9.1 Mechanisms and signs of head and spinal injuries

Head and spinal injuries can be life-altering. From mild concussions to severe brain trauma, these injuries impact the body's control center. Understanding the signs and mechanisms is crucial for quick action and proper care.

Assessing head and spine injuries involves checking consciousness, pupil response, and neurological function. Recognizing high-risk situations and using tools like the NEXUS criteria helps identify who needs immediate attention and imaging.

Head Injuries

Traumatic Brain Injury (TBI) and Skull Fractures

• Traumatic Brain Injury (TBI) occurs when an external force causes damage to the brain
• Can range from mild (concussion) to severe (coma or death)
• Symptoms of TBI include loss of consciousness, confusion, headache, dizziness, and memory problems
• Skull fractures involve a break in the bones of the skull
• Can be linear (a straight break) or depressed (pushed inward)
• Basilar skull fractures occur at the base of the skull and can be life-threatening

Intracranial Hemorrhage and Neurological Assessment

• Intracranial hemorrhage is bleeding inside the skull that can compress the brain
• Types include epidural (between skull and dura mater), subdural (between dura mater and arachnoid mater), and subarachnoid (between arachnoid mater and pia mater)
• Glasgow Coma Scale assesses level of consciousness based on eye opening, verbal response, and motor response
• Scores range from 3 (coma) to 15 (fully alert)
• Pupillary response evaluates size and reactivity of pupils to light
• Abnormal pupil size or reactivity can indicate brain injury

Signs of Basilar Skull Fracture

• Battle's sign is bruising behind the ear that indicates a basilar skull fracture
• Raccoon eyes are bruising around the eyes that also suggests a basilar skull fracture
• Cerebrospinal fluid leak from the nose or ear is another sign of basilar skull fracture
• Cerebrospinal fluid surrounds and cushions the brain and spinal cord
• A leak indicates a tear in the protective membranes around the brain

Spinal Injuries

Cervical Spine Injury

• Cervical spine injury affects the neck region of the spinal column
• Can range from mild (whiplash) to severe (paralysis or death)
• Symptoms include neck pain, tenderness, limited range of motion, and neurological deficits
• Cervical collar should be applied to immobilize the neck and prevent further injury

Spinal Cord Injury and Neurological Deficits

• Spinal cord injury involves damage to the spinal cord itself
• Can result in partial or complete loss of sensation and movement below the level of injury
• Neurological deficits are abnormalities in sensory or motor function
• Examples include numbness, tingling, weakness, and paralysis
• Level and extent of deficits depend on the location and severity of the spinal cord injury

Assessment and Criteria

Mechanism of Injury

• Mechanism of injury refers to the way in which the trauma occurred
• High-risk mechanisms for head and spinal injuries include falls from height, motor vehicle collisions, and diving accidents
• Understanding the mechanism can help predict potential injuries and guide assessment and treatment
• For example, a fall from a ladder onto the head suggests possible TBI and cervical spine injury

NEXUS Criteria for Cervical Spine Assessment

• NEXUS (National Emergency X-Radiography Utilization Study) criteria guide decision-making for cervical spine imaging
• Criteria include no midline cervical tenderness, no focal neurological deficit, normal level of alertness, no intoxication, and no painful distracting injury
• If all criteria are met, cervical spine injury is unlikely and imaging may not be needed
• Helps reduce unnecessary radiation exposure and cost while identifying patients who require further evaluation