TL;DR
Head and Spine Injuries: Concussion, intracranial hemorrhage, vertebral fractures, spinal cord injury. Cushing triad = increased ICP.
Head and Spine Injuries
Definition
Concussion, intracranial hemorrhage, vertebral fractures, spinal cord injury. Cushing triad = increased ICP.
Historical Context
The modern EMS system in the United States traces to the 1966 "Accidental Death and Disability" white paper (NAS/NRC). Understanding of head and spine injuries has advanced significantly with evidence-based protocols. The NREMT, founded in 1970, standardized certification levels. Current ACLS and PALS guidelines are updated every 5 years by the AHA based on the International Liaison Committee on Resuscitation (ILCOR) evidence review.
Practical Example
Field Scenario: A 65-year-old male presents with crushing substernal chest pain radiating to the left arm, diaphoresis, and nausea. 12-lead shows ST elevation in leads II, III, aVF (inferior MI).
This scenario tests your ability to apply knowledge of head and spine injuries under time pressure with incomplete information, exactly the type of decision-making the certification exam assesses.
Key Values & Ranges
Key values and ranges relevant to head and spine injuries in prehospital care:
| Parameter | Adult | Pediatric |
|---|---|---|
| blood pressure | 90/60-120/80 mmHg | 70+(2*age) systolic minimum |
| heart rate | 60-100 bpm | 80-150 bpm (infant), 70-120 bpm (child) |
| respiratory rate | 12-20 breaths/min | 25-50 (infant), 15-30 (child) |
| blood glucose | 70-140 mg/dL | 60-100 mg/dL (neonates lower) |
| GCS | 15 is normal, under 8 = severe TBI | modified pediatric GCS for preverbal |
| SpO2 | 95-100% | 95-100% |
Clinical Significance
In prehospital care, understanding head and spine injuries can mean the difference between a positive patient outcome and a critical miss. A construction worker stung by wasps, developing urticaria, stridor, and hypotension. Anaphylaxis: epinephrine 0.3mg IM, IV fluids, diphenhydramine, albuterol for bronchospasm.
Related pharmacology: epinephrine at 1:10,000 1mg IV/IO q3-5min (cardiac arrest), 1:1,000 0.3mg IM (anaphylaxis), indicated for Cardiac arrest, anaphylaxis, severe asthma.
Related Procedures
Procedures related to head and spine injuries in the EMS setting:
- STEMI protocol: 12-lead ECG within 10 min then aspirin 324mg then NTG if SBP >90 then notify cath lab then transport code 3
- RSI sequence: preoxygenation then sedation (etomidate 0.3mg/kg or ketamine 2mg/kg) then paralytic (succinylcholine 1.5mg/kg or rocuronium 1mg/kg) then intubation then confirm placement with waveform capnography
- Trauma assessment: scene safety then MOI then primary survey (XABCDE) then rapid transport then secondary survey en route
Overview
Concussion, intracranial hemorrhage, vertebral fractures, spinal cord injury. Cushing triad = increased ICP. Tested on EMT and Paramedic exams.
In prehospital assessment, blood pressure reference range: adult 90/60-120/80 mmHg, pediatric 70+(2*age) systolic minimum. Deviations from these norms guide treatment decisions in the field.
Why It Matters
Tested on EMT and Paramedic exams.
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