Chapter 28 - Head and Spine Injuries

The nervous system

  • Central nervous system

    • CNS: includes the brain, brainstem, spinal cord, cerebellum, etc

    • brain: controls the body and is the center of consciousness

    • cerebrum: makes up the majority

    • spinal cord: carries messages between the brain and the body via grey and white matter + made up of fibers that extend from the brain’s nerve cells —> when damaged, can completely cut off all signaling to the rest of the body

    • Brain + spinal cord protected by 3 layers —> In between each layer contains blood cells and CSF (produced by the ventricular chambers inside the brain)

      • CSF can leak from nose, ears, or head when an injury penetrates the protective layer

        • dura matter: outer layer that resembles leather

        • arachnoid matter: contains blood vessels and bridging veins

        • Pia matter: innermost layer

  • The Peripheral nervous system

    • 31 pairs of skeletal nerves

      • conduct impulses from organs to spinal cord

      • conduct motor impulses from spinal cord to muscles

    • 12 pairs of cranial nerves

      • transmit information to and from the brain

      • perform special facial functions including sight, smell, taste, hearing, and expressions

    • 2 divisions

      • autonomic and somatic divison

      • sympathetic: activated in fight or flight situations and slows down digestion

      • parasympathetic: reverses the fight or flight effects and speeds up digestion

Diagram of Nervous System | Quizlet

  • How the nervous system works

    • receptors detect a change —> sensory neurons carry the message of a change to spinal cord

    • message is sent from spinal cord to brain/brainstem —> brain process info

    • example: blood pressure (automatic, involuntary) —> sympathetic nervous system is activated

  • The skeleton System

    • skull: face and cranium (frontal occipital parietal temporal)

    • spinal column: 33 vertebrae


  • Closed injury: the brain is injured but there is no opening to the skull/brain → most common

  • open injury: there is an opening from the brain to the outside world

Types of Head Injuries

  • scalp lacerations: can be minor or serious —> even minor lacerations can lead to significant blood loss and can often distract from other life-threatening injuries

    • primary thing to focus on when treating the patient is stopping the bleeding

  • skull fractures

    • linear: no outward physical signs and most common type of skull fracture

    • depressed skull fractures: high energy blunt trauma, risk of bone fragments puncturing brain

      • periorbital and mastoid ecchymosis

    • basilar: CSF drainage from ears, raccoon eyes and battle signs

    • Open skull fractures: brain tissue may be exposed, high mortality rate

Traumatic brain injuries

  • direct: results instantly from impact to the head

  • indirect: hypoxia, hypotension, internal bleeding, etc

  • coup-contrecoup injury: initial impact injuries the front part of the brain along with stretching/tearing of the posterior portion

Determining ICP (Intracranial pressure)

  • Cushing’s triad: bradycardia, irregular respirations, and hypertension

  • recognize subtle symptoms of ICP, act quickly

Managing Head Injuries based on EMS level

  • 3 principles

    • control bleeding and avoid shock

    • maintain the airway

    • always utilize ALS for severe head injuries

Spinal Injuries

  • axial loading injuries

  • hyperflexion

  • hyperextension

  • excessive lateral bending

  • distraction

Emergency management of spinal injury

  • manage airway and breathing

  • manage circulation

  • maintain spinal motion restriction

  • ALS should always be utilized for significant spinal injuries