Head
Whether you have an open or closed head wound what is the key care?
restrict spinal movement
nothing - there is no abnormalities seen because a concussion reflects a functional disturbance rather than a structural injury
What are the signs and symptoms of a retinal detachment?
shadow or curtain over visual field
floaters
abnormal flashes of light
What is whiplash?
muscles and ligaments strained
How do you perform C-spine stabilization?
manual cervical inline stabilization via traditional hand hold or modified trap squeeze (preferred)
do not apply traction
do not attempt to align in neutral position
do not align if you feel resistance, airway becomes compromised, or patient emphasizes pain or apprehension
What sports have the highest incidences for head injuries?
Explain the difference between post-concussion syndrome and second impact syndrome.
post-concussion syndrome is the symptoms after impact; usually takes 2-3 weeks to resolve
second impact syndrome is getting a second concussion after not completely recovering from previous concussion
What are risk factors for a TMJ dislocation?
capsular or ligamentous laxity
muscle spasm
facial dystonia
marfans syndrome
What are the signs and symptoms of a laryngeal injury?
hoarseness, dysphonia, stridor, respiratory distress, anterior neck tenderness, hemoptysis, subcutaneous emphysema
What are the common mechanisms of a spinal injury?
axial loading - compression force where head is loaded and compresses the spine
buckling
spearing
forced flexion
tension
horizontal shearing - internal decapitation
Explain the differences in the 4 types of skull fractures.
depressed = part of skull is sunken in
linear = one line break in the bone
basilar = involves bone at the base of the skull (will often see otorrhea or rhinorrhea)
diastatic = along suture line - widening of suture line
What is coupe and contrecoupe?
coupe = where damage occurs
contrecoupe = damage is opposite to where the injury occured
What are the signs and symptoms of a facial fracture?
difficulty breathing and or speaking
blurred or double vision
numbness
pain
malocclusion
blow out fx = inability to look upward
What is the difference between spinal column injury and a spinal cord injury?
spinal column injury = disruption of ligamentous and boney structures surrounding cord
spinal cord injury = neurologic soft tissue injury
You would immediately send an individual to the hospital if you saw what three signs/symptoms with a back injury?
severe pain / pressure in back independent of movement or palpation
numbness, weakness, tingling or loss of feeling or movement
loss of bladder or bowel control or loss of sensation in groin area
What is a concussion?
temporary disruption of electrochemical activity in the brain
What is a subdural hematoma
bleeding collects under the inner layer of dura matter but is external to the brain/arachnoid membrane
what do you do for a patient whose tooth has come out?
rinse tooth with whole milk or saline solution and put it back in and refer to dentist
When performing an assessment on a spinal injury for a conscious victim 3 things would you ask while stabilizing c-spine?
1. MOI - what happened?
2. Does your head, back or neck hurt?
3. Where does it hurt?
When performing an assessment for a spinal injury for an unconscious patient what do you do?
look for MOI
maintain airway and breathing
stabilize head/neck/back manually in position found
ask bystanders about MOI and persons mental status before you arrived
Your patient was hit in the head by a baseball and is now experiencing headache, nausea, weakness, and seizures. You take their vitals and they have a decreased pulse and respiration rate, a decreased LOC, and an increased BP. What is your diagnosis and immediate management?
epidural hematoma
stabilize ABCs, immobilize, transport
Give 5 red flags for intracranial injuries.
worsening headache, increased drowsiness, change in mental status/confusion, repetitive nausea and vomiting, post traumatic seizure, focal neurological deficits, visual changes, abnormal behavior, unequal pupil sizes, progressive loss of consciousness, seizures, numbness or tingling in extremities, GCS < 15, inability to speak
If you place your fingers into the patient's mouth on the interior border of the mandible and press outwards and they have pain and movement.. what is the diagnosis? What about if they only have pain at TMJ?
pain and movement = mandible fracture
pain only at TMJ = dislocation
Why is the Canadian C-spine rule better than the nexus criteria?
What are the key recommendations for prehospital care of c-spine injuries?
preparticipation planning and communication: use EAPs
scene management: treat as c-spine injury as soon as expected & perform a primary assessment
spinal motion restriction: cervical collar ASAP
equipment considerations: shoulder pads, helmet, etc
transport decisions: know where trauma facility is and transport them there ASAP
training an interprofessional collaboration: make sure you collaborate with spine boarding