevent the tooth from becoming dehydrated.

Care for a Knocked-Out Tooth• Have victim rinse

mouth. • Place gauze in

socket. • Find the tooth. • Keep tooth moist.• Take the victim

and the tooth to a dentist.

Broken Tooth• The front teeth are frequently broken

by falls or direct blows.

• Such damage is not unusual in the victims of violent acts or motor vehicle crashes.

• It is also common in children, especially those with an overbite.

Care for a Broken Tooth• Gently clean dirt and blood with a

sterile gauze pad and water.

• Apply an ice pack to the face to the area of the injury.

• If you suspect a jaw fracture, stabilize the jaw.

• Seek immediate dental care.

Toothache• The most common reason for

toothaches is dental decay.

• Victims frequently complain of pain limited to one area.

• Pain can also affect the ear, eye, neck, or the opposite side of the jaw.

Recognizing a Toothache

• The tooth will be sensitive to heat and cold.

• Identify the diseased tooth by tapping the area with a spoon handle or similar object.

• A diseased tooth will hurt.

Care for a Toothache• Rinse mouth with warm water.

• Use dental floss to remove any food caught in teeth.

• If you suspect a cavity, paint the tooth with clove oil to help suppress pain.

• Give the victim pain medication if needed.

• Seek dental care immediately.

Spinal Injuries• The spine is a column of vertebrae stacked on

one another from the tailbone to the base of the skull.

• The spinal cord consists of long tracts of nerves that join the brain with the other body organs.

• If a broken vertebrae pinches spinal nerves, paralysis can result.

• All unresponsive victims should be treated as though they have a spinal injury.

• Suspect a spinal injury in all head-injury victims.

Recognizing Spinal Injuries• Painful movement or paralysis of

arms and legs

• Numbness, tingling, weakness, burning sensation in arms and legs

• Loss of bladder or bowel control

• Deformity of neck

Care for Spinal Injuries• Monitor breathing.

• For an unresponsive victim, open the airway and check for breathing.

• Stabilize the victim to prevent movement by using one of the following methods:

• Grasp the victim’s head over the ears and hold the head and neck still until EMS arrives.

• Kneel with the victim’s head between your knees or place objects on each side of the victim’s head to prevent it from rolling side to side.