HEAD INJURY AND SPINAL CARE

 

Traumatic head injury is caused by a number of mechanisms including, falls, assaults, motor vehicle accidents and sporting injuries. A patient may sustain a significant head injury without loss of consciousness or loss of memory (amnesia). (ARC 2016)

PRIMARY BRAIN INJURY: occurs at the time of impact due to direct neuronal and vascular injury.

SECONDARY BRAIN INJURY: biochemical processes that occur following primary injury. Hypoxia, hypotension and inflammation main contributing factors.

Symptoms of head injury vary...however should be suspected in anyone who has a reported or witnessed injury, has signs of injury to the head/face or is found in a confused or unconscious state.

Treatment:

  1. Complete thorough DRSABCD assessment

  2. Consider spinal care whilst maintaining open airway

  3. Identify and control any significant bleeding with direct

    pressure if possible

  4. Rest and reassure conscious patients; stop all activity

  5. Pre-empt onset of shock- treat for environment

  6. All patients who appear to have suffered a head injury

    (including a minor head injury) should be assessed by a healthcare professional

Evacuation: Consider: All patients who have a relevant MOI, changes in LOC caused by a head injury (including concussion) should be assessed by a health professional; Acute onset of unexplained headache Rapid: Any persistent decreased LOC or deterioration

The spine is made up of 33 separate bones, known as vertebrae, extending from the base of the skull to the coccyx (tailbone). Each vertebra surrounds and protects the spinal cord (nerve tissue). Fractures or dislocations to the vertebral bones may result in injury to the spinal cord. The direct mechanical injury from the traumatic impact can compress or sever the nerve tissue. This is followed by secondary injury caused by ongoing bleeding into the spinal cord as well as continued swelling at the injured site and surrounding area.

The possibility of spinal injury must be considered in the overall management of all trauma victims. The risk of worsening the spinal injury in the prehospital period is probably less than previously thought, yet to minimise the extent of the secondary injury, caution must be taken when moving a victim with a suspected spinal injury.

Spinal injuries can occur in the following regions of the spine:

  • the neck (cervical spine)

  • the back of the chest (thoracic spine)

  • the lower back (lumbar spine).

The cervical spine is most vulnerable to injury, which must be suspected in any victim with injuries above the shoulders. More than half of spinal injuries occur in the cervical region. Suspected spinal injuries of the neck, particularly if the victim is unconscious, pose a dilemma for the rescuer because correct principles of airway management often cause some movement off the cervical spine.

Treatment

The priorities of management of a suspected spinal injury are:

  1. calling for an ambulance

  2. management of airway, breathing and circulation

  3. spinal care.

An awareness of potential spinal injury and careful victim handling, with attention to spinal alignment, is the key to harm minimisation.

The clinical importance of prehospital immobilisation in spinal trauma remains unproven. 

Evacuation: Consider: All patients who have a relevant MOI Rapid: All patients who have a relevant MOI and Signs of a Spinal Injury 

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