Closed Head Injuries
- Incidence
- Morbidity
- Mortality
- Anatomy and Physiology of the Brain and Spine
- Spine
- Spinous process
- Cervical
- Thoracic
- Lumbar
- Spinal Fluid
- Spinal Cord
- Brain
- Skull
- Meninges
- Dura mater
- Arachnoid mater
- Pia mater
- Gray matter – composed of nerve cells
- White matter – covered nerve pathways that conduct messages of the brain
- Brain stem – center for involuntary functions, temperature regulation, respiratory and heart rate, nerve function transmissions
- Cerebrum – main part of brain, divided into two hemispheres, with four lobes
- Cerebellum – center for equilibrium and coordination
- Meninges – coverings of the brain
- Cerebral spinal fluid
- Types of Skull Fractures
- Basal
- Compressed
- Open
- Linear
- Types of Brain injuries
- Concussion – temporary disruption to brain without injury due to closed trauma
- Contusion – bruise of brain matter, may be diffuse or localized to one area
- Cerebral laceration
- Space occupying lesions
- Epidural bleed – typically arterial with high emergent risk
- Subdural – typically venous, may be acute or chronic
- Penetrating wounds
- Spine
- General Assessment Considerations for Brain Trauma Patients
- Airway and Ventilation
- Maintain airway
- Assess for adequate ventilation
- Mechanism of Injury
- Consider the potential for blunt head trauma based on mechanism of injury
- Assess the need to remove the helmet with proper spinal considerations if airway compromise or bleeding under the helmet is present
- Spinal Immobilization
- In patients with head injuries with altered mental status
- Mechanism of injury that suggests the possibility of trauma to the spine
- Respiratory Status -- brain injuries can cause irregular breathing patterns due to injuries affecting the brain stem
- Complete a Neurological Exam
- Appearance and behavior
- Alert
- Responds to verbal stimuli
- Responds to painful stimuli
- Unresponsive
- Observe posture and motor behavior – appropriate movement
- Facial expression
- Speech and language
- Thoughts and perceptions
- Logical
- Ability to make decisions
- Memory and attention
- Assess orientation
- person
- place
- time
- purpose
- Knowledge of recent events
- Assess orientation
- Pupils
- Equal
- React to light
- Vital signs
- Blood pressure
- systolic pressure increase
- hypotension is associated with poorer outcomes in head injured patients
- Pulse rate – may be slower than normal if severe head injury
- Blood pressure
- Appearance and behavior
- Management Considerations With Brain Trauma
- Maintain airway throughout care
- Administer oxygen by non-rebreather mask – maintain oxygen saturation >90 percent at all times
- Airway and Ventilation
- Nasopharyngeal airways should not be used
- Assist ventilation if indicated – avoid hyperventilation; except in specific circumstances
- Transport Considerations
- Head trauma patients with impaired airway or ventilation, open wounds, abnormal vital signs, or who do not respond to painful stimuli may need rapid extrication
- Head trauma patients must be transported to appropriate trauma centers
- Head trauma patients may deteriorate rapidly and may need air medical transport
- Adequate airway, ventilation, and oxygenation are critical to the outcome of head trauma patients
- Head trauma patients frequently vomit – keep suction available
- Head trauma patient frequently have seizures
- Refer to Brain Injury Foundation Guidelines
- Age-Related Variations for Pediatric and Geriatric Assessment and Management of Brain Injury
- Pediatric
- Geriatric
- Neurological examination considerations
- Movement of extremities
- absent or weak
- note level of impairment
- Respiratory ability
- chest wall movement
- abdominal Excursion
- Sensation
- present throughout body
- absent – note the specific level of impairment
- altered sensation distal to injury – jingling, numbness, “electric shocks”
- Pain and tenderness present at site
- Vital signs
- Hypotension may be present with cervical or high thoracic spine injuries;
- Heart rate may be slow or fail to increase in response to hypotension
- Other signs or symptoms associated with spinal cord trauma
- priapism
- inability to maintain body temperature
- loss of bowel or bladder control
- Movement of extremities
- History for patient with suspected spinal trauma
- Describe the types of closed head injuries and the location of the injury
Content Creator: Carli Wymore
CAPCE Course Number: 20-EMTP-F3-2211
Total CE Hours: 1
Level: Advanced
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.