Injuries

Head Injuries

• Any injury to the skull, brain, or both that requires medical attention

• A blow to the head may cause serious injury even when there are no external signs of injury

• All head injuries are potentially serious because they may involve the brain, which is the seat of consciousness and controls every human action

Brain

Soft with a rich blood supply, and suspended in cerebrospinal fluid within the skull

Contrecoup Injury

When a severe blow to the head causes the brain to bounce from side to side, resulting in injury on the side opposite the blow

Open Head Injury

• If skin overlying the broken bone is punctured

• If an injury is open to the skull or meninges, the brain is vulnerable to damages and infection because its protective casing has been broken

Closed/Blunt Head Injury

• Concussion, contusion, hemorrhage, or hematoma (Last 3 associated with bleeding)

• The brain tissue may swell. The swelling is limited by the confines of the skull, and the resulting intracranial pressure (ICP) may cause extensive damage.

• The brain has little healing power, so any injury to it must be considered potentially permanent and serious.

• A rise in ICP may cause seizures, loss of consciousness, or respiratory arrest

Basal Skull Fractures

• May be open or closed depending on the skin overlying the broken bone

• Often have accompanying fractures of the facial bones

• This type of injury may result in a tear in the dura mater, the outer membrane surrounding the brain and spinal cord, and leakage of the cerebrospinal fluid may result

Open Head Injury Manifestations

• Abrasions, contusions, or lacerations apparent on the skull

• A break of penetration in the skull or meninges apparent by inspection or on radiographic images

• Varying levels of consciousness

• Basal fractures resulting in leakage of CSF may show as blood on sheet or dressing surrounded by a yellow halo sign

• CSF may also leak from nose or ears or postnasal drip

• Subconjuctival hemorrhage

• Hearing loss

• Facial nerve play

• Periorbital eccymosis (Raccoon eyes)

Contusion

• Bruising of the brain tissue

• Occurs when an injury damages blood vessels under the skin and they leak below the skin surface

Hemorrhage

• Active bleeding

• A type of stroke

• Caused by an artery in the brain bursting and causing localized bleeding in the surrounding tissues.

• This bleeding kills brain cells

Hematoma

• Collection of blood that has already clotted

• A collection of blood outside of a blood vessel

• It occurs because the wall of a blood vessel wall, artery, vein, or capillary, has been damaged and blood has leaked into tissues where it does not belong

• May be tiny, with just a dot of blood or it can be large and cause significant swelling

• 4 types - Epidural, subdural, subarachnoid, and intracerebral

Epidural Hematoma

Bleeding between the dura mater and the skull

Subdural Hematoma

Bleeding between the arachnoid mater and the dura mater

Subarachnoid Hematoma

Bleeding in the subarachnoid space

Intracerebral Hematoma

Bleeding inside the brain

Concussion

• Usually minimal amount of damage

• Characterized by “seeing stars” or a very brief loss of consciousness

• Most are mild and have a strong tendency toward spontaneous and complete recovery

• Every one injures the brain to an extent

• Does not contain significant bleeding like a contusion

Closed Head Injury Manifestations

• Varying levels of consciousness, ranging from drowsiness, confusion, irritability, and stupor to coma

• Lucid periods followed by periods of unconsciousness are possible

• Loss of reflexes

• Changes in vital signs

• Headaches, visual disturbances, dizziness, and giddiness

• Gait abnormalities

• Unequal pupil dilation

• Seizures, vomiting, and hemiparesis (weakness on one side of the body)

Basal Skull Fracture Manifestations

• Raccoon Eyes

  • From bilateral subconjuctival hemmorrhage and occurs when damage at the time of the fracture tears the meninges and causes the venous sinuses to bleed into the arachnoid villi and the cranial sinuses. It develops 2-3 days after a closed head injury that results in a basilar skull fracture

• Battle’s Sign

  • May accompany raccoon eyes

  • Bleeding behind the ear

Radiographer’s Response to Head Injuries

• Keep head immobilized until spinal cord injury ruled out

• If possible, elevate head 15-30 degrees

• Do not remove immobilization devices

• Do not flex or rotate patient’s head

• Keep body temp as normal as possible

• Check pulse and respirations frequently

• Observe for airway obstruction

• Apply a sterile pressure dressing if bleeding is profuse, and call for help

• Watch for changes in loss of consciousness (LOC)

• Be prepared to assist with oxygen administration

The Four Levels of Consciousness

• Alert and conscious

• Drowsy, but responsive

• Unconscious, but reactive to painful stimuli

• Comatose

• Use the Glasgow Coma Scale to objectively assess changes in LOC over time

  • Score ranges from 3-15, immediately report changes in LOC to attending physician

Intoxicated Patients

• Be aware of changes in consciousness with patients that are under the influence of alcohol

• The alcohol effects may obscure important symptoms

• Be especially alert to LOC changes

Spinal Injuries Clinical Manifestation - Complete Transection of Spinal Cord

• Flaccid paralysis of the skeletal muscles below the level of the injury

• Loss of all sensation below the level of the injury; pain at the site of injury possible

• Respiratory distress

• Bradycardia

• Loss of body temperature control

• Absence of somatic and visceral sensations below the site of injury

• Unstable lowered blood pressure

• Loss of ability to perspire below injury site

• Bowel and bladder incontinence

Spinal Injuries Clinical Manifestation - Partial Transection of the Spinal Cord

• Asymmetrical flaccid paralysis below injury level

• Asymmetrical loss of reflexes

• Some sensory retention; feeling of pain, temperature, pressure, and touch

• Some somatic and visceral sensation

• More stable blood pressure

• Ability to perspire intact unilaterally

Radiographer’s Response to Spinal Injury

• Monitor vital signs

• Maintain an open airway, if respirations changes notify team

• Do not allow or request the patient to move for xrays, may log roll patients with physician supervision

• Do not move head or neck

• Do not removed immobilization devices

• Observe for signs and symptoms of shock

• Keep the patient warm

• If unconscious, assume there is a spinal cord injury

Log Roll

• A - Pull table pad toward you and lift edge, keeping spine in one plane

• B - As patient approaches lateral position, stabilize with hand on hip. Flexing knees helps to maintain position

• C - The sheet alone may serve as support for returning patient to supine position

Closed Fracture

• May not be obvious to the untrained eye

• Often there is swelling around the injured areas, pain, and deformity of the limb

• All or some of these symptoms may be absent and this fracture still present

Open Fracture/Compound Fracture

• Indicates a visible wound that extends between the fracture and skin surface

• The broken bone itself often breaks through the soft tissue making the fracture visible

Greenstick Fracture

A fracture in a young soft bone in which the bone bends and partially breaks

Spiral/Torsion Fracture

• Occurring when torque is applied along the axis of a bone

• While torsional forces are being applied along the parallel axis of a bone, planes perpendicular to this axis are not affected

• Tension is exerted upon on part of the bone, while compressive forces are exerted upon the other

• When these forces have exceeded the limit tolerable by the bone, fracture occurs

Overriding Fracture

A fracture in which the broken ends of the bone slip past each other and are held in the overlap position by contracted muscles

Comminuted Fracture

One in which the bone is splintered or crushed

Transverse Fracture

One at right angles to the axis of the bone

Compression Fracture

A collapse of a vertebra

Depressed Fracture

A fracture especially of the skull in which the fragment is depressed below the normal surface

Avulsion Fracture

Occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma

Fracture Clinical Manifestations

• Pain and swelling

• Functional loss

• Deformity of the limb

• Grating sound or feel or crepitus if moved

• Discoloration of surrounding tissue caused by hemorrhage with tissue (closed fracture)

• Overt bleeding (open fracture)

• Possible signs and symptoms of shock

Radiographer’s Response Fractures

• Keep affected limb or body part immobilized

• Any movement must be directed by the physician

• Do not remove splints or supportive devices

• In moving a splinted limb support both joints and the injury, move in a single motion

• With an open fracture wear sterile gloves if in contact with the wound and use standard precautions

• Observe patient for signs and symptoms of shock

Care with a Plastic Cast

• Be careful not to put undue pressure on a wet cast

  • May cause it to change shape. Lift the cast by placing your open hands underneath it; never grasp it from above. Observe patient’s fingers or toes for evidence of impaired circulation

• Pay attention to the condition of fingers and toes

  • Should be warm pink and sensitive to touch and pressure. Coldness, numbness, or lack of normal coloration should be reported

• Swelling and pressure can cause permanent damage

  • Can compromise circulation and cause nerve and tissue damage

Open Wounds

• Maintain dressings and report any fresh bleeding sufficient to soak through a fresh dressing

• If a laceration or incision opens, causing severe hemorrhaging, apply direct pressure to the site of bleeding while summoning immediate assistance

Post Surgical Wound Dehiscene

• When a surgical suture line parts

• Partial or superficial

  • Involves only the outer layers of the wound

• Complete

  • Involves all layers of the wound. It may lead to protrusion of underlying tissues through the wound, or to evisceration (loss or organs from the body cavity). Patient may state that something has given way and complain of pain, or a rush of liquid may saturate the dressings. If this occurs, ease the patient to a recumbent or semi-recumbent position to take the strain off of the area

Postsurgical Care

If patient is ambulatory, stand nearby to steady them. An abdominal binder may be applied to help support the abdominal tissues. Unless stated, do not remove the binder. If you must, wait until the patient is comfortable on the table. Replace the binder before the patient is transferred back to stretcher

Burns

• Frequently associated with respiratory complaints

• Inhalation of hot gases may result in edema (swelling) of the respiratory tract, pleural effusion, or pneumonia

Burn Categories

• Categorized by the cause of injury, percentage of body surface involved, and depth of tissue destruction

• The depth of burns is classified as first, second, third, or fourth degree

First Degree Burn

• Epidermis Only

• Skin is red, warm, tender, and painful. May be swelling without blistering

Second Degree Burn

• Dermal layer, but not enough to prevent the growth of new epidermis during healing

• Pain swelling and blisters may be extensive and require medical attention

Third Degree/Full Thickness

• Deep into the subcutaneous tissues and destroy nerve endings

• The skin appears charred or white and lifeless, such as burns caused by scalds or steam. Subcutaneous tissue, dermis and epidermis are involved and skin transplants may be needed

Fourth Degree/Full Thickness

• Involves skin, fat, muscle, and sometimes bone

• The charred skin may be completely burned away. Extensive surgical debridement and grafting are commonly needed, and sometimes amputation is necessary

Radiography of Burn Victims

• Coordinate with nurse to ensure pain medications have been given around 30 minutes prior to exam

• May have protective precautions to avoid infection

• Beware of grafts or healing skin that is tender. It is easily damaged during transfer and positioning

• Allow them to move themselves as much as possible

• Use a transfer sheet to avoid abrasion