Accidents that involve the head, neck, and back are invariably serious because of the dangers they pose to the central nervous system; namely, the brain and spinal cord. Because these injuries often occur together, the presence of a serious head injury should be assumed to involve also the neck or back (and vice versa) until proven otherwise. The severity of a head, neck, or back injury is often difficult to judge. Superficial scalp wounds tend to bleed profusely and may look more serious than they are. In contrast, a seemingly minor blow to the head or a fall can cause serious brain damage or a broken back.
Diagnostic Studies And Procedures
Upon arrival at the hospital, the victim’s vital signs (blood pressure, pulse, respiration), state of consciousness, and neurological responses are evaluated, and X-rays are taken to look for fractures. A doctor may order CT scans or MRI, especially if a brain or spinalcord injury is suspected. The Glasgow Coma Scale measures the patient’s eye responses, verbal ability, and nerve reflexes. The scale is used during the emergency room evaluation, and then regularly in the days that follow. The results are especially useful in predicting the extent of a patient’s recovery from a serious brain injury.
Painkillers, excluding morphine and other drugs that depress the central nervous system, are given as necessary. For severe head injuries, anticonvulsants may be administered to protect against seizures, and diuretics may be given to reduce brain swelling. For a serious head injury, care during the first week is critical. There is often bleeding inside the skull or a swelling of brain tissue. In either instance, the brain will become compressed, which could possibly result in coma. During this period, the intracranial pressure requires constant monitoring, and if it should rise, emergency measures must be taken to prevent any permanent damage. One approach entails draining away small amounts of cerebrospinal fluid to reduce the pressure inside the skull. Breathing must also be monitored to prevent hyperventilation, or over breathing. Rapid, shallow breathing may help reduce the intracranial pressure by lowering blood flow, but it can be dangerous if the brain becomes deprived of vital oxygen. A spinalcord injury also requires immediate action and constant monitoring. A severed spinal cord results in permanent paralysis of the body served by spinal nerves below the point of injury. Artificial respiration is necessary if the breathing muscles are paralyzed. When the spinal cord is compressed but not severed, varying degrees of nerve function may return as swelling subsides and healing takes place. In some cases, emergency surgery can minimize the long-term effects. Advances in microsurgery techniques make it possible to repair many nerve injuries once considered hopeless. Rehabilitation, which includes intensive physical and occupational therapy, ideally begins as soon as the patient’s condition is stable. The person must do assisted range of motion exercises several times a day to preserve muscle tone and prevent contractures. Learning new ways to do simple tasks may take months or even years, but electronic devices enable some patients to walk and carry out tasks despite paralysis.
Many rehabilitation programs include a variety of alternative approaches.
This ancient Chinese therapy helps with pain management.
Using electronic monitors, patients are taught to control involuntary functions, such as breathing, that are disrupted by their injuries.
Whirlpools and under water exercise help patients to regain muscle tone and strength.
Music encourages movement, and exercising to music can improve coordination and gait. Music also prompts the brain to increase production of endorphins, the body’s natural painkillers and mood enhancers.
Animals can help paralyzed people achieve greater self sufficiency. For example, monkeys trained to perform simple tasks are sometimes sent home with patients. Other rehabilitation programs use horses; a horse’s gait is similar to that of a human, so a patient who can master riding a horse can often relearn how to walk.
Recovery from a head or spinal cord injury can be arduous and frustrating, and success often depends upon the patient’s persistence and determination. Numerous accounts of miraculous recoveries can be explained only by the person’s tremendous will power and effort. Experts agree that starting with an optimistic attitude is a big plus.
Other Causes of Head Neck and Back Injuries
Most of these injuries are accidental, but child abuse is also a major cause.