Trauma · Chapter 21 Not started

Spine, Brain, and Nervous System Injuries

Concussion through cord injury: recognition, spinal motion restriction, and helmet decisions.

Key points

Suspect spine injury with high-energy MOI, midline neck/back pain or tenderness, numbness/tingling/weakness, altered mental status, or a distracting injury.
Spinal motion restriction: manual stabilization first, maintained until the patient is fully secured — torso strapped before the head.
Concussion signs: confusion, headache, nausea, balance problems, memory gaps; any suspected concussion is done for the day and needs evaluation.
Red flags after head injury: worsening headache, repeated vomiting, unequal pupils, decreasing consciousness — signs of possible intracranial bleeding.
A lucid interval (knocked out → wakes up fine → deteriorates) is classic for epidural bleeding — a reason head-injured patients are monitored, not released.
Helmet removal per protocol: generally left in place unless it prevents airway management or assessment; if removed, remove it as a trained two-rescuer skill.

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