Head and Spinal Injury

Advanced First Aid

Introduction and Motivation

[0:00] Aims:

• Be able to identify likely mechanisms of head and spinal trauma
• Know the signs and symptoms of head and spinal injury
• Be able to provide appropriate treatment for these injuries

Motivation

• Head injury is the most likely cause of death in age group 18-25
• Spinal injury can result in permanent paralysis

Anatomy and Physiology

[02:00] Skeleton:

• Skull is a box enclosing the brain
• Jaw hangs off the skull
• Skull balances on the spinal column, pegged onto the top
• Spinal column divided into cervical, thoracic, lumbar, sacral

Nervous system:

• Brain floats in CSF inside skull
• Meninges cover brain: pia mater, arachnoid, dura mater (in to out)
• NB, brain is very vascular
• Spinal cord comes out of hole in base of skull, goes inside spinal column
• Spinal cord is transmission medium between brain and motors / sensors of the body.

[06:00] Respiration and ICP

• Remember that respiration is caused by increased PaCO2
• If PaCO2 increases, cerebral blood vessels dilate to increase blood flow (and hence amount of O2 getting to brain)
  Pulse pressure narrows to increase blood flow
  Resp depth increases to increase percent of O2
  Finally pulse slows to increase O2 pickup through brain
• If PaCO2 plummets, vessels constrict to decrease blood flow
• So increased PaCO2 aggravates cerebral bleeds, hence increasing intercranial pressure (ICP); "balloon in box" simile
• So: keep PaCO2 low in head injuries => high O2!

Head Injury

[11:00] Causes:

• Direct blow to skull e.g. baseball bat
• Indirect fracture e.g. "Don Juan" falling from height onto feet; often causes basal skull fracture

Signs and Symptoms

• Skull deformation, tenderness if fractured
• "Panda eyes" and Battle's sign - late signs of fracture
• Decreased LOC (concussion or compression)
• Deep, noisy breathing
• Flushed, dry skin
• Slowing pulse
• Disruption to neuro function
• Narrowing pulse pressure
• Blown pupil(s)
• Posturing

[16:00] Treatment

• Safeguard airway
• Guard C-spine
• High-flow O2
• Ventilate if resps too slow

Spinal Injury

[18:00] Causes

• Direct blow to spine
• Trauma above clavicles
• Crushing
• Penetrating trauma
• Wrenching of spine (e.g. scrum collapse)

Note:

• Most common age of injury is 16-35 years
• Spine tends to break at extremes of bends

[21:00] Signs and symptoms

• Fractured spine: tenderness, abnormalty
• Paralysis
• Altered feeling or sensation
• Weakness or numbness
• Pain
• Loss of muscle tone below injury level, lowered BP
• Vasoconstrictiopn above injury level

[24:00] Treatment

• Grab head and immobilise it: demonstrate
• "Think spinal, do airway"
• You do not let go of the head
• You DO NOT let go of the HEAD
• High-flow O2 to minimise shock and prevent hypoxia of spinal cord
• Immobilisation all the way

Conclusions

[28:00]

Summary of head and spinal injuries

• Both are prevalent in age group 16-35
• Head injuries are airway problems
• C-spine injuries are breathing and circulation problems

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