ObjectivesObjectives
Review the anatomy and physiology of Review the anatomy and physiology of the nervous system and spinal columnthe nervous system and spinal column
Identify the types and mechanisms of Identify the types and mechanisms of head and spine injuries, and describe head and spine injuries, and describe their featurestheir features
Describe the assessment of head and Describe the assessment of head and spine injuriesspine injuries
Neurological InjuriesNeurological Injuries
Responsible for one half of the deaths that Responsible for one half of the deaths that occur secondary to traumaoccur secondary to trauma
The major cause of long-term disabilityThe major cause of long-term disability Caused most frequently by falls and MVA’sCaused most frequently by falls and MVA’s Can be prevented in part by helmetsCan be prevented in part by helmets
Anatomy 101Anatomy 101
NeuronNeuron: : nerve cellnerve cell Peripheral neurons (nerves outside of the Peripheral neurons (nerves outside of the
brain and spinal cord) are sheathed with brain and spinal cord) are sheathed with a protective fatty coating called a protective fatty coating called myelinmyelin
Nerve impulses are transmitted across Nerve impulses are transmitted across synapses synapses (junctions)(junctions)
Anatomy 101Anatomy 101
Central Nervous System: Central Nervous System: Brain Spinal Cord Brain Spinal Cord
Anatomy 101Anatomy 101
Peripheral Nervous Peripheral Nervous System: System: spinal nerves and spinal nerves and their branchestheir branches
Anatomy 201Anatomy 201
Meninges: protective triple layer coverMeninges: protective triple layer cover Dura materDura mater = outer layer = outer layer ArachnoidArachnoid = middle layer= middle layer Pia materPia mater = inner layer= inner layer
Cerebral spinal fluid circulates within Cerebral spinal fluid circulates within the the ArachnoidArachnoid
Anatomy 201Anatomy 201
Cranial NervesCranial Nerves: originate : originate at base of the brainat base of the brain
Provide sensory/motor Provide sensory/motor supply to the supply to the head & facehead & face
Anatomy 201Anatomy 201
Motor nerves - brain Motor nerves - brain to muscle unitsto muscle units
Sensory nerves - skin Sensory nerves - skin back to brainback to brain
Traumatic Traumatic Brain Brain InjuryInjury
Severity depends on the amount of primary Severity depends on the amount of primary and secondary brain injuryand secondary brain injury
Primary Injury:Primary Injury: THE INITIAL TRAUMATHE INITIAL TRAUMA Main cause of secondary injuryMain cause of secondary injury: : HYPOXIAHYPOXIA
Traumatic BrainTraumatic BrainInjuriesInjuries
Categories: Open or ClosedCategories: Open or Closed Open Open Closed Closed
Traumatic Brain Traumatic Brain
InjuriesInjuries Forces: Shearing and CompressiveForces: Shearing and Compressive
Shearing Shearing CompressiveCompressive
Types of Traumatic Types of Traumatic Brain InjuryBrain Injury
Concussion:Concussion: Temporary Temporary
loss or alteration of part loss or alteration of part
or all of the brain’s or all of the brain’s
abilities to function, abilities to function,
without apparent without apparent
physical damage physical damage
to the brainto the brain
Types of Traumatic Types of Traumatic Brain InjuryBrain Injury
Cerebral Contusion:Cerebral Contusion: Bruised BrainBruised Brain
Far more serious Far more serious than a concussion!than a concussion! Involves physical Involves physical injury to the braininjury to the brain May be long-lasting May be long-lasting or permanentor permanent
Types of Traumatic Types of Traumatic Brain InjuryBrain Injury
Cerebral HematomaCerebral Hematoma or Bleed or Bleed Subdural Subdural IntracerebralIntracerebral EpiduralEpidural
Traumatic Brain InjuryTraumatic Brain Injury General Signs & SymptomsGeneral Signs & Symptoms
HeadacheHeadache DizzinessDizziness Nausea/vomitingNausea/vomiting AmnesiaAmnesia
Traumatic Brain Injury Traumatic Brain Injury General Signs & SymptomsGeneral Signs & Symptoms
Decreasing level of Decreasing level of responsivenessresponsiveness
ConfusionConfusion CombativenessCombativeness Loss of Loss of responsivenessresponsiveness
Assessing Traumatic Brain Assessing Traumatic Brain Injuries Injuries
Level of Responsiveness (LOR)Level of Responsiveness (LOR)
LOR usually corresponds to the LOR usually corresponds to the extent of loss of brain functionextent of loss of brain function
Progressive deterioration Progressive deterioration usually indicates serious brain usually indicates serious brain injuryinjury
Assessing Traumatic Brain Assessing Traumatic Brain InjuriesInjuries
Level of Responsiveness (LOR)Level of Responsiveness (LOR) AVPU SCALEAVPU SCALE AA == AlertAlert VV == VerbalVerbal PP = Pain= Pain UU == UnresponsiveUnresponsive Obtain BaselineObtain Baseline Monitor FrequentlyMonitor Frequently
(q. 5-15 minutes)(q. 5-15 minutes)
The Progressive Downward SpiralThe Progressive Downward Spiral
Brain Swelling Brain Swelling
Increased Intracranial Pressure (ICP)Increased Intracranial Pressure (ICP)
HypoxiaHypoxia
Further Secondary InjuryFurther Secondary Injury
More SwellingMore Swelling
Increased ICPIncreased ICP
Signs Of Increasing Signs Of Increasing Intracranial PressureIntracranial PressureThe General Signs of Head The General Signs of Head Injury Described PreviouslyInjury Described Previously
PLUSPLUS Change in pupilChange in pupil
size and reactivitysize and reactivity to light to light
Slowing pulseSlowing pulse Rising BP.Rising BP.
Signs Of Increasing Signs Of Increasing Intracranial PressureIntracranial Pressure The General Signs of Head The General Signs of Head Injury Described PreviouslyInjury Described Previously
PLUSPLUS
Change in respirationChange in respiration Unilateral weaknessUnilateral weakness IncontinenceIncontinence SeizuresSeizures
Urgent Urgent InterventionsInterventions
Presume C-Spine injury: immobilize neckPresume C-Spine injury: immobilize neck Open airway, administer oxygenOpen airway, administer oxygen
Do not hyperventilateDo not hyperventilate Treat bleeding and shockTreat bleeding and shock
Urgent Urgent InterventionsInterventions
Prevent aspiration of vomit/secretionsPrevent aspiration of vomit/secretions Transport immediatelyTransport immediately
Elevate head 6”, Transport head uphillElevate head 6”, Transport head uphill
The SpineThe Spine
33 vertebra – 33 vertebra – 7 cervical7 cervical 12 thoracic 12 thoracic 5 lumber5 lumber 5 sacral5 sacral 4 coccygeal4 coccygeal
Bony Spine InjuryBony Spine Injury Signs & SymptomsSigns & Symptoms
Usually produced by compression Usually produced by compression or bending trauma or bending trauma
Pain at injury sitePain at injury site Localized acute tendernessLocalized acute tenderness Self-splinting or guardingSelf-splinting or guarding Deformity – usually not obviousDeformity – usually not obvious
Bony Spine InjuryBony Spine Injury Signs & SymptomsSigns & Symptoms
Compression-Cervical 4 Compression-Cervical 4
Bony Spine Injury Bony Spine Injury Signs & SymptomsSigns & Symptoms
Bending (Flexion) TraumaBending (Flexion) Trauma Cervical 5 on Cervical 6 VertebraCervical 5 on Cervical 6 Vertebra
Spinal Cord InjurySpinal Cord Injury
Significance of spine injury Significance of spine injury depends whether spinal cord depends whether spinal cord injuredinjured
Spinal Cord damage more Spinal Cord damage more common with neck injury common with neck injury than mid/lower back injurythan mid/lower back injury
Spinal Cord InjurySpinal Cord Injury Mechanism: axial compression, Mechanism: axial compression,
hyperextension, hyperflexion, rotationhyperextension, hyperflexion, rotation The higher the cord injury, the more The higher the cord injury, the more nerve fibers damagednerve fibers damaged Cervical 5 Thoracic 5 Cervical 5 Thoracic 5
Types of Spinal Types of Spinal Cord InjuriesCord Injuries
Paraplegia - paralysis of both legsParaplegia - paralysis of both legs Quadriplegia - paralysis of both armsQuadriplegia - paralysis of both arms
and both legsand both legs Hemiplegia - paralysis of an arm andHemiplegia - paralysis of an arm and
leg on the same sideleg on the same side
Spinal Cord Injury Spinal Cord Injury Signs and SymptomsSigns and Symptoms
Abnormal sensationAbnormal sensation Loss of sensationLoss of sensation Muscle weaknessMuscle weakness
or paralysis or paralysis
Spinal Cord Injury Spinal Cord Injury Signs and SymptomsSigns and Symptoms
Signs of neurogenic Signs of neurogenic shockshock
Difficulty breathingDifficulty breathing IncontinenceIncontinence PriapismPriapism
EmergencyEmergency Care - Spine Care - Spine
Urgent interventions for Urgent interventions for obstructed airway, abnormal obstructed airway, abnormal breathing, bleedingbreathing, bleeding
Stabilize head and neck manuallyStabilize head and neck manually Care for other injuriesCare for other injuries
Emergency Care - SpineEmergency Care - Spine
Transfer to spine board with Transfer to spine board with proper technique to minimize proper technique to minimize movementmovement
Immobilize on long spine board Immobilize on long spine board with CID; apply cervical collarwith CID; apply cervical collar