Chapter 29: Head and Spine Injuries

Welcome to Chapter 29 of the "Emergency Care and Transportation of the Sick and Injured" 12th Edition. This chapter covers trauma-related issues of the head and spine, emphasizing the recognition of life-threatening conditions and the need for immediate stabilization and support.

Key Learning Objectives

• Understand management of head and spine trauma.
• Recognize life threats and need for spinal stabilization.
• Assess and manage traumatic brain and spinal cord injuries.
• Detailed anatomy and physiology of the nervous system.
• Recognize transport considerations and potential deterioration.
• Perform skills such as bandaging, airway control, stabilization, and helmet removal.

Nervous System Overview

• Complex network of nerve cells: Enables body functionality.
• Includes: Brain, spinal cord, nerve fibers, and nerves.
• Protection: Brain by skull, spinal cord by bony spinal canal.

Anatomy and Physiology

• Central Nervous System (CNS):

  • Brain and spinal cord.
  • Brain divided into cerebrum (voluntary function), cerebellum (coordinates movements), and brainstem (basic life functions).
  • Protected by meninges: dura mater, arachnoid mater, pia mater.
  • CSF acts as a shock absorber.

• Peripheral Nervous System (PNS):

  • 31 pairs of spinal nerves and 12 pairs of cranial nerves.
  • Sensory nerves (body to brain) and motor nerves (CNS to muscles).

Autonomic Nervous System

• Somatic (voluntary): Handles voluntary activities.
• Autonomic (involuntary): Manages functions without effort.
  • Sympathetic (fight or flight) and parasympathetic (rest and digest) systems balance to maintain homeostasis.

Skeletal System

• Skull: Composed of cranial and facial bones.
• Spinal Cord: 33 vertebrae divided into five sections: cervical, thoracic, lumbar, sacral, coccygeal.

Head Injuries

• Types: Closed (no opening) and open (exposed brain tissue).
• Mechanisms: Falls, motor vehicle crashes, sports incidents.
• Skull Fractures:
  • Linear: Common, often not visible.
  • Depressed and Basilar: High-energy trauma, visible signs like raccoon eyes.
  • Open: Exposes brain, risk of infection.

Traumatic Brain Injuries (TBI)

• Primary vs. Secondary injuries:
  • Primary results from impact, secondary increases severity.
  • Secondary caused by factors like cerebral edema, hemorrhage.
• Coup-contrecoup injury: Dual impact causing brain injury.
• Concussions: Mild TBI, temporary loss of function.
• Contusion: More serious than a concussion, involves bruising of brain tissue.

Spine Injuries

• Types:
  • Compression from falls or direct blows.
  • Hyperextension or flexion from trauma.
  • Spinal cord injuries may not show immediate signs.

Assessment and Management

• Assessment:
  • Scene safety, mechanism of injury evaluation.
  • Apply cervical spine immobilization if suspected injury.
• Primary Assessment:
  • ABCs (Airway, Breathing, Circulation).
  • Consider rapid transport, especially with impaired airways.
• History Taking:
  • Gather information from patient or bystanders.
  • Obtain SAMPLE history.
• Secondary Assessment:
  • Systematic head-to-toe exam.
  • Monitor vital signs and neurologic status.
• Reassessment:
  • Regularly check for changes in condition.

Emergency Care

• Head Injuries:
  • Manage airway and monitor ICP.
  • Control bleeding, monitor neurologic signs.
• Spinal Injuries:
  • Immobilize, maintain airway.
  • Use appropriate equipment for transport (e.g., backboards).

Helmet Removal

• Remove if it obstructs airway or proper immobilization.
• At least two-person job, follow proper protocols to minimize movement.

Review Questions

• Central Nervous System is divided into cerebrum, cerebellum, and brain stem.
• Scalp lacerations can lead to significant blood loss.
• Epidural hematoma involves loss of consciousness and lucid interval.
• Concussion involves alteration of consciousness and amnesia.

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