(INJ) Head, Neck and Spinal Injuries Lesson Four

Head, Neck and Spinal Injuries

Head wounds must be treated with particular care, since there is always the possibility of brain damage. The general treatment for head wounds is the same as that for other flesh wounds. However, certain special precautions must be observed if you are giving first aid to a person who has suffered a head wound. Victims with a head injury causing decreased level of consciousness (no matter how brief) require assessment by a physician. Victims with a head injury also require assessment for a potential spinal injury.

Any mechanisms of injury that can cause a head injury can also cause a spinal injury. Also it is important to note that injuries to the head involve more blood than lacerations to other parts of the body.

Concussion • Mild head injury that causes a brief "short-circuit" of the brain Essentially, the brain has been rattled within the skull • No damage or injury to brain tissue Recognition • Possibly unconscious for a short period of time • Dazed and confused for several minutes • Vomiting • Visual disturbances (seeing stars) • Amnesia (memory loss) • Pupils unequal in size or unresponsive to light • Head pain • Anxiety & agitation. Compression • Pressure on the brain caused by a build-up of fluids or a depressed skull fracture The brain has been bruised Damage to brain tissue is likely Symptoms are progressive, and will usually get worse over time Recognition • Possibly unconscious for a short period of time • Dazed and confused for several minutes • Vomiting • Visual disturbances (seeing stars) Amnesia (memory loss) • Pupils unequal in size or unreactive to light • Head pain • Anxiety & agitation ⚫ Symptoms usually worsen over time

Neck and Spinal Injuries

image of wordle in the shape of spinal columnThe spinal cord is a thick nerve that runs down the neck and back; it is protected by bones called vertebrae. If the spinal cord is injured, this can lead to paralysis. Since the vertebrae protect the spinal cord, it is generally difficult to cause such an injury. Note that only an x-ray can conclusively determine if a spinal injury exists. If a spinal injury is suspected, the victim must be treated as though one does exist.

Signs of a Spinal cord Injury

  • Mental confusion (such as paranoia or euphoria)
  • Dizziness
  • Head, neck or back pain
  • Paralysis
  • Any fall where the head or neck has fallen more than two meters (just over head height on an average male)
  • Cerebrospinal fluid in the nose or ears
  • Resistance to moving the head
  • Pupils which are not equal and reactive to light
  • Head or back injury

General Guidelines for Treating a Spinal Injury

The victim should not be moved unless absolutely necessary. Without moving the victim, check if the victim is breathing. If they are not, CPR must be initiated; the victim must be rolled while attempting to minimize movement of the spine. If the victim is breathing, immobilize their spine in the position found. The easiest way to immobilize the spine in the position found is sandbagging. Despite the name, it doesn't necessarily require bags of sand. Simply pack towels, clothing, bags of sand etc. around the victim's head such that it is immobilized. Be sure to leave their face accessible, since you'll need to monitor their breathing.

If you must roll the victim over to begin CPR, take great care to keep their spine immobilized. You may want to recruit bystanders to help you.

Treating head, neck and spinal injuries can be scary. Read the American Red Cross First Aid/CPR/AED Participants Manual below for detailed information regarding these very sensitive injuries.

Injuries Involving the Eye

Wounds that involve the eyelids or the soft tissue around the eye must be handled carefully to avoid further damage. If the injury does not involve the eyeball, apply a sterile compress and hold it in place with a firm bandage. If the eyeball appears to be injured, use a loose bandage. (Remember that you must NEVER attempt to remove any object that is embedded in the eyeball or that has penetrated it; just apply a dry, sterile compress to cover both eyes, and hold the compress in place with a loose bandage). Any person who has suffered a facial wound that involves the eye, the eyelids, or the tissues around the eye must receive medical attention as soon as possible. Be sure to keep the victim lying down. Use a stretcher for transport.

Many eye wounds contain foreign objects. Dirt, coal, cinders, eyelashes, bits of metal, and a variety of other objects may become lodged in the eye. Since even a small piece of dirt is intensely irritating to the eye, the removal of such objects is important. However, the eye is easily damaged. Impairment of vision (or even total loss of vision) can result from fumbling, unskilled attempts to remove foreign objects from the eye.

The following precautions must be observed:

  • DO NOT allow the victim to rub the eye.
  • DO NOT press against the eye or manipulate it in any way that might cause the object to become embedded in the tissues of the eye. Be very gentle; roughness is almost sure to cause injury to the eye.
  • DO NOT use such things as knives, toothpicks, matchsticks, or wires to remove the object.

DO NOT UNDER ANY CIRCUMSTANCES ATTEMPT TO REMOVE AN OBJECT THAT IS EMBEDDED IN THE EYEBALL OR THAT HAS PENETRATED THE EYE! If you see a splinter or other object sticking out from the eyeball, leave it alone! Only specially trained medical personnel can hope to save the victim's sight if an object has actually penetrated the eyeball. However if you have two rolls of gauze, apply one to each side of the impaled object and then cover it with a plastic cup and then secure the cup to the victim with tape.

Small objects that are lodged on the surface of the eye or on the membrane lining the eyelids can usually be removed by the following procedures:

  1. Try to wash the eye gently with lukewarm, sterile water. A sterile medicine dropper or a sterile syringe can be used for this purpose. Have the victim lie down, with the head turned slightly to one side. Hold the eyelids apart. Direct the flow of water to the inside corner of the eye, and let it run down to the outside corner. Do not let the water fall directly onto the eyeball.
  2. Gently pull the lower lid down, and instruct the victim to look up. If you can see the object, try to remove it with the corner of a clean handkerchief or with a small moist cotton swab. You can make the swab by twisting cotton around a wooden applicator, not too tightly, and moistening it with sterile water.
  3. If you cannot easily remove the foreign object, DO NOT MAKE ANY FURTHER ATTEMPTS TO REMOVE IT. Instead, place a small, thick gauze dressing over both eyes and hold it in place with a loose bandage. This limits the movement of the injured eye.
  4. Get medical help for the victim at the earliest opportunity.

CAUTION: Never use dry cotton anywhere near the eye. It will stick to the eyeball or to the inside of the lids, and you will have the problem of removing it as well as the original object.

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