Central nervoussystem lesson3

Emergency Services, LLC / Copyright 2013

1

TREATING BRAIN INJURIES (continued from Lesson 2)• Specific management

– Secure Airway and provide good oxygenation.Secure Airway and provide good oxygenation.• If GCS is less than eight, intubate.If GCS is less than eight, intubate.

– Spinal immobilization (collar, padded head-immobilization Spinal immobilization (collar, padded head-immobilization device)device)

– Record baseline vitals and Glasgow Coma Score.Record baseline vitals and Glasgow Coma Score.

– Two large-bore I.V. catheters (en-route)Two large-bore I.V. catheters (en-route)

– Rapid transport to facility able to deal with critical head-injured patients

• Remember the Golden Hour!

Hands-On:Central Nervous System Training, Lesson 3


2

TYPES OF SPINAL TRAUMA• Hyperextension/Hyperflexion

– Excessive posterior or anterior movement of the head. Examples are:

• Face into windshield in MVA• Elderly person falling to floor• Football tackle• Dive into shallow water• Rider thrown from horse or motorcycle.



3

TYPES OF SPINAL TRAUMA• Compression

– The weight of the head or pelvis is driven into stationary neck or torso. Examples are:

• Dive into shallow water• Fall of greater than 10-20 feet onto head or legs.



4

TYPES OF SPINAL TRAUMA• Rotation

– Excessive rotation of the torso or head and neck, moving one side of the spinal column against the other. Examples are:

• Rollover MVC• Motorcycle accident• Sports injuries



5

TYPES OF SPINAL TRAUMA• Lateral Stress

– Direct lateral force on the spinal column, typically shearing one level of the cord from another. Examples are:

• “T-Bone” type MVC• Falls



6

TYPES OF SPINAL TRAUMA• Distraction

– Excessive stretching of the column and cord. Examples are:

• Hanging• Child wearing seatbelt inappropriately• Snowmobile or motorcycle under rope or wire



7

TYPES OF SPINAL TRAUMA• Mechanism of Injury

– How important is mechanism of injury in predicting patient injuries? Very important to the Paramedic/EMT!

– The accident will determine the mechanism of injury which may suggest the type of injury which in turn may determine early patient treatment and handling.



8

TYPES OF ACCIDENTS• What type of CNS injuries would you expect in

these examples?

Accident: Head-On

Injuries: Hyperextension/hyperflexion, Compression

Accident: T-Bone

Injuries: Lateral Stress



9

TYPES OF ACCIDENTS

Accident: T-Bone, Rollover

Injuries: Lateral Stress, Rotation

Accident: Rollover

Injuries: Rotation

– Depending upon the severity and duration of a motor vehicle crash, you might have multiples or combinations of these injuries.



10

SPINAL INJURIES• Signs and Symptoms

– Mechanism of injury– Pain in neck or back– Neurological signs

• Numbness

• Tingling

• Loss of motor function

– Shock– Respiratory distress



11

SPINAL INJURIES• Treatment for spinal injuries

– Most treatment in the pre-hospital setting involves prevention of further injury, not remedying the current injury.

• Types of immobilization devices– KED

– Long spine board

– Short spine board

– Vacuum splint (may fail in cold weather!)



12

SPINAL INJURIES• Specific Treatment

Most people who sustain a spinal injury have other injuries as well!– Remember ABC’s

– Oxygen

– IV therapy

– Immobilization

– Medication considerations



13

SPINAL INJURIES• Protocols: Will a Spinal Immobilization Rule-Out

protocol be in our future?– Some departments now have the ability not to board a

patient if it appears that the patient has no spinal injury or fracture.

– Some patients who feel they don’t want to be immobilized, because they feel constrained, claustrophobic, or whatever, do not have their wishes honored by protocols that say all accident patients, even if a spinal injury is not in evidence, must be boarded. Sometimes an internal injury might be aggravated by immobilization.



14

SPINAL INJURIES• Protocols: Will a Spinal Immobilization Rule-Out

protocol be in our future?– Most EMS departments use protocols to protect them from

liability, even if these protocols are not truly sensitive to the wishes of the patient.


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Central nervoussystem lesson3