Lesson Outlines Chapter 12
Lesson 12: Head and Spinal Injuries
Lesson Objectives
After completing this lesson, participants should be able to:
· Describe how to care for various types of head injuries.
· Identify various types of dental injuries and how to care for them.
· Demonstrate how to check a victim for a spinal injury.
Points
Head Injuries
· Types of head injuries:
o Scalp wounds
o Skull fracture
o Brain injuries
Scalp Wounds
· Associated with heavy bleeding
o The scalp has a rich blood supply.
o The vessels do not constrict.
o The brain obtains its blood supply from arteries in the neck.
Care for Scalp Wounds
· Control bleeding by applying pressure with a dry, sterile dressing
· If the dressing becomes blood filled, do not remove it.
o Add another dressing on top of the first one.
· If a fractured skull is suspected, apply pressure around the edges of the wound.
· If you do not suspect a spinal injury, elevate the head and shoulders.
· Seek medical care.
Skull Fracture
· A skull fracture is a break or crack in the cranium.
· The fracture may be open or closed.
Recognizing a Skull Fracture
· Pain at point of injury
· Deformity of skull
· Bleeding from the ears or nose
· Clear, pink, watery cerebrospinal fluid (CSF) leaking from an ear or the nose
· Discoloration around eyes (“raccoon eyes”) appearing several hours after the injury
· Discoloration behind an ear (Battle’s sign)
· Heavy scalp bleeding if the skin is broken
· Penetrating wound
Care for Skull Fracture
· Monitor the victim’s breathing and provide appropriate care.
· Stabilize the victim’s neck to prevent movement.
· Elevate the victim’s head and shoulders to help prevent bleeding.
· Cover the wounds with a sterile dressing.
· Apply pressure around the edges of the wound.
Brain Injuries
· When the head is struck with sufficient force, the brain bounces against the inside of the skull.
· Swelling of brain tissue compresses the brain, which interferes with brain functioning.
· There are three types of commonly occurring brain injuries:
o A concussion is a temporary loss of brain function.
o A contusion is bruising of brain tissue.
o A hematoma is a localized collection of blood as a result of a broken blood vessel.
Recognizing Brain Injury
· Confused facial expression
· Slow to answer questions or follow instructions
· Easily distracted and unable to follow through with normal activities
· Unaware of time, date, and place, walking in the wrong direction
· Making disjointed or incomprehensible statements
· Stumbling, inability to walk a straight line
· Distraught, crying for no apparent reason
· Asking a question that has already been answered or inability to memorize and recall a series of three words or objects 5 minutes later.
· Coma, unresponsiveness
Care for Brain Injuries
· Seek immediate medical care.
· Suspect a spinal injury in an unresponsive victim until proven otherwise.
o Stabilize the victim’s head and neck
· Monitor the victim’s breathing.
· Control scalp bleeding with sterile dressings.
· Roll the victim onto his or her side to drain vomit and keep airway open.
· If spinal injury is not suspected, keep the victim in a slightly head-elevated position to prevent increased blood pressure on the brain.
o If the victim is unresponsive, roll him or her onto the left side to keep the airway open.
· The victim’s level of responsiveness is one of the best indicators of neurologic function.
· Observations for the first 24 hours may offer clues to problems.
· Using the AVPU mnemonic to assess and describe a victim’s mental status is especially helpful with small children who do not talk.
Eye Injuries
· Types of eye injuries
· Penetrating eye injuries
· Blow to the eye
· Cut of the eye or lid
· Chemical in the eyes
· Eye avulsion
· Loose objects in the eye
· Light burns to the eye
Penetrating Eye Injuries
· Penetrating eye injuries are severe injuries that result when a sharp object, such as a knife or needle, penetrates the eye.
· Suspect penetration any time you see a lid laceration or cut.
Care for Penetrating Eye Injuries
· Seek immediate medical care.
· Stabilize the object.
· Stabilize a long, protruding object with bulky dressings or clean cloths.
· For short objects, surround the eye without touching the object with rolled gauze bandage or cloths held in place with a roller bandage.
Blows to the Eye
· Blows to the eye can range in severity from minor to sight threatening.
· A shiner or black eye occurs when some of the blood vessels around the eye rupture.
· A blunt object can break the eye around the eyeball.
Care for Blows to the Eye
· Apply ice or cold pack for about 15 minutes.
· Do not apply pressure on the eye.
· Seek medical care if there is double vision, pain, or reduced vision.
Cuts of the Eye or Lid
· Recognizing cuts of the eye or lid
o “Cut” appearance of the cornea or sclera.
o Inner liquid filling of the eye may come out through the wound.
o Lid is cut.
Care for Cuts of the Eye or Lid
· If eyeball is cut, do not apply pressure.
o If eyelid is cut, apply sterile dressing with gentle pressure.
· Bandage both eyes lightly.
· Seek medical care immediately.
Chemicals in the Eyes
· Chemicals in the eyes can threaten sight.
· Alkalis cause greater damage than acids because they penetrate deeper and continue to burn longer.
· Damage can occur in 1 to 5 minutes.
Care for Chemicals in the Eye
· Hold the eye open as widely as possible.
· Flush the eye with water for at least 20 minutes, continuously and gently.
· Loosely bandage both eyes with cold, wet dressings.
· Seek immediate medical care.
Eye Avulsion
· A blow to the eye can avulse it (knock it out) from its socket.
o This is a serious injury.
Care for Eye Avulsion
· Cover the eye loosely with a moist sterile dressing.
· Protect the injured eye with a paper cup or similar object.
· Cover the undamaged eye.
· Seek medical care immediately.
Loose Objects in the Eye
· Loose objects in the eye are the most frequent eye injury and can be very painful.
· Tearing is common because it is the body’s way of trying to remove the object.
Care for Loose Objects in the Eye
· Lift the upper lid over the lower lid, so that the lower lashes can brush the object off the inside of the upper lid.
o Have the victim blink a few times.
o If the object remains, keep the eye closed.
· Try flushing the object out by rinsing the eye with warm water.
o Tell the victim to move the eye as it is rinsed.
· Examine the lower lid by pulling it down gently.
· If you see the object, remove it with moistened sterile gauze.
Light Burns to the Eye
· Burns can result if a person looks at a source of ultraviolet light such as sunlight, bright snow, or tanning lamps.
· Severe pain occurs 1 to 6 hours after exposure.
Care for Light Burns to the Eye
· Cover both eyes with cold, wet packs.
o Tell the victim not to rub the eyes.
· Have the victim rest in a darkened room.
o Do not allow light to reach the victim’s eyes.
· Give pain medication, if needed.
· Seek medical care.
Ear Injuries
· Most ear problems are not life threatening.
o Fast action may be needed, however, to relieve pain and to prevent hearing loss.
· Except for disk batteries and live insects, few foreign bodies must be extracted immediately.
· First aiders should seek medical care for the victim because attempts to remove a foreign body from the ear can rupture the eardrum or lacerate the ear canal.
Nose Injuries
· Nosebleeds
· Broken nose
· Objects in the nose
Nosebleeds
· Anterior nosebleeds
o From the front of the nose
o Most common and the easiest to care for
· Posterior nosebleeds
o From the back of the nose
o More serious and requires medical care
Care for Nosebleeds
· Pinch the soft parts of the nose together.
· Press firmly toward the face, compressing the pinched parts of the nose against the bones of the face.
o Continue for 5 to 10 minutes.
· Keep the head higher than the level of the heart.
· Apply ice over nose.
· If bleeding continues, have the victim gently blow the nose to clear blood clots, use decongestant spray if available, and seek medical care if needed.
Recognizing a Broken Nose
· Pain, swelling, and a possible crooked appearance
· Bleeding and breathing difficulty through nostrils
· Black eyes appearing 1 to 2 days after the injury
Care for a Broken Nose
· Seek medical care.
· If bleeding is present, give care as for a nosebleed.
· Apply an ice pack to the nose for 15 minutes.
· Do not try to straighten a crooked nose.
Objects in the Nose
· A foreign object in the nose is a problem mainly among small children.
Care for Objects in the Nose
· Try to induce sneezing by having the victim sniff pepper.
· Have the victim blow gently while you put compression on the opposite nostril.
· Use tweezers to pull out an object that is visible.
· Seek medical care if the object cannot be removed.
Dental Injuries
· Objects caught between the teeth
· Bitten lip or tongue
· Loosened tooth
· Broken tooth
· Toothache
Objects Caught Between the Teeth
· The main method of detecting a problem is if the victim says that something is caught between the teeth.
· The object may or may not be seen.
Care for Objects Caught Between the Teeth
· Try to remove the object with dental floss.
· If unsuccessful, seek dental care.
Recognizing a Bitten Lip or Tongue
· Immediate pain when it happens.
· Blood may be seen.
Care for Bitten Lip or Tongue
· Apply direct pressure with sterile gauze.
· If swelling is present, apply ice or cold pack.
· If bleeding does not stop, seek medical care.
Loosened Tooth
· Trauma can cause teeth to become loosened in their sockets.
· Applying pressure on either side of each tooth with the fingers can determine looseness.
· Any tooth movement, even if it is barely felt, indicates a possibly loose tooth.
Care for a Loosened Tooth
· Have the victim bite down on a piece of gauze to keep the tooth in place.
· Consult a dentist or an oral surgeon.
Knocked-Out Tooth
· A majority of the teeth knocked out each year in the United States could be saved with proper treatment.
· Time is crucial for successful reimplantation.
o Steps must be taken to prevent the tooth from becoming dehydrated and to protect the ligament fibers from damage.
Care for a Knocked-Out Tooth
· Have the victim rinse his or her mouth (if possible).
· Place rolled gauze in the socket to control bleeding.
· Find the tooth and handle it by the crown.
· Tooth must be kept moist.
· Take the victim and the tooth immediately to a dentist.
· If you are in a remote location, try to replace the tooth into the socket, using adjacent teeth as a guide.
Broken Tooth
· The front teeth are frequently broken by falls or direct blows.
· Such damage is not unusual in the victims of violent acts or motor vehicle crashes.
· It is also common in children with an overbite.
Care for a Broken Tooth
· Gently clean dirt and blood from the injured area with a sterile gauze pad or a clean cloth and warm water.
· Apply ice on the face in the area of the injured tooth to decrease swelling.
· If you suspect a jaw fracture, stabilize the jaw by wrapping a bandage under the chin and over the top of the head.
· Seek dental care immediately.
Toothache
· The most common reason for toothaches is dental decay.
· Victims frequently complain of pain limited to one area of the mouth.
· The pain can also affect the ear, eye, neck, and opposite side of the jaw.
Recognizing a Toothache
· The tooth will be sensitive to heat and cold.
· Identify the diseased tooth by tapping the area with a spoon handle or similar object.
· A diseased tooth will hurt.
Care for Toothaches
· Rinse mouth with warm water.
· Use dental floss to remove food.
· Give pain medication.
o Do not place medication on gums.
· Seek dental care immediately.
Spinal Injuries
· The spine is a column of vertebrae stacked on one another from the tailbone to the base of the skull.
· The spinal cord 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.
· All unresponsive victims should be treated as though they have a spinal injury.
· All responsive victims should be carefully checked for a spinal injury before being moved.
· Suspect a spinal injury in all head-injury victims.
Recognizing Spinal Injuries
· Pain radiating into the arms or legs
· Neck or back pain
· Numbness, tingling, weakness, burning, or lessened sensation in the arms or legs
· Loss of bowel or bladder control
· Paralysis of the arm or legs
· Deformity of neck
Care for a Spinal Injury
· Monitor breathing.
o For an unresponsive victim, open the airway and check for breathing.
· Stabilize the victim to prevent movement by using one of the following methods:
o Grasp the victim’s head over the ears and hold the head and neck still until the EMS arrives.
o If you anticipate a long wait for EMS or are tired, kneel with the victim’s head between your knees or place objects on each side of the victim’s head to prevent it from moving side to side.
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