Overview
This lecture covers the recognition, assessment, and management of head and spinal injuries, including anatomy, types of injuries, signs/symptoms, and emergency care protocols.
Anatomy & Physiology of the Nervous System
- The nervous system consists of the brain, spinal cord (central), and peripheral nerves (peripheral nervous system).
- The brain has three main parts: cerebrum (voluntary function), cerebellum (balance), and brainstem (automatic functions).
- The brain is protected by the skull; the spinal cord by the spinal canal and meninges (dura mater, arachnoid, pia mater).
- Cerebrospinal fluid acts as a shock absorber around the brain and spinal cord.
Types and Mechanisms of Head and Spine Injuries
- Head injuries include scalp lacerations, skull fractures, traumatic brain injuries (TBI), concussions, contusions, and hematomas.
- Skull fractures: linear (most common), depressed (bone presses inward), basilar (base of skull, CSF leak, raccoon eyes, battle signs).
- Brain injuries: primary (direct), secondary (hypoxia, swelling, bleeding, infection).
- Common causes: motor vehicle crashes, falls, assaults, sports injuries, diving accidents, hangings.
- Spinal injuries can result from blunt or penetrating trauma, excessive flexion, extension, rotation, or axial loading.
Assessment and Recognition
- Look for altered mental status, amnesia, headache, vomiting, unequal pupils, decerebrate posturing, and Cushing’s triad (bradycardia, hypertension, irregular respirations).
- Always suspect spine injury with significant trauma.
- Use Glasgow Coma Scale (GCS) to assess brain injury severity.
- Monitor for CSF leakage, especially from ears/nose.
- Assess CMS (circulation, motor, sensory) in all extremities.
Emergency Management Principles
- Ensure airway with jaw-thrust maneuver; avoid head tilt-chin lift if spine injury is suspected.
- Provide supplemental oxygen; maintain SpOâ‚‚ above 90%.
- Control bleeding with direct pressure unless skull fracture suspected.
- Immobilize suspected spine injuries with a cervical collar and backboard or vacuum mattress.
- Only log roll or move patients if necessary for airway management or transport.
- Remove helmets only if airway/breathing is compromised, helmet fits poorly, or during cardiac arrest.
Key Terms & Definitions
- Central Nervous System (CNS) — brain and spinal cord.
- Peripheral Nervous System (PNS) — nerves outside the CNS.
- Meninges — protective layers covering CNS: dura mater, arachnoid, pia mater.
- Concussion — temporary brain dysfunction, often no loss of consciousness.
- Contusion — bruising of brain tissue, more severe than concussion.
- Epidural Hematoma — fast arterial bleed between skull and dura mater.
- Subdural Hematoma — slow venous bleed beneath dura mater.
- Cushing’s Triad — bradycardia, hypertension, irregular breathing (signs of increased intracranial pressure).
- Retrograde Amnesia — loss of memory before injury.
Action Items / Next Steps
- Review brain and spinal anatomy diagrams.
- Study signs/symptoms and emergency management for head/spine injuries.
- Practice applying cervical collars and backboarding techniques.
- Review and memorize Glasgow Coma Scale criteria.
- Complete assigned readings on head and spinal trauma protocols.