Head and Neck Injuries

Layers of the Brain

  • Meninges - 3 layers b/w the skull and brain

    • Dura mater - durable mother

    • Arachnoid - soft membrane

    • Pia mater - delicate inner layer with numerous tiny blood vessels

Conditions involving the layers

  • Hematoma - Brian bleed b/w layers. Very serious

  • Epidural - Bleed b/w skull and dura

  • Subdural - Bleed b/w dura and arachnoid

Closed head injuries

Mechanism of Injuries

  • Brain Injuries

    • concussion (brain bruise)

    • Cerebral hematoma (brain bleed)

    • Cushing’s reflex (brain injury resulting in numerous conditions)

Concussion

it is a TBI

There are 3 types

  • direct impact

  • Acceleration-deceleration

  • blast

S/S

T

tinnitus

headache

vomiting

neasua

slurred speach

dizziness

light sensitivity

blown pupils

temp loss of consciousness confusion

amnesia

fatigue

SMR if warranted

O2 if needed

Supportive care

consider pain management

Transport

Limit light and loud noises

Cushing’s Reflex

Cushing’s Reflex (Cushing’s Triad) – a traumatic brain injury, tumor, or infection resulting in increased ICP (intracranial pressure). ICP causes the following to occur:

  • Hypertension (High BP)

  • Bradycardia (High pulse rate)

  • Irregular breathing (referred to as Cheyne-Stokes breathing)

    • Rapid breathing followed by apnea (no resps)

Skull Fractures

  • Closed location names

    • Orbit (eye)

    • Jaw (mandible)

    • Basilar (temporal to back of skull)

    • Malar (triangle - Facial/nose)

  • Basic Types skull Fractures

    • Closed - no need to apply direct pressure, protect the area

    • Open - gently apply pad to opening, apply pressure to surrounding area but NOT directly on the opening, do not move bones

    • *Never apply pressure directly to a skull fracture. If it is open and has moderate to major bleeding apply pressure. ensuring not to press directly on the fracture itself.

Spinal Injuries

MOI

  • Compression

  • Distraction

  • Flexion

  • Rotation

  • Hyperextension

  • Penetration

S/S

T

Visible damage to the skull, neck or back

Fluid coming from the ears

Battle’s Sign or raccoon eyes

Unequal pupil sizes (anisocoria)

Changes in responsiveness

Paresthesia (loss of sensation/tingling)

Paralysis (loss motion)

Irregular respirations (Cheyne-Stokes)

High blood pressure and slow pulse

Amnesia

Spinal motion restriction

Oxygen based on patient condition

Supportive care

Consider pain management (Entonox) (no Ento for lung puncture! Pneumothorax)

SMR - Spinal Motion Restirction

Simple SMR - Collar only (30 degree elevation of cot for head injuries)

Full SMR - Collar, Clamshell, rollers/foam blocks

Nexus

Modifies Nexus

  1. is there midline tenderness?

  2. Is there an altered LOC (must be alert and oriented x3)

  3. are there new focal neurologial deficits?

  4. Are they intoxicated (judgement and pain sensation must be intact)

  5. is there a major distractin injury? (significant enough to interfere with their ability to assess pain response when palpating the spine)

* No to all five questions = no SMR warranted

ALWAYS EXPOSE AND ASSESS THE BACK FOR ALL SMR PTS.

SMR Grips

Movements for SMR

  • Prone to supine

  • Ÿ prone to supine

  • standing takedown

  • Ked

  • Rapid extraction