Chapter 29: Head and Spinal Injuries

Introduction

• The nervous system is a complex network of nerve cells that enables all parts of the body to function.

• Includes:

  • Brain

  • Spinal cord

  • Nerves and nerve fibers

• The nervous system is well protected.

  • The brain is protected by the skull.

  • The spinal cord is protected by the spinal canal.

• Despite this protection, serious injuries can damage the nervous system.

ok?

ok

Anatomy and Physiology

• The nervous system is divided into two anatomic parts.

  • — nervous system

  • — nervous system

central peripheral

Central Nervous System

• Includes the — and — —

• The brain controls the body and is the center of consciousness.

• Brain is divided into three major areas:

  • —

  • —

  • —

• Cerebrum

  • Controls a wide variety of activities, including most voluntary — function and — thought

  • Contains about 75% of the brain’s total volume

  • Divided into — hemispheres with — lobes

• Cerebellum

  • Coordinates — and — movements

• Brainstem

  • Controls most functions necessary for —

  • Best —- part of the CNS

brain spinal cord 

cerebrum, cerebellum, brainstem 

motor, conscious, two four 

balance body 

life, protected 

Central Nervous System

• Spinal cord

  • Made up of fibers that extend from the brain’s — cells

  • Carries messages between the brain and the body via the grey and white matter of the spinal cord

• Protective coverings

  • The entire CNS is contained within a protective framework.

  • The thick, bony structures of the skull and spinal canal withstand injury very well.

  • The CNS is further protected by the —-.

• Meninges

  • Outer layer (dura mater) is a tough, fibrous layer that forms a sac to contain the CNS.

  • Inner two layers (arachnoid mater and pia mater) contain the —- —-.

• Cerebrospinal fluid (CSF)

  • Produced in a chamber inside the brain called the — —

  • Approximately 125 to 150 mL of CSF in the brain at any time

  • Primarily acts as a — —

nerve

meninges

blood vessels

third ventricle, shock absorber

Peripheral Nervous System

• 31 pairs of spinal nerves

  • Conduct impulses from the — and other — to the spinal cord

  • Conduct — impulses from the spinal cord to the —

• 12 pairs of cranial nerves

  • Transmit information —- to or from the brain

  • Perform special functions in the head and face, including sight, smell, taste, hearing, and facial expressions

• Two types of peripheral nerves

  • Sensory nerves

    • Carry only — type of information from the —- to the —- via the spinal cord

  • Motor nerves

    • One for each —-

    • Carry information from the — to the —-

• Connecting nerves

  • Found only in the — and — —

  • — the sensory and motor nerves with short fibers

  • Allow the — of simple messages

skin organs, motor, muscles, directly, one, body, brain, muscle, brain muscles

brain spinal cord, connect, exchange

How the Nervous System Works

• Controls virtually all the body’s activities, including:

  • — activities

  • — activities

  • — activities

• Connecting nerves in the spinal cord form a — —.

  • If a sensory nerve in this arc detects an irritating stimulus, it —- the brain and sends the message directly to a —- nerve.

• Voluntary activities are activities we consciously perform.

• Involuntary activities are the actions that are not under conscious control.

• Somatic (voluntary) nervous system handles —- activities.

• Autonomic (involuntary) nervous system handles — —.

  • Divided into two sections: — and — nervous systems

  • Sympathetic nervous system reacts to — with a — — — response.

  • Parasympathetic nervous system has the opposite effect on the body.

reflex, voluntary involuntary

reflex arc, bypasses, motor

voluntary, body functions, sympathetic parasympathetic

stress, fight or flight

Skeletal System

• Skull

  • Composed of two groups of bones: —- and —- bones.

  • The brain connects to the spinal cord through the — —.

  • Four major bones make up the cranium: —, —, —, and —.

  • Face is composed of — bones: maxillae, zygomas, mandible, and orbit.

• Spinal column

  • Body’s central supporting structure

  • — vertebrae are divided into five sections:

    • — Cervical

    • — Thoracic

    • — Lumbar

    • — Sacral

    • — Coccygeal

  • Injury to the vertebrae can result in —-.

  • Vertebrae are connected by — and separated by cushions, called — —.

  • Spinal column is almost entirely surrounded by —.

cranium facial

foramen magnum 

occipital parietal temporal frontal, 14

33, 7, 12, 5, 5, 4

paralysis, ligaments, intervertebral disks, muscles 

Head Injuries

• Traumatic insult to the head that may result in injury to soft tissue, bony structures, or the brain.

• Account for more than — of all traumatic deaths

• The patient may have sustained additional trauma.

• Closed injuries

  • The brain has been injured but there is — — into the brain.

• Open injuries

  • An opening from the brain to the outside world exists.

  • Often caused by —- trauma

  • May be —- and —- brain tissue

• — and — — crashes are among the most common MOI.

  • Head injuries also commonly occur:

    • In victims of assault

    • During sports-related incidents

half

no opening

penetrating, bleeding exposed

falls motor vehicle

General Signs and Symptoms of a Head injury

• Most important 3

  • — — —

  • — breathing pattern

  • — heart rate

• Indicates intracranial —-

  • Brain being pushed against skull and compressing areas of the —-

  • Once at irregular respiratory patterns it is close to being deadly

widening pulse pressure

irregular

slow

pressure, brainstem

Scalp Lacerations

• Can be minor or serious

• Even small lacerations can lead to significant blood loss.

  • May be severe enough to cause —- shock

• They are often an indicator of —-, more — injuries.

hypovolemic, deeper serious

Skull Fracture

• Significant force applied to the head may cause a skull fracture.

• May be open or closed, depending on whether there is an overlying laceration of the scalp

• Injuries from bullets or other penetrating weapons often result in skull fractures.

• Signs of skull fracture include:

  • Patient’s head appears —-.

  • Visible —- in the skull

  • — (bruising) that develops under the — (— —)

    • — sign of skull fracture

  • — that develops behind one — over the — — (— —)

    • — sign of skull fracture

deformed, cracks, ecchymosis, eyes, late raccoon eyes, ecchymosis, ear mastoid process, late, battle sign 

physical 

Skull Fracture

• Linear skull fractures

  • Account for about 80% of all skull fractures

  • Radiographs are required to diagnose a linear skull fracture because there are no —- signs.

• Depressed skull fractures

  • Result from — —- direct trauma to the head with a — object

  • — and — bones are most susceptible.

  • Bony fragments may be driven into the —.

  • Patient usually —-

• Basilar skull fractures

  • Associated with — — trauma

  • Usually occur following diffuse impact to the head

  • Signs include —- drainage from the ears (Halo sign), — —, and — —.

• Open skull fractures

  • Often associated with trauma to multiple body systems

  • Brain tissue may be exposed to the environment.

  • — mortality rate or with survival high chance of brain —-

physical

high energy, blunt, frontal parietal, brain, unconscious

high energy, diffuse, CSF, raccoon eyes, battle sign

multiple, environment, high, death

Traumatic Brain Injuries

• Most —- of all head injuries

• Two broad categories: primary (direct) injury and secondary (indirect) injury

  • Primary brain injury results —- from impact to the head.

  • Secondary brain injury increases the — of the primary injury.

• Secondary injury may be caused by:

  • —

  • —

  • Cerebral —

  • Intracranial —

  • Increased intracranial —

  • Cerebral —

  • —

serious, instantaneously, severity

hypoxia, hypotension, edema, hemorrhage, pressure, ischemia, infection

Traumatic Brain Injuries

• The brain can be injured directly by a penetrating object or indirectly as a result of external forces.

• A ———— injury can result from striking a windshield.

  • Head hits the windshield; brain comes to an abrupt —- by striking the —- the —-.

  • Head falls back against headrest; brain slams into the —- of the —-.

  • Front hit and back hit to the brain

• Cerebral edema may not develop for several —-.

  • Low blood —- levels aggravate cerebral edema.

• Monitor the patient for any —- activity.

coup-contrecoup, stop, front skull, back skull

hours, oxygen, seizure

Intracranial Pressure

• Accumulations of —- within the skull or —- of the brain can rapidly lead to an increase in —- —-

  • Increased ICP squeezes the brain against bony prominences within the cranium.

• Signs of increased intracranial pressure 

  • Cheyne-Stokes respirations = —, —- breaths with period of —-)

  • Ataxic (—) respirations = —, —, respirations with no identifiable —-

  • — pulse rate, headache, nausea, vomiting, decreased alertness, bradycardia

  • Sluggish or —- pupils

  • — (extension) posturing

  • — or — blood pressure. 

  • — reflex

• Intracranial hemorrhage

  • — inside the skull also increases the ICP.

  • Bleeding can occur:

    • Between the skull and dura mater

    • Beneath the dura mater but outside the brain

    • Within the tissue of the brain itself

blood, swelling, intracranial pressure, slow, deep, apnea, Biot, chaotic irregular, pattern, decreased, nonreactive, decerebrate, increased widened, cushing

bleeding

Cushing’s Traid/Reflex 

• Sign of dangerously high —- —-

• Three components

  • —

  • —

  • — (Cheyne-Stokes or Ataxic/Biot)

intracranial pressure, hypertension, bradycardia, irregular respirations

Intracranial Pressure

• Epidural hematoma

  • Accumulation of blood between the —- and — —

  • Nearly always the result of a blow to the head that produces a —- fracture

• Subdural hematoma

  • Accumulation of blood —- the dura mater but —- the brain

  • Occurs after —- or injuries involving strong —- forces

  • May or may not be skull fracture

• Intracerebral hematoma

  • Bleeding within the —- —— itself

  • Can occur following a —- injury to the head or because of rapid —- forces

• Subarachnoid hemorrhage

  • Bleeding occurs into the — —, where the —- circulates.

  • Results in —- CSF and signs of —- irritation

  • Common causes include —- or rupture of an —-.

skull, dura mater, linear

beneath, outside, falls, deceleration

brain tissue, penetrating, deceleration

subarachnoid space, CSF, bloody, meningeal, trauma, aneurysm

Concussion

• A blow to the —- or —- may cause concussion of the brain.

  • Closed injury with a temporary loss or alteration of part or all of the brain’s abilities to —- without demonstrable —- damage to the brain

  • About 90% of patients do not experience a loss of consciousness.

• A patient with a concussion may be confused or have amnesia.

  • Retrograde amnesia = loss of memories from —- the event

  • Anterograde amnesia = inability to form — memories 

• Usually a concussion lasts only a —- time.

• Ask about these symptoms:

  • Dizziness

  • Weakness

  • Visual changes

  • Nausea and vomiting

  • Ringing in the ears

  • Slurred speech

  • Inability to focus

head, face, function, physical, confused, amnesia, before, new, short

Contusion

• Far more —- than a concussion

• Involves —- injury to brain —-

• May sustain long-lasting and even permanent damage

• A patient may exhibit any or all of the signs of brain injury.

serious, physical, tissue,

Other Brain Injuries

• Brain injuries can also arise from medical conditions, such as blood —- or —-.

• Signs and symptoms of non-traumatic injuries are often the —- as those of traumatic brain injuries.

clots, hemorrhages, same

Spine Injuries

• — injuries can result from a fall.

  • Forces that compress the patient’s vertebral body can cause —- of disks. 

• Motor vehicle crashes can —- the spine.

• Rotation-flexion injuries of the spine result from rapid —- forces. 

• When the spine is pulled along its length (hyperextension), it can cause —-.

• Any one of these unnatural motions, as well as excessive lateral bending, can result in fractures or neurologic deficit. 

• When bones of the spine are altered from traumatic forces, they can fracture or move out of place. 

compression, herniation, overextend, acceleration, fractures,

Patient Assessment

• Always suspect a possible head or spinal injury with:

  • — — collisions

  • — vs. motor vehicle collisions

  • —

  • — trauma

  • — trauma to the head, neck, back, or torso

  • Rapid — injuries

  • —

  • Axial loading injuries 

  • — accidents

motor vehicle, pedestrian, falls, blunt, penetrating, deceleration, hangings, diving 

Scene Size-up

• Scene safety

  • Evaluate every scene for hazards to your health and the health of your team or bystanders.

  • Be prepared with appropriate standard precautions.

  • Call for ALS as soon as possible.

• Mechanism of injury/nature of illness

  • Look for indicators of the MOI.

  • Consider how the MOI produced the injuries expected

• Always remember to consider —- —-

c-spine immobilization

Primary Assessment

• Focus on identifying and managing life-threatening concerns.

• — of on-scene time and recognition of a critical patient increase the patient’s chances for survival or a reduction in the amount of irreversible damage. 

• Spinal immobilization considerations

  • Assess the patient in the position found. 

  • Determine whether or not a — — needs to be applied. 

  • Assess the scene to determine the risk of injury.

  • Form a general impression based on level of consciousness and chief complaint.

• The backboard often places the patient in an anatomically — position for a long period of time. 

  • — to areas of skin may become compromised.

  • Some patients could experience — compromise while lying flat. 

  • Try to minimize the amount of time a patient is on a backboard.

reduction, cervical collar, incorrect, circulation, respiratory, 

Primary Assessment

• Cervical collar

  • Helps maintain spinal motion restriction 

  • The best time to apply the cervical collar depends on the patient’s injuries. 

  • Once the cervical collar is on, do —- remove it unless it causes a problem with maintaining the —-. 

• Assessing for signs and symptoms of a head or spine injury 

  • Ask about the chief complaint.

  • Confused or slurred speech, repetitive questioning, or amnesia in responsive patients are good indications of a —- injury.

  • In the setting of trauma, assume your patient has a —- injury until your assessment proves otherwise. 

  • Unresponsive trauma patients should be assumed to have a —- injury. 

  • Patients with a decreased level of responsiveness should be considered to have a —— injury based on their chief complaint. 

not, airway, head, head, spinal, spinal

Primary Assessment

• Airway, breathing, and circulation considerations

  • Use a jaw-thrust maneuver to open the airway.

  • If the jaw-thrust maneuver is ineffective, use the head tilt–chin lift maneuver as a — —.

  • — may occur in the patient with a head injury.

  • Irregular breathing may result from increased — —. 

  • Oxygen is —- indicated for patients with head and spinal injuries.

  • Pulse oximeter values should be maintained above —-.

  • Hyperventilation should be reserved for specific conditions. 

  • A pulse that is too —- in the setting of a head injury can indicate a serious condition.

  • A single episode of hypoperfusion in a patient with a head injury can lead to significant brain damage and even death.

  • Assess for signs and symptoms of shock.

  • Control bleeding.

last resort, vomiting, intracranial pressure, always, 90%, slow, hypoperfusion

Primary Assessment

• Manner of transport

  • Patients with impaired airways, open head wounds, or abnormal vital signs may need to be rapidly extracted from a motor vehicle and transported.

  • Ensuring a patent airway and providing supplemental oxygen is paramount.

  • Suction should be readily available.

  • Maintain immobilization of the spine.

ok?

ok

Secondary Assessment

• Instruct the patient to keep still and not to move the head or neck.

• Physical examinations

  • May be a systematic head-to-toe, full-body scan or a systematic assessment that focuses on a certain area or region of the body

  • Vital signs

    • Significant head injuries may cause the pulse to be —- and the BP to —-.

    • With neurogenic shock, the blood pressure may —-, and the heart rate may —- to compensate. 

    • Respirations will become —-.

  • Use monitoring devices.

  • Use DCAP-BTLS to examine the head, chest, abdomen, extremities, and back.

  • Check perfusion, motor function, and sensation in all extremities prior to moving the patient.

  • A decreased —- is the most reliable sign of a head injury.

  • Look for leaking —- or —-.

  • Assess pupil — and reaction to —-, and continue to monitor the pupils.

  • Do not probe open scalp lacerations with your gloved finger.

slow, rise, decrease, increase, erratic, LOC, blood, CSF, size, light

Secondary Assessment

• Neurologic examination 

  • Perform baseline assessment using the — — — (GCS).

  • If your jurisdiction uses the Revised Trauma Score (RTS), then the findings from the GCS will be used in determining the RTS value.

  • Record levels of consciousness that — or —-.

• Spine examination

  • Inspect for DCAP-BTLS, and check the extremities for circulation, motor, or sensory problems.

  • If there is impairment, note the level.

  • — or — when you palpate is a warning sign.

  • Other signs and symptoms: deformity, numbness, weakness, or tingling in the extremities; and soft-tissue injuries

Glasgow coma scale, fluctuate, deteriorate, pain tenderness

Reassessment

• Repeat the primary assessment.

• Reassess vital signs and the chief complaint.

• Recheck patient interventions.

  • Reassess at least every 5 minutes.

• Interventions

  • Compare — vital signs with — vital signs. 

  • Rapid deterioration of neurologic signs is a sign of an expanding — in the brain or rapidly progressing brain —-. 

  • If CSF is present, cover the wound with sterile gauze, but do not bandage tightly.

  • Administer high-flow oxygen and apply a cervical collar.

• Communication and documentation

  • Your documentation should include:

    • The history you obtained at the scene

    • Your findings during your assessment

    • Treatments you provided

    • How the patient responded to them

  • Document vital signs for unstable patients every 5 minutes; every 15 for stable patients.

baseline, repeated, bleed, swelling

Emergency Medical Care of Head Injuries

• Three general principles:

  • Establish an adequate —-.

  • Control —- and provide adequate circulation to maintain cerebral —-.

  • Assess the patient’s baseline —- and continuously monitor.

airway, bleeding, perfusion, LOC

Emergency Medical Care of Head Injuries

• Managing the airway

  • Perform the —- —- maneuver.

  • Once the airway is open, maintain the head and cervical spine in a neutral, in-line position until you have placed a — — and have secured the patient on a —.

  • Remove any foreign bodies, secretions, or vomitus.

  • Check ventilation.

  • Give supplemental oxygen to any patient with suspected head injury.

  • Focus on identifying —- breathing patterns

  • On any suspected head injuries, NEVER use a —— airway

    • If there is a basilar skull fracture, the NPA can enter the cranium

jaw thrust, cervical collar, backboard, abnormal, nasopharyngeal 

Emergency Medical Care of Head Injuries

• Circulation

  • Begin CPR if the patient is in cardiac arrest.

  • Active blood loss aggravates hypoxia.

  • You can almost always control bleeding from a scalp laceration by applying —- —- over the wound.

• Shock is usually the result of —-.

  • Indicates that the situation is critical 

  • Transport immediately to a trauma center.

  • Patients with head injuries are usually never in shock, usually have ——

    • But if shock is present it indicates a severely progressed head injury 

direct pressure, hypovolemia, hypertension

Emergency Medical Care of Head Injuries

• Cushing triad

  • Indicate increased ICP

  • —

  • —

  • Irregular respirations (——- respirations or —/—- respirations)

  • Manage shock, administer oxygen, and ventilate as necessary, avoiding ——. 

    • Hyperventilate = vasoconstriction = further increase blood pressure

hypertension, bradycardia, irregular, Cheyne-Stokes, Ataxic/Biot, hyperventilation 

Emergency Medical Care of Spinal Injuries

• Follow standard precautions.

• Maintain the patient’s airway while keeping the spine in the proper position.

• Assess respirations and give supplemental oxygen.

• Managing the airway

  • Perform the —- —- maneuver.

  • Consider inserting an oropharyngeal airway.

  • Have a suctioning unit available.

  • Provide supplemental oxygen.

• Spinal motion restriction of the cervical spine

  • Immobilize the —- and —- so that bone fragments do not cause further damage.

  • Never force the head into a neutral, in-line position.

  • Immobilize the patient in his or her — position. 

jaw thrust, head trunk, current

Emergency Medical Care of Spinal Injuries

• Cervical collars 

  • Provide preliminary, partial support

  • Should be applied to every patient who has a possible —- injury 

  • To be effective, a rigid cervical collar must be the correct size.  

  • Once the patient’s head and neck have been manually stabilized, assess the —, —-, — in all extremities. Then assess the cervical spine area and neck. 

  • Maintain —- support until the patient has been fully secured to the backboard or vacuum mattress.

spinal, pulse motor sensory, manual

Preparation for Transport

• Supine patients

  • Secure to a long —- or vacuum mattress.

  • Another procedure to move a patient from the ground to a backboard is the four-person —- —-.

  • You may also —- the patient onto a backboard or vacuum mattress.

• Vacuum mattress

  • An alternative to the long backboard is a vacuum mattress.

  • Molds to the specific contours of patient’s body 

  • Excellent for the elderly or a patient with abnormal curvature of the spine

  • Can be used on a supine, sitting, or standing patient

backboard, log roll, slide,

Preparation for Transport

• Sitting patients

  • Use a —- backboard to restrict movement of the cervical and thoracic spine.

  • Then secure the short board to the —- board.

  • Exceptions include situations in which:

    • You or the patient is in danger.

    • You need immediate access to other patients.

    • The patient’s injuries justify urgent removal.

• Standing patients

  • Transfer patient to a position in which spinal motion restriction can be maintained.

  • Clinical indications for spinal motion restriction:

    • Spinal tenderness or pain

    • Altered level of consciousness

    • Neurologic deficits

    • Obvious spinal deformity

    • High-energy trauma in an intoxicated patient or one with a distracting injury 

short, long

Preparation for Transport

• Spinal immobilization devices

  • Assume the presence of spinal injury in all patients who have sustained —- injuries.

  • Use —- in-line stabilization or a — — and long —.

• Short backboards

  • Vest-type device and rigid short board

  • Designed to immobilize and restrict movement of the head, neck, and torso

  • Used to immobilize —- patients found in a —- position

• Long backboards

  • Provide —- —- spinal immobilization and motion restriction to the head, neck, torso, pelvis, and extremities

  • Used to immobilize patients found in —- position

head, manual, cervical collar, backboard, noncritical, sitting, full body, any

Helmet Removal

• A helmet that fits well prevents the patient’s head from moving and should be —- —-, provided:

  • There are no impending —- or —- problems.

  • It does not interfere with —- and —- of airway or ventilation problems.

  • You can properly immobilize the —-.

• Remove a helmet if:

  • It is a — —- helmet.

  • It makes assessing or managing —- problems difficult. 

  • It prevents you from properly immobilizing the —-.

  • It allows excessive —- movement.

  • The patient is in —- —-.

left on, airway breathing, assessment, treatment, spine, full face airway, spine, head, cardiac arrest 

Helmet Removal

• Preferred method

  • Removing a helmet should always be at least a —- —— job.

  • You should first consult with —- —- about your decision to remove a helmet.

• Alternate method

  • The advantage is that it allows the helmet to be removed with the application of —- force, therefore reducing the likelihood of — occurring in the neck.

  • The disadvantage is that it is slightly more —- consuming.

  • Remove the chin strap.

  • Remove the face mask.

  • Pop the jaw pads out of place.

  • Place your fingers inside the helmet.

  • Hold the jaw with one hand and the occiput with the other.

  • Insert padding behind the occiput.

  • The person at the side of the patient’s chest is responsible for making sure that the head and neck do not move during removal of the helmet.

  • Remember that children may require additional padding to maintain the in-line neutral position.

two person, medical control, less, motion, time,

The brain, a part of the central nervous system (CNS), is divided into the:

cerebrum, cerebellum, and brainstem.

cerebrum, brainstem, and spinal cord.

cerebellum, cerebrum, and spinal cord.

spinal cord, cerebrum, and cerebral cortex.

cerebrum, cerebellum, and brainstem.

As you are assessing a 24-year-old man with a large laceration to the top of his head, you should recall that:

the scalp, unlike other parts of the body, has relatively fewer blood vessels.

blood loss from a scalp laceration may contribute to hypovolemic shock in adults. 

any avulsed portions of the scalp should be carefully cut away to facilitate bandaging.

most scalp injuries are superficial and are rarely associated with more serious injuries.

blood loss from a scalp laceration may contribute to hypovolemic shock in adults. 

A patient who experiences an immediate loss of consciousness followed by a lucid interval has a(n):

epidural hematoma.

subdural hematoma.

concussion. 

contusion.

epidural hematoma.

A 44-year-old man was struck in the back of the head and was reportedly unconscious for approximately 30 seconds. He complains of a severe headache and “seeing stars,” and states that he regained his memory shortly before your arrival. His presentation is MOST consistent with a(n):

contusion.

concussion.

subdural hematoma.

intracerebral hemorrhage.

concussion.

A young male was involved in a motor vehicle accident and experienced a closed head injury. He has no memory of the events leading up to the accident but remembers that he was going to a birthday party. What is the correct term to use when documenting his memory loss?

Concussion

Cerebral contusion

Retrograde amnesia

Anterograde amnesia

Retrograde amnesia

A distraction injury to the cervical spine would MOST likely occur following:

a diving accident.

blunt neck trauma. 

hyperextension of the neck. 

hanging-type mechanisms.

hanging-type mechanisms.

During immobilization of a patient with a possible spinal injury, manual stabilization of the head must be maintained until:

an appropriate-size extrication collar has been placed.

the patient is fully immobilized on a long backboard.

a range of motion test of the neck has been completed.

pulse, motor, and sensory functions are found to be intact.

the patient is fully immobilized on a long backboard.

Your patient is a 21-year-old male who has massive face and head trauma after being assaulted. He is lying supine, is semiconscious, and has blood in his mouth. You should:

insert a nasal airway, assess his respirations, and give 100% oxygen. 

suction his airway and apply high-flow oxygen via a nonrebreathing mask. 

manually stabilize his head, log roll him onto his side, and suction his mouth. 

apply a cervical collar, suction his airway, and begin assisting his ventilations.

manually stabilize his head, log roll him onto his side, and suction his mouth. 

A man is found slumped over the steering wheel, unconscious and making snoring sounds, after an automobile accident. His head is turned to the side and his neck is flexed. You should:

gently rotate his head to correct the deformity. 

carefully hyperextend his neck to open his airway. 

apply an extrication collar with his head in the position found. 

manually stabilize his head and move it to a neutral, in-line position.

manually stabilize his head and move it to a neutral, in-line position.

You should NOT remove an injured football player’s helmet if:

a cervical spine injury is suspected, even if the helmet fits loosely.

the patient has a patent airway, even if he has breathing difficulty. 

he has broken teeth, but only if the helmet does not fit snugly in place. 

the face guard can easily be removed and there is no airway compromise.

the face guard can easily be removed and there is no airway compromise.