CH12.pptx

Chapter 12 Head and Spinal Injuries Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com. Head Injuries  Scalp wounds  Skull fractures  Brain injuries  Spinal injuries can also present in people with a head injury. Copyright © 2021 by Publi...

Chapter 12 Head and Spinal Injuries Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com. Head Injuries  Scalp wounds  Skull fractures  Brain injuries  Spinal injuries can also present in people with a head injury. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Any head injury is potentially serious. Scalp Wounds: What to Do  Replace any skin flap to original position and apply pressure. FIGURE 12-1 Apply direct pressure with a dry, sterile dressing to control the bleeding © Jones & Bartlett Learning. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Control bleeding by pressing on wound. Scalp Wounds: What to Do (cont.)  Press on edges of wound to help control bleeding. FIGURE 12-2 Apply pressure around the edges of the wound to control bleeding from a suspected skull fracture © Jones & Bartlett Learning. Courtesy of MIEMSS. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  If skull fracture is suspected: Scalp Wounds: What to Do (cont.)  Keep head and shoulders slightly elevated if no spinal injury is suspected.  If bleeding continues, add dressings over the first dressing.  Call 9-1-1 if wound is extensive, significant facial damage, or signs of concussion. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Apply a dry, sterile or clean dressing. Skull Fracture: What to Look For  Skull deformity  Bleeding from ears/nose  Leakage of CSF FIGURE 12-3 Discoloration around the eyes © American Academy of Orthopaedic Surgeons.  Discoloration around eyes or behind ears  Unequal pupils  Heavy scalp bleeding  Penetrating object FIGURE 12-4 Battle sign Courtesy of Rhonda Hunt. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Pain Skull Fracture: What to Do  Control bleeding.  Call 9-1-1. FIGURE 12-5 Make a doughnut for skull fracture–related bleeding and to surround an eye for protection when a short object is embedded in an eye. A. Using a cravat bandage or strip of cloth, wrap about half the length into a circle large enough to surround the injured area. B. Pass the tail thorough the hole repeatedly to form a circle. C. The completed dressing should have a hole large enough to surround the injury. © Jones & Bartlett Learning. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Apply sterile or clean dressing over wound and hold in place with gentle pressure. Traumatic Brain Injury  Mishandling a person could result in permanent damage or death.  The brain will swell when it is injured.  Swelling can interfere with brain functioning. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Injury to the brain causes most short- and long-term problems. Traumatic Brain Injury (cont.)  A penetrating foreign object  Bony fragments from a skull fracture  The brain striking the inside of the skull  Deceleration injury: person’s head hits a stationary object.  Acceleration injury: person has been hit by a moving object.  Coup-contrecoup: two points of injury Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Brain injuries can be caused by: Concussions  Most resolve within 7-10 days; some take much longer  Most people make a full recovery.  Postconcussion syndrome. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Occur when a blow to the head alters the function of the brain Other Traumatic Brain Injuries  Coup-contrecoup: blow to the head that causes a contusion at site of impact and hits brain to opposite side of skull  Diffuse axonal: shaking or strong rotation of the head that causes a tearing injury  Penetration: a bullet, knife, or other sharp object enters the brain Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Contusion: direct blow to the head Traumatic Brain Injuries: What to Look For  Difficulty thinking clearly  Feeling slowed down  Difficulty concentrating  Difficulty remembering new information Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Thinking/remembering symptoms Traumatic Brain Injuries: What to Look For (cont.)  Headache  Fuzzy or blurred vision  Nausea or vomiting  Dizziness  Sensitivity to noise or light  Balance problems  Feeling tired, having no energy Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Physical symptoms Traumatic Brain Injuries: What to Look For (cont.)  Irritability  Sadness  More emotional  Nervousness or anxiety  Sleep disturbance symptoms  Sleeping more than usual  Sleeping less than usual  Trouble falling asleep Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Emotional/mood symptoms Traumatic Brain Injuries: What to Do  If a neck injury is suspected, or if person is unresponsive:  Do not move head, neck, or spine.  Call 9-1-1. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  If unresponsive, check for breathing. Traumatic Brain Injuries: What to Do (cont.)  You suspect an obstructed airway  You cannot stabilize spine  You must remove it to provide life-saving care of an airway Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  If the person is wearing helmet, do not remove unless: Traumatic Brain Injuries: What to Do (cont.)  Drowsiness  One pupil larger than the other  Seizure  Inability to recognize people or places  Confusion  Restlessness  Unusual behavior  Unresponsiveness  Headache that gets worse and/or does not go away  Repeated vomiting  Slurred speech Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Seek immediate medical care for: Traumatic Brain Injuries: What to Do (cont.)  Get plenty of sleep and rest.  Avoid visual and sensory stimuli.  Ease into normal activities slowly.  Avoid strenuous physical activities.  Avoid another blow to head or body.  DO NOT use aspirin or anti-inflammatory medications other than acetaminophen. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Following injury, the person should: Further Care of Brain Injuries  Headache lasts more than 1 or 2 days  Nausea lasts more than 2 hours  Vomiting occurs hours after initial episodes of vomiting have stopped  Confusion or disorientation after waking  Vision changes  Mobility or speech impairment  Seizures or convulsions Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Required if: Eye Injuries  Examination by an ophthalmologist or other physician should occur as soon as possible after injury. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  The eyes are easily damaged by trauma. Blow to the Eye: What to Look For  Person reports being hit by fist, ball, or blunt object  Broken bone around eyeball indicated by:  Double vision  Inability to look upward FIGURE 12-6 Blow to the eye © American Academy of Orthopaedic Surgeons. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Black eye Blow to the Eye: What to Do  DO NOT place on eye.  Have person keep eyes closed.  Seek medical care. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Apply ice or cold pack around eye for 15 minutes. Loose Objects in the Eye  Severe pain  Tearing  What to do:  Have person blink eye several times.  Pull upper eyelid out and over lower lid.  Gently irrigate with clean, warm water. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Loose Objects in the Eye (cont.)  Lift upper eyelid up and over a cotton swab. FIGURE 12-7 Removing loose objects from the eye. A. If tears or gentle flushing do not remove the object, gently pull down the lower lid. Remove an object by gently flushing with lukewarm water or by using wet, sterile gauze. B. If unsuccessful, tell the person to look down. Pull gently downward on the upper eyelashes. Lay a swab or matchstick across the top of the lid. C. Next, fold the lid over the swab or matchstick. Remove an object by gently flushing with lukewarm water or by using wet, sterile gauze © Jones & Bartlett Learning. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Examine lower lid by pulling it down gently. Cut or Scratch on the Eyeball or Eyelid  Cut appearance of cornea or sclera  Inner liquid filling of eye coming out through wound  Cut lid  What to do:  Do not apply pressure.  Cover both eyes with gauze pads, and lightly wrap bandage.  Call 9-1-1. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Penetrating Eye Injuries  Lid laceration or cut  What to do:  DO NOT remove object.  For long object:  Place padding around object.  Cover with cup. FIGURE 12-9 Stabilize a long penetrating object against movement. A. Place padding around the object. B. Place a shield (ie, paper cup or similar object) over, but not touching, the penetrating object to protect the object from being hit. C. Cover both eyes to prevent the uninjured eye from moving with the injured eye © American Academy of Orthopaedic Surgeons. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Penetrating Eye Injuries (cont.)  For short object:  Place doughnut-shaped pad around eye.  Wrap bandage around head to hold pad in place.  Cover both eyes.  Keep person flat on his or her back.  Call 9-1-1. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to do (cont.): Chemicals in the Eyes  Hold eye open; flush with warm water for at least 15 minutes or until EMS arrives.  Loosely bandage if necessary.  Contact poison control center. FIGURE 12-10 Flushing the eye to treat a chemical burn © American Academy of Orthopaedic Surgeons. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to do: Eye Avulsion  Eye knocked out of socket  What to do:  Cover loosely with sterile dressing moistened with clean water.  Protect injured eye.  Cover undamaged eye with a patch.  Call 9-1-1. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Burns to Eye Caused by Light  Reports of looking at a source of UV light  Severe pain occurring 1 to 6 hours after exposure  What to do:  Cover both eyes with moist, cool cloths.  Give pain medication, if needed.  Seek medical advice. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Conjunctivitis  Redness in the sclera (white part of the eye)  Itching or gritty sensation in the eye  Oozing discharge  Excessive tearing  Swollen eyelids  Dried crusts that form during sleep may bind the eyelids together.  Discomfort caused by bright lights Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Conjunctivitis (cont.)  Apply cool compresses to the eye.  Apply artificial tears to dilute the offending allergen.  Seek professional medical care if signs and symptoms do not improve after 3 or 4 days of treatment. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to do: Subconjunctival Hemorrhage  Only one eye affected  Red patch or large area of redness in the sclera  Does not cause pain, visual changes, tearing, irritation, itching, or discharge from the eye  Can occur in people with eye injury or sneezed violently; can also occur during bowel movement or while lifting a heavy weight  Drugs that help prevent blood from clotting Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Subconjunctival Hemorrhage (cont.)  Treatment is not required.  DO NOT use OTC eye drops that aim to eliminate redness.  Reassure the person that it is safe to continue activities.  If the eye is injured and hyphema is suspected, seek professional medical attention immediately. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to do: Hyphema  Visible pool of blood in front of the iris of the eye  Impaired vision  Pain in eye Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Hyphema (cont.)  Keep physical activity to a minimum.  Keep both eyes closed and cover the affected eye with an eye patch.  Apply an eye shield over the eye patch to protect the eye from being struck.  Keep head in an elevated and upright position.  Seek professional medical care immediately. FIGURE 12-11 Hyphema © Jones & Bartlett Learning. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look do: Ear Injuries  Only disk batteries and live insects must be removed immediately.  First aid providers should seek medical care for the person. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Most ear problems are not life-threatening. Objects Stuck in Ear  DO NOT use tweezers unless object can be seen near ear canal opening.  Seek medical care to remove object.  For live insect:  Shine small light into ear.  If insect does not crawl out, pour warm water into ear and then drain it.  If insect cannot be removed, seek medical care. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to do: Fluids Coming From Ear  DO NOT attempt to stop bleeding or CSF coming from ear.  Place sterile dressing over ear and loosely bandage in place.  Stabilize head and neck against movement.  Call 9-1-1. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to do: Nose Injuries  In cases of accompanying head or neck injuries, stabilize head and neck for protection. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Most nosebleeds are self-limiting and seldom require medical attention. Broken Nose  Pain, swelling, and bleeding  Difficulty breathing through nostrils  Black eyes appearing 1 to 2 days after injury  What to do:  If bleeding, provide care.  Apply ice or cold pack for 15 minutes.  DO NOT try to straighten a crooked nose. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Nosebleeds  Anterior nosebleeds  Posterior nosebleeds  What to do:  If nose was hit, suspect broken nose.  Have person sit leaning slightly forward.  Pinch nostrils shut constantly for 10 minutes. FIGURE 12-12 Control bleeding from the nose by pinching the nostrils together © American Academy of Orthopaedic Surgeons. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Nosebleeds (cont.)  If bleeding has not stopped:  Have person gently blow his or her nose.  Pinch nostrils shut again for 10 minutes.  If bleeding continues, try other methods. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to do (cont.): Care After a Nosebleed  Avoid too much physical activity.  Elevate head when lying down.  Keep nostrils moist.  Avoid picking or rubbing the nose. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Sneeze through an open mouth. Foreign Object in Nose  Have the person gently blow his or her nose while compressing the opposite nostril.  If an object is visible, pull it out with tweezers.  Seek medical care if the object cannot be removed. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to do: Object Caught Between the Teeth  Person reports something is caught between his or her teeth  Object may or may not be seen  What to do:  Try to remove object with dental floss.  If unsuccessful, seek dental care. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Bitten Lip or Tongue  Immediate pain, bleeding, swelling  What to do:  Apply direct pressure.  Clean area.  If bleeding does not stop, seek medical care. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Loosened Tooth  Apply pressure on either side of each tooth.  Tooth movement indicates a possibly loose tooth.  What to do:  Have the person bite down on gauze.  Consult a dentist or oral surgeon. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Toothache  Pain, tooth sensitivity  Dental decay  What to do:  Rinse mouth with warm water.  Use dental floss to remove any food.  Place an ice pack on outside of cheek.  Give acetaminophen or ibuprofen.  Seek a dentist. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Broken Tooth: What to Do  Rinse mouth with warm water.  For swelling, place ice pack on outside of cheek. FIGURE 12-13 Broken teeth © American Academy of Orthopaedic Surgeons. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Collect tooth or teeth fragments. Broken Tooth: What to Do (cont.)  If jaw fracture is suspected, stabilize jaw.  Seek dentist as soon as possible.  Transport fragments as you would a knocked-out tooth. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  For pain, keep air exposure to minimum. Knocked-Out Tooth: What to Do  If unable to reimplant, store tooth in:  Hank’s Balanced Salt Solution  Egg white  Coconut water  Whole milk  Seek dentist. FIGURE 12-14 Knocked-out tooth © American Academy of Orthopaedic Surgeons. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Attempt to reimplant tooth. Infected or Abscessed Tooth  Swelling of the gums  Foul breath  Pain that is increased by tapping the tooth with something metal  What to do:  Rinse the mouth several times a day.  Give OTC pain medication.  Seek a dentist. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Cavity  Sensitivity to heat, cold, or sweets  Sensitivity to touch  What to do:  Rinse mouth with warm water.  Apply oil of cloves (eugenol).  Seek a dentist. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Bleeding From Mouth: What to Do  For bleeding tongue, put a dressing on wound and apply pressure.  For cut through lip, place rolled dressing between lip and gum and press another dressing against outer lip.  Seek medical care. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Allow blood to drain out of mouth. Spinal Injuries  Consists of long tracts of nerves that join the brain with all other body organs and parts  If a broken vertebra pinches spinal nerves, paralysis can result. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  The spine is a column of vertebrae stacked from the tailbone to the base of the skull. Spinal Injuries (cont.)  All unresponsive people with an injury should be treated as though they have a spinal injury. FIGURE 12-15 Common causes of spinal cord injury Reproduced from National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham, 2016. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  Suspect spinal injury whenever significant cause of injury occurs. Reliable Person With Signs of Spinal Injury  Back pain, leg numbness and tingling  Tenderness/pain when you run fingers down spine  Failure of tests for sensation and movement Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Reliable Person With Signs of Spinal Injury (cont.)  Call 9-1-1.  DO NOT move person.  Apply spinal stabilization.  Prevent heat loss. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to do: Reliable Person Without Signs of a Spinal Injury  Alert  No neck pain or neurologic symptoms  Able to move fingers and toes  What to do:  Spinal injury not suspected  Treat other injuries. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: Unreliable Person With Signs of Spinal Injury  Altered mental status  Intoxication, combativeness, confusion  Painful distracting injury  What to do:  Assume spinal injury exists.  Stabilize the person. Copyright © 2021 by Public Safety Group, A Division of Jones & Bartlett Learning. www.psglearning.com.  What to look for: