Overview
This lecture covers the recognition, assessment, and management of head and spine injuries, with focus on relevant anatomy, injury mechanisms, and emergency care procedures.
Nervous System Anatomy & Function
- The nervous system includes the brain, spinal cord (central nervous system), and all peripheral nerves.
- The brain is divided into the cerebrum (voluntary actions, 75% brain volume), cerebellum (balance and movement), and brain stem (basic life functions).
- The spinal cord transmits signals between the brain and body via nerve fibers.
- The brain/spinal cord are protected by the skull/spinal canal and meninges (dura mater, arachnoid, pia mater).
- Cerebral spinal fluid (CSF) acts as a shock absorber for the brain.
Types of Nervous System Injuries
- Head injuries can be closed (no opening) or open (opening to outside world).
- Skull fractures may present as deformity, raccoon eyes, or battle signs.
- Brain injuries: primary (direct) or secondary (indirect from hypoxia, hypotension, cerebral edema, etc.).
- Coup-contracoup injuries involve the brain striking inside the skull in two directions.
- Intracranial hemorrhage: epidural (fast, unconscious-lucid-unconscious), subdural (slow, common in elderly), intracerebral, subarachnoid.
- Concussions cause temporary, often mild symptoms; contusions involve actual brain tissue and lasting damage.
Spinal Injuries
- Causes include vehicle accidents, falls, axial loading (e.g., diving injuries), and hangings.
- Vertebral column has 5 sections: cervical (7), thoracic (12), lumbar (5), sacral, and coccygeal.
- Injuries can cause paralysis, herniated discs, and sensory/motor deficits.
- Always suspect spine injury with trauma to head, neck, back, or torso.
Assessment & Management
- Scene safety, rapid assessment, and maintaining scene time under 10 minutes are critical.
- Primary survey: check airway (jaw thrust over head tilt-chin lift), breathing, and circulation.
- Apply c-collar and backboard only if indicated; minimize backboard time due to discomfort and risk of pressure sores.
- Oxygenate and maintain pulse oximeter >90%; monitor for vomiting, seizures, and signs of increased intracranial pressure (Cushing's triad: ↑BP, ↓pulse, irregular respirations).
- Assess CMS (circulation, motor, sensory) in all extremities and use the Glasgow Coma Scale for neurologic status.
- Do not probe or remove objects from scalp wounds; control bleeding with gentle direct pressure.
Spine Immobilization & Transport
- Maintain manual in-line stabilization until patient is secured to backboard or vacuum mattress.
- Use KED (short board) for seated patients; avoid immobilization if urgent move is required.
- Helmet removal: only if airway is compromised, helmet fits poorly, or excessive movement possible; otherwise, leave in place.
Key Terms & Definitions
- Meninges — Protective layers covering the brain and spinal cord (dura mater, arachnoid, pia mater).
- Coup-contracoup injury — Brain injury from impact bouncing brain inside skull.
- Epidural hematoma — Bleeding between skull and dura mater, fast onset, lucid interval.
- Subdural hematoma — Bleeding beneath dura mater, slow onset, common in elderly.
- Cushing's triad — Increased blood pressure, decreased pulse, irregular breathing, indicates increased intracranial pressure.
- Glasgow Coma Scale — Tool to assess patient’s level of consciousness.
Action Items / Next Steps
- Review respiratory patterns (Cheyne-Stokes, ataxic, Biot’s).
- Practice spinal immobilization and helmet removal skills in lab.
- Memorize Glasgow Coma Scale scoring.
- Complete assigned reading on head and spine trauma assessment.