CPR Chapter 23:Head, Neck, & Back

Care for open head injuries

-Control bleeding promptly with dressings, direct pressure and a pressure bandage, while limiting spinal movement -Do not apply direct pressure over where there is an obvious skull fracture or depression. -Do not remove any penetrating object

Signs and symptoms of a skull fracture with brain injury

-Damage to the skull, including deformity to the skull or face. -Pain or swelling at the site of injury. -Blood or other fluids leaking from the mouth, nose, ears or scalp wound. -Unequal facial movements; drooping, unequal or unresponsive pupils; or vision problems in one or both eyes. -Bruising around the eyes ("raccoon eyes") -Bruising behind the ear ("Battle's sign")

Eye injuries

-Involvement of eyeball, bone and soft tissue surrounding eye -Physician exam necessary for all injuries -Examples of injuries: •Foreign bodies •Chemical exposure (flush the eye for at least 20 minutes; lean the affected side of the face down) •Impaled objects (leave in place)

concussion

A _____________ is a common type of traumatic brain injury that involves a temporary loss of brain function. These are common sports-related injuries, but they can occur whenever a person experiences a bump, blow or jolt to the head or body that results in rapid movement of the head. A person who has had one is at increased risk for subsequent such injuries. This may or may not result in a loss of consciousness. Your best clues to this condition are that the patient changes their behavior after they experience a bump, blow, or jolt.

spinal cord

A bundle of nerve endings that, if damaged, can lead to paralysis

Further signs of head injury

A softness or depression in the skull and blood or cerebrospinal fluid leaking from the nose or ears

Nose bleeds

Can also be caused by dryness and high blood pressure. These can be painful or the nose may be tender, there can be bleeding only from the nose or the patient could vomit swallowed blood

Care for closed head injury

If you suspect a closed head injury, do not control bleeding using direct pressure

open head injuries

Involve a break in the skull or occur when an object penetrates the skull. Head injuries bleed profusely, and a patient may lose blood quickly.

Closed head injuries

Occur when the brain is struck against the skull but the skull remains intact. They can also occur from impact with a blunt object.

Spinal injuries

Paralysis, paraplegia, quadriplegia, and death can result dependent upon the injury location. Remember that any injury to the spinal cord results in paralysis from that point down.

Skull fractures

Should be suspected any time there has been significant trauma to the head, even if the patient has suffered a closed head injury. These may be accompanied by brain damage, caused by bleeding or swelling within the brain, which is a life-threatening condition (also cerebrospinal fluid leak). If the patient is showing any of the signs of head injury, a skull fracture may be present and brain injury is possible.

Traumatic brain injury (TBI)

Swelling in the brain causes a lot of damage because there is no place for the swelling to go and it can cause pressure to build up and damage the brain Typically swelling in the brain is very serious and often potentially fatal; if brain exits bottom of skull, the brain stem is very susceptible to damage and can break off, which is a fatal injury.

back

The ________ is made up of soft tissue, bones, cartilage, nerves, muscles, tendons and ligaments. It supports the skull, shoulder bones, ribs and pelvis, and protects the spinal cord and other vital organs.

head

The _________ contains special sense organs (e.g., eyes, nose and ears), the brain, mouth and related structures. It is also formed by the skull (protective mechanism for brain)

neck

The _________ contains the esophagus, larynx and part of the trachea. It also contains major blood vessels, muscles and tendons, and the cervical bones of the spine and the face.

5, 4

There are __ bones in the sacrum and __ bones in the coccyx, which are fused together

7

There are __ cervical vertebra (though there are 8 nerve endings)

5

There are __ lumbar vertebra

12

There are ____ thoracic vertebra

Care for nose bleeds

•Apply cold packs to reduce swelling and take special care to maintain an open airway. You can usually control bleeding by having the patient sit with the head slightly forward while pinching the nostrils together for about 10 minutes

Signs and symptoms of head and brain injury

•Damage to the skull, including deformity to the skull or face •Pain or swelling at the site of the injury •Irregular breathing •Sudden, debilitating headache •Nausea or vomiting •Incontinence •High blood pressure and slowed pulse •Difficulty with urination/defecation •Paralysis or droopiness, usually on one side •of the body; limb rigidity •Loss of balance •Asymmetrical facial movements •Altered mental state •Facial bruising, including "raccoon eyes"(visible bruising around the eyes) •External bleeding •Some of these are very similar to FAST tests with strokes

Signs and symptoms of concussions

•Difficulty thinking clearly, concentrating or processing information •Difficulty remembering events prior to and after the incident, as well as new information •Headache •Nausea or vomiting •Blurry vision •Dizziness and balance problems •Significant sensitivity to light or noise

Care for penetrating wounds to the skull

•Do not try to remove an object that is impaled in the skull. •Stabilize the object and the wound site with bulky dressings, and then dress the surrounding area with sterile gauze. •No bleeding control should be done directly on the wound site or any indented area you may notice

When to suspect serious head, neck, or back injuries (MOI)

•Fall from a height greater than the victims •Diving mishap •Motor vehicle collision •Unconscious for unknown reasons •Blunt force trauma •Penetrating injuries •Broken helmet •Injuries resulting from lightning

Prevention of head, neck, and spinal injuries

•Knowing your risk and being aware of your surroundings •Not diving into a body of water if unsure of the depth •Wearing seatbelts in a motor vehicle •Safety-proofing your home and workplace to prevent falls •Always using a step stool or a stepladder to reach objects out of reach and not attempting to pull heavy objects that are out of reach over your head•Using good lifting techniques •Using nonslip treads or carpet on stairways, and securing any area rugs •Using nonslip mats in the bathtub or installing handrails •Knowing your risk for osteoporosis

Care for neck and spinal injuries

•Maintain spinal motion restriction. •Assess the pulse, movement and feeling in the extremities •Approach the patient from the front. •Have them respond verbally to your questions (does your neck or back hurt? Where? Can you move your hands and feet? What happened?) •Control any bleeding. •Perform a primary assessment. •For an unresponsive patient, maintain an open airway and assist ventilation, if needed. •Don't remove a helmet (requires special training)

Observations and care steps for concussions

•Many patients who have experienced a concussion say that the concussion caused them to feel "sluggish", "groggy", or just "not right." •Signs and symptoms of a concussion usually are apparent soon after the injury, although some can appear hours or days later. •The effects of the concussion can last for several days, weeks, or longer.

Signs and symptoms of neck injuries

•Obvious lacerations, swelling or bruising •Objects impaled in the neck •Profuse external bleeding •Impaired breathing as a result of the injury •Difficulty speaking or complete loss of voice •A crackling sound when the patient is speaking or breathing, due to air escaping from an injured trachea or larynx •Obstructed airway caused by swelling of the throat Should also be suspected anytime a head injury is (until we know otherwise!)

Signs and symptoms of spinal injuries

•Pain or pressure in the back, independent of movement or palpation •Tenderness in the area of the injury •Pain associated with moving •Numbness, weakness, tingling, or loss of feeling or movement in the extremities (check radial pulse as well) •Partial or complete loss of movement or feeling below the suspected level of injury •Difficulty breathing or shallow breathing •Loss of bladder and/or bowel control

Care for head and brain injury

•Summon more advanced medical personnel. •Follow standard precautions. •Establish manual stabilization. •Perform a primary assessment. •Maintain an open airway. •Control any bleeding. •If cerebrospinal fluid is leaking from the ears or a wound in the scalp, cover the area loosely with a sterile gauze dressing. •Do not attempt to remove any penetrating object; instead stabilize it with a bulky dressing. •Do not apply direct pressure if there are signs and symptoms of an obvious skull fracture •Maintain manual stabilization until other EMS responders relieve you. •Monitor vital signs and mental status. •Calm and reassure patient. •Keep them as still as possible for as long as possible

Further signs and symptoms of head and brain injury

•Unusual bumps or depressions •Blood or other fluids (ex: cerebrospinal fluid; do not stop this flow as it could cause pressure to build and more damage to occur) from the ears, mouth or nose •Bruising behind the ears ("Battle's sign") •Unequal pupil size and unresponsive pupils •Disturbance of vision in one or both eyes •Speech problems •Seizures