Chapter 29: Head and Spine Injuries

Overview

• Focus on managing trauma-related head and spine issues.
• Recognizing life threats and need for immediate spinal stabilization and potential airway support.
• Includes anatomy and physiology of the nervous system, pathophysiology, assessment, and management of traumatic brain/spinal cord injuries.
• Skills intensive: bandaging, traumatic airway control, in-line stabilization, cervical collar placement, patient mobilization, helmet removal.

Nervous System Anatomy and Physiology

• Nervous System: Comprised of brain, spinal cord, nerve fibers, and peripheral nerves. Protected by skull and spinal canal.
• Central Nervous System (CNS): Brain (cerebrum, cerebellum, brainstem) and spinal cord.
  • Cerebrum: Voluntary motor function, consciousness.
  • Cerebellum: Coordinates balance and body movements.
  • Brainstem: Controls vital functions (cardiac, respiratory).
• Peripheral Nervous System (PNS): 31 pairs of spinal nerves, 12 pairs of cranial nerves.
  • Sensory Nerves: Carry information from body to brain.
  • Motor Nerves: Carry information from CNS to muscles.
  • Reflex arcs and somatic vs. autonomic systems (sympathetic/parasympathetic).

Skeletal System

• Skull: Cranial bones protect the brain.
• Spine: Comprised of 33 vertebrae (cervical, thoracic, lumbar, sacral, coccyx).

Head Injuries

• Traumatic insult to head causing injury to soft tissue, bones, brain.
• Types: Closed (no opening to brain) vs. Open (exposure to outside world).
• Common Causes: Falls, motor vehicle crashes.
• Signs: Skull fractures, ecchymosis (raccoon eyes, battle sign), skull deformities.

Traumatic Brain Injuries (TBIs)

• Classified as primary (immediate impact) or secondary (resulting from primary).
• Secondary Causes: Cerebral edema, hemorrhage, increased intracranial pressure (ICP).
• Types of Hematomas:
  • Epidural: Between skull and dura mater, rapid onset.
  • Subdural: Beneath dura mater, gradual onset.
  • Intracerebral: Within the brain tissue, high mortality.
  • Subarachnoid: In subarachnoid space, can lead to bloody CSF.

Spinal Injuries

• Types: Compression, overextension, flexion injuries.
• Mechanism of Injury: Falls, motor vehicle accidents, blunt trauma.

Patient Assessment

• Scene Size-Up: Determine safety, mechanism of injury.
• Primary Assessment: Focus on identifying life-threatening issues (circulation, airway, breathing).
• Spinal Immobilization: Minimize movement, apply cervical collar.
• Signs of Head Injury: Altered consciousness, neurological deficits.
• Transport Considerations: Rapid extrication for severe cases, airway management.

Managing Head Injuries

• Airway Management: Ensure airway patency, use BVM if necessary.
• Bleeding Control: Direct pressure for scalp lacerations, avoid excessive pressure on skull fractures.
• Cushing's Triad: Manage increased ICP with careful ventilation, avoid hyperventilation.

Managing Spinal Injuries

• Spinal Immobilization: Proper alignment with cervical collar, backboard use.
• Transport Patient: Secure using log-roll or vacuum mattress methods.

Helmet Removal

• Remove if full-face, obstructing airway, or during cardiac arrest.
• Requires at least two individuals, careful technique to avoid neck movement.

Review Questions

• Cerebrum, cerebellum, brainstem as parts of CNS.
• Blood loss from scalp lacerations contributes to hypovolemic shock.
• Epidural hematoma associated with lucid interval.
• Concussion symptoms: confusion, amnesia.

Conclusion

• The chapter emphasizes thorough assessment and immediate intervention for head and spine injuries, integrating knowledge of anatomy with practical skills for emergency response.