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TREATING BRAIN INJURIES (continued from Lesson 2)
• Specific management
– Secure Airway and provide good oxygenation.Secure Airway and provide good oxygenation.
• If GCS is less than eight, intubate.If GCS is less than eight, intubate.
– Spinal immobilization (collar, padded head-immobilizationSpinal immobilization (collar, padded head-immobilization
device)device)
– Record baseline vitals and Glasgow Coma Score.Record baseline vitals and Glasgow Coma Score.
– Two large-bore I.V. catheters (en-route)Two large-bore I.V. catheters (en-route)
– Rapid transport to facility able to deal with critical head-
injured patients
• Remember the Golden Hour!
Hands-On:
Central Nervous System Training, Lesson 3

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TYPES OF SPINAL TRAUMA
• Hyperextension/Hyperflexion
– Excessive posterior or anterior movement of the head.
Examples are:
• Face into windshield in MVA
• Elderly person falling to floor
• Football tackle
• Dive into shallow water
• Rider thrown from horse or motorcycle.
Hands-On:
Central Nervous System Training, Lesson 3

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TYPES OF SPINAL TRAUMA
• Compression
– The weight of the head or pelvis is driven into stationary
neck or torso. Examples are:
• Dive into shallow water
• Fall of greater than 10-20 feet onto head or legs.
Hands-On:
Central Nervous System Training, Lesson 3

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TYPES OF SPINAL TRAUMA
• Rotation
– Excessive rotation of the torso or head and neck, moving
one side of the spinal column against the other.
Examples are:
• Rollover MVC
• Motorcycle accident
• Sports injuries
Hands-On:
Central Nervous System Training, Lesson 3

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TYPES OF SPINAL TRAUMA
• Lateral Stress
– Direct lateral force on the spinal column, typically
shearing one level of the cord from another. Examples
are:
• “T-Bone” type MVC
• Falls
Hands-On:
Central Nervous System Training, Lesson 3

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TYPES OF SPINAL TRAUMA
• Distraction
– Excessive stretching of the column and cord.
Examples are:
• Hanging
• Child wearing seatbelt inappropriately
• Snowmobile or motorcycle under rope or wire
Hands-On:
Central Nervous System Training, Lesson 3

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TYPES OF SPINAL TRAUMA
• Mechanism of Injury
– How important is mechanism of injury in predicting
patient injuries? Very important to the Paramedic/EMT!
– The accident will determine the mechanism of injury
which may suggest the type of injury which in turn may
determine early patient treatment and handling.
Hands-On:
Central Nervous System Training, Lesson 3

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TYPES OF ACCIDENTS
• What type of CNS injuries would you expect in
these examples?
Accident: Head-On
Injuries: Hyperextension/hyperflexion,
Compression
Accident: T-Bone
Injuries: Lateral Stress
Hands-On:
Central Nervous System Training, Lesson 3

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TYPES OF ACCIDENTS
Accident: T-Bone, Rollover
Injuries: Lateral Stress, Rotation
Accident: Rollover
Injuries: Rotation
– Depending upon the severity and duration of a motor vehicle crash,
you might have multiples or combinations of these injuries.
Hands-On:
Central Nervous System Training, Lesson 3

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SPINAL INJURIES
• Signs and Symptoms
– Mechanism of injury
– Pain in neck or back
– Neurological signs
• Numbness
• Tingling
• Loss of motor function
– Shock
– Respiratory distress
Hands-On:
Central Nervous System Training, Lesson 3

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SPINAL INJURIES
• Treatment for spinal injuries
– Most treatment in the pre-hospital setting involves
prevention of further injury, not remedying the current
injury.
• Types of immobilization devices
– KED
– Long spine board
– Short spine board
– Vacuum splint (may fail in cold weather!)
Hands-On:
Central Nervous System Training, Lesson 3

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SPINAL INJURIES
• Specific Treatment
Most people who sustain a spinal injury have other
injuries as well!
– Remember ABC’s
– Oxygen
– IV therapy
– Immobilization
– Medication considerations
Hands-On:
Central Nervous System Training, Lesson 3

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SPINAL INJURIES
• Protocols: Will a Spinal Immobilization Rule-Out
protocol be in our future?
– Some departments now have the ability not to board a
patient if it appears that the patient has no spinal injury or
fracture.
– Some patients who feel they don’t want to be immobilized,
because they feel constrained, claustrophobic, or
whatever, do not have their wishes honored by protocols
that say all accident patients, even if a spinal injury is not in
evidence, must be boarded. Sometimes an internal injury
might be aggravated by immobilization.
Hands-On:
Central Nervous System Training, Lesson 3

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SPINAL INJURIES
• Protocols: Will a Spinal Immobilization Rule-Out
protocol be in our future?
– Most EMS departments use protocols to protect them from
liability, even if these protocols are not truly sensitive to the
wishes of the patient.
Hands-On:
Central Nervous System Training, Lesson 3