You have been taught in previous lessons how to treat and care for obvious trauma and recognize disease processes. It is here where you will learn how the effects of trauma and disease might impact on the central nervous system and how these effects might manifest themselves. You will learn how to properly and accurately assess the casualty/patient and the appropriate steps for dealing with these complications
consists of the brain and spinal cord, which are encased in bone, and continuous with each other
(1) Brain stem - connects the spinal cord to the brain and responsible for many essential functions
(a) Medulla (Medulla oblongata)
(i) Conduction pathway for both ascending and descending nerve tracts
(ii) Controls regulation of heart rate, blood vessel diameter, breathing, swallowing, vomiting, coughing, and sneezing
(b) Pons
(i) Contains ascending and descending nerve tracts and relays information from cerebrum to the cerebellum
(ii) Houses sleep and respiratory control centers
(c) Mid brain (mesencephalon) - involved in hearing through audio pathways in the CNS and visual reflexes such as visual tracking of moving objects and turning the eyes
(2) Diencephalon - located between the brain stem and the cerebrum. Major components include the thalamus and hypothalamus.
(a) Thalamus
(i) Largest portion of the diencephalon
(ii) Receives and sends sensory input from various sense organs to the cerebral cortex
(iii) Influences mood and general body movements associated with anger and fear
(b) Hypothalamus
(i) Serves as the gatekeeper to determine which information is passed along to the cerebrum
(ii) Active participant in emotions, hormone cycles, and sexuality
(iii) Helps regulate body temperature, appetite, and sleep-wake cycle
(3) Cerebellum
(a) Second largest part of the brain
(b) Involved in gross motor coordination, producing smooth, flowing movements
(c) Compares an individuals intended movement with actual movement. Any differences in the two causes the cerebellum to send signals to the motor cortex and spinal cord for correction.
(d) Loss of the cerebellum results in an inability to make precise movements
(4) Cerebrum
(a) Largest portion of the brain, controls highest mental functions
(b) Divided into the right and left hemispheres, and each hemisphere is divided into lobes named for the bones that lie over them
(i) Frontal Lobe - controls voluntary function, motivation, aggression, and mood
(ii) Parietal Lobe - major center for the reception and evaluation of most sensory information (i.e., smell, hearing and vision)
(iii) Occipital Lobe - reception and integration of visual input
(iv) Temporal Lobe - reception and evaluation of olfactory and auditory input and plays an important role in memory
(v) Cerebral Cortex - a thin layer of grey matter made up of neuron dendrites and cell bodies that covers the cerebrum
(5) The Spinal Cord - located within the spinal column and extends from the occipital bone to the level of the second lumbar vertebra
(a) Made up of both gray and white matter
(i) The white matter consists of nerve tracts that are covered by connective tissue layers. Nerve tracts are made up of neurons. A neuron is comprised of a cell body, dendrites, and an axon. Dendrites carry nerve impulses toward the cell body, as opposed to axons, which carry the impulses away from the cell bodies to other neurons.
(ii) The gray matter consists of nerve cell bodies and dendrites
(b) The spinal cord is the primary reflex center of the body. This process is autonomic (automatic). Examples include stretch reflex (knee-jerk reflex) and withdrawal reflexes (removing a limb from painful stimuli.)
(c) Spinal cord tracts carry impulses to the brain in afferent (sensory), ascending tracts, and carry motor impulses from the brain in efferent (motor), descending tracts
(d) A tough, fluid - containing membrane called the meninges surrounds organs of the CNS. This outer covering has three connective tissue layers:
(i) Dura Mater - thickest, outermost layer
(ii) Arachnoid layer - second layer
(iii) Pia Mater - innermost layer
(e) The space between the arachnoid and pia mater is filled with blood vessels and cerebrospinal fluid
(f) Cerebrospinal fluid serves to bathe the brain and spinal cord and to act as a protective cushion. The four ventricles of the brain constantly produce this fluid.
(1) Spinal nerves
(a) Arise from numerous roots along the dorsal and ventral surfaces of the spinal cord
(b) All 31 pairs of spinal nerves, except for the first pair and the spinal nerves in the sacrum, exit the vertebral column through adjacent vertebra
(c) A total of 8 spinal nerve pairs exit the vertebral column in the cervical region, 12 in the thoracic region, 5 in the lumbar region, 5 in the sacral region, and 1 in the coccygeal region
(2) Cranial nerves
(a) The 12 cranial nerves are divided into three general categories
(i) Sensory - controls vision, touch and pain
(ii) Somatomotor - controls skeletal muscles through motor neurons
(iii) Parasympathetic - involves regulations of glands, smooth muscle, and cardiac muscle (functions of the autonomic nervous system)
(b) Some cranial nerves have only one of the three functions, whereas others have more than one
(1) Neurons of the autonomic nervous system innervate smooth muscle, cardiac muscle, and glands
(2) Usually considered to be unconsciously controlled
(3) Serves to maintain or restore homeostasis - homeostasis - a state of equilibrium in the body with respect to functions and composition of fluids and tissues
(4) Composed of the sympathetic and parasympathetic divisions
(a) Sympathetic neurons generally prepare an individual for physical activity (fight or flight)
(b) Parasympathetic neurons prepare an individual for vegetative functions (i.e., digestion, defecation, and urination
Abnormal levels of consciousness may be associated with decreased or increased neurological activity, such as stupor, coma, delirium, or violent behavior. There may be partial to complete mental clouding or loss of consciousness.
(1) Frequent causes of altered levels of consciousness are cerebrovascular accident (CVA), drugs, poisons, metabolic illness, fever, head injury, subarachnoid hematoma (SAH), Subdural hematoma (SDH), and epidural hematoma
(2) The two major categories of altered levels of consciousness are stupor and coma
(a) Stupor ranges from partial to almost complete loss of consciousness
(b) Coma is complete unconsciousness from which the patient cannot be roused
(3) Emergency Management of Life-Threatening Neurological Problems
(a) Confirm an unconscious state
(i) Attempt to arouse the patient by pinching or shouting to rule out sleep or a simple faint
(b) Secure the airway
(c) Give supplemental oxygen, if needed
(d) Establish adequacy of ventilation
(i) If respirations are slow or diminished, begin assisted ventilation
(e) Establish circulation - Begin CPR, if needed. Obtain vital signs, and treat shock, if present.
(f) Obtain description of the onset of illness or injury and a history of chronic illnesses e.g. diabetes, hypertension, drug abuse, chronic headaches
(g) Perform a rapid physical examination, utilizing the Glasgow Coma Scale
(4) The Glasgow Coma Scale
(a) Widely used method of evaluating the level of consciousness
(b) Glasgow Coma Scale assigns a numerical score to the patient’s responses in three categories
(i) Eye opening
(ii) Best motor response
(iii) Best verbal response
(c) Repeat assessment frequently to assess for changes
(d) Assess the patient’s score in each category, and total the scores of the tree categories.
(5) Treatment - the immediate objective of emergency treatment and stabilization is to maintain life until a specific diagnosis can be made. DONT Protocol:
(a) Dextrose
(b) Oxygen
(c) Narcan
(d) Thiamin
Seek an appropriate location to conduct the neurological status exam
(1) In a hostile zone
(a) Move the casualty to an area that provides adequate cover and concealment
(b) As with all injuries a primary survey must be conducted focusing on the ABC's and stabilizing life-threatening injuries before any type of assessment is started
(c) Time and Circumstances may not permit a full neurological assessment and in fact may dictate that the soldier medic move on to the next casualty after treating for life threatening injuries
(d) Assess the casualty using the Glasgow Coma Scale
A clinical environment lends itself to the conduct of a full neurological assessment.
Seek an appropriate setting to conduct the neurological status exam.
(1) Use a well-lit room
(2) Free of distractions
(3) If available, question family and friends
(1) Determine level of consciousness
(a) Normal
(b) Drowsiness
(c) Stupor
(d) Coma
(2) Observe posture and motor behavior
(a) Gait
(b) Gestures
(c) Mannerisms
(d) Speed of movement - fast, normal, and slow
(e) Over or under active
(f) Purposeful or disorganized
(3) Observe dress, grooming, and personal hygiene
(a) Appropriately dressed for age, social status
(b) Cleanliness
(c) Hair, teeth, and nail care
(4) Observe facial expressions
(a) Appropriate to topics being discussed
(b) Describe
(i) Alert
(ii) Tense
(iii) Worried
(iv) Sad
(v) Happy
(vi) Angry
(vii) Laughing
(5) Observe and record the patient’s manner, affect, and relationship to persons and things
(a) Describe (afraid, seeking help, evasive, etc.)
(b) Affect- is the patient’s voice, facial expression, and movement appropriate to topic being discussed?
(1) Quantity
(2) Rate
(3) Volume - rapid and loud, mania, soft and low
Observe Mood - as reported by patient
(1) Intensity
(2) Duration
(3) Appropriate to circumstances
Observe thought and perceptions – are the patient’s perceptions appropriate to the situation?
(1) Orientation
(a) person - does pt know who he/she is
(b) place - location, where he/she lives
(c) time - day of week, date, time of day
(2) Attention- does the patient answer appropriately?
(3) Remote memory - place of birth, where he/she is from
(4) Recent memory - questions related to the presenting problem. (the days weather, appointment time, etc.)
(1) MUST be evaluated by a Medical Officer (MO)
(2) Most are not mentally ill, but overwhelmed by life stressors
Summary/Assessment of Mental Status
(1) Summary of findings/conclusions
(2) The mental exam is the psychiatric counterpart of the physical exam
General approach to the neurologic exam
(1) Organize exam into 5 basic areas
(a) mental status/speech -as previously discussed
(b) cranial nerves
(c) cerebellar
(d) motor
(e) sensory
(f) reflexes
(1) Mental status and speech- as described above
(2) Cranial nerves
(a) Mnemonics for remembering nerves (1st letter stands for first letter of nerve)
(i) On Old Olympus Towering Tops, A Finn And German Viewed Some Hops (Tests the olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, acoustic, glossopharyngeal, vagus, spinal accessory, & hypoglossal)
(b) Cranial Nerve I (CN-I): Olfactory
(i) Sense of smell
(ii) Test by holding familiar items under the patient’s nose with their eyes closed. Clamp each nostril testing each one separately.
(c) Cranial nerve II (CN-II): Optic
(i) Vision sense
(ii) Tests visual acuity, visual fields, peripheral vision, and fundoscopic exam
(d) Cranial nerves III, IV, & VI: Oculomotor = CN-III, Trochlear = CN-IV, Abducens = CN-VI
(i) Function
* CN-III - extraocular muscle movement, pupillary light accommodation and consensual reflexes, and elevation of eyelid
* CN-IV – extraocular muscle movement
* CN-VI – extraocular muscle movement
(ii) Test for extraocular muscle movement by:
* Holding a small object in front of patient
* Have patient follow object as it is moved through the 6 cardinal positions of gaze
(iii) Test for size and shape of pupils and pupillary reaction to light
(e) Fifth cranial nerve (CN-V): Trigeminal nerve
(i) Function
* Motor - temporal, and masseter muscles along with lateral movement of the jaw
* Sensory - three separate distributions, V-1 = to the forehead, V-2= to the cheeks, V-3 = to the chin
(ii) Test function
* Test motor function by having patient clench teeth and move jaw side to side. Palpate strength of muscle contraction. Feel contraction of temporal muscles.
* Test sharp/dull sensation with a safety pin and light touch to forehead, cheeks, and chin on both sides
(f) 7th cranial nerve (CN-VII): Facial nerve
(i) Function
* Motor - muscle of facial expression
(ii) Test function
* Inspect face for symmetry or abnormal movements
* Have patient raise eyebrows, frown, close eyes tightly (and test strength by trying to open them with your fingers). Show upper and lower teeth, smile and puff out cheeks
(g) 8th cranial nerve (CN-VIII): Vestibulocochlear
(i) Function
* Hearing
(ii) Test hearing
* Snap fingers in front of each ear to assess gross hearing function
(h) 9th & 10th cranial nerves: CN-IX Glossopharyngeal, CN-X Vagus
(i) Function
* CN-IX: sensory - posterior ear drum/canal, pharynx. Motor - pharynx.
* CN-X: sensory - pharynx & larynx. Motor - soft palate, pharynx, and larynx/vocal cords.
(ii) Test for
* Vocal quality
* Observe upward movement of posterior oropharynx and symmetry
* Stimulate gag reflex on each side with cotton swab
* Ability to elevate palate
(i) 11th cranial nerve (CN-XI): Spinal accessory nerve
(i) Function
* Motor - upper portion of sternocleidomastoid and trapezius muscles
(ii) Test for
* Ability to turn head side to side
* Ability to shrug shoulders upwards against resistance
(j) 12th cranial nerve (CN-XII): Hypoglossal nerve
(i) Function
* Motor to tongue
(ii) Test for function
* Symmetry, atrophy, or fasciculations
* Have patient move tongue side to side
* Have patient stick tongue out, should not deviate from midline
(3) Cerebellar
(a) Inspection
(i) Ask pt to walk across room, down hall, turn and come back
(ii) Observe posture
(iii) Note presence of involuntary movements or swaying
(iv) Special maneuvers
* Heel to toe walking in a straight line
* Walk on toes
* Walk on heels
* Romberg test - have pt stand with heels and feet together, arms at sides and eyes closed. Observe for loss of position sense and tendency to fall.
* Hop in place on each foot. This indicates intact lower extremity motor systems, cerebellar function and position sense.
(4) Motor
(a) Assessment of muscle tone
(i) Passive range of motion (with pt relaxed, perform range of motion to limbs for each joint.)
(b) Testing muscle strength
(i) Test specific motor groups
(ii) Have patient actively resist your attempts to flex or extend across specific joints
(iii) Grade muscle strength on scale of 0-5
* 0 = no muscular contraction noted
* 1 = barely detectable flicker of contraction
* 2 = active movement of body part with gravity
* 3 = active movement against gravity
* 4 = active movement against gravity with some resistance
* 5 = active movement against full resistance & without any evidence of fatigue (normal muscle strength)
(5) Sensory
(a) General principles
(i) Note ability to perceive stimulus
(ii) Compare sensation
(iii) Scatter stimuli to cover most major peripheral nerves
(iv) Vary the placement of your exam
(v) Map areas of altered sensation by proceeding in a stepwise fashion outwards until patient detects change
(b) Pain
(i) Use sharp/dull areas of a safety pin
(ii) Use light pressure
(c) Light touch
(i) Touch skin lightly with wisp of cotton and ask patient to respond
(ii) Compare sides
(6) Reflexes
(a) Graded on a 0-4 scale
(i) Four plus (4+) = very brisk, hyperactive
(ii) Three plus (3+) = brisker than normal
(iii) Two plus (2+) = normal
(iv) One plus (1+) = diminished
(v) Zero (0) = absent, no response
(1) Dizziness is a perception of self-motion or a distortion of gravitational orientation. Dizziness is not a defined disease, but a sensory syndrome that may be produced by numerous diseases.
(2) Vertigo is an illusionary sensation of motion or having objects move around the patient
(3) Dizziness and vertigo should be distinguished from imbalance and syncope (loss of consciousness)
(4) Symptoms - the patient is usually in an upright position when an acute attack occurs. They may experience:
(a) Motor weakness
(b) Epigastric distress
(c) Perspiration
(d) Restlessness
(d) Nausea and vomiting
(e) Tinnitus (ringing in the ears)
(h) Patients commonly have recurrent episodes
(5) Treatment
(a) Management of the patient depends on the disease causing the dizziness or vertigo. All patients MUST have a full cardiac and neurological examination during initial assessment. Dizziness and vertigo are common symptoms in the elderly with cardiac disease.
(b) Initial stabilization utilizing a Glasgow Coma Scale should be performed if the patient is rapidly deteriorating. Serial neurological examinations should be performed while transporting patient to a MD/PA to assess.
(c) All patients with an acute onset of dizziness or vertigo need to be evaluated by an MD/PA
Headaches –
Headaches are the most common pain complaint in patients. The number of different types of headache, their causes, signs, symptoms and treatments often make headache difficult to diagnose and treat. They may be caused by, tension, tumors, trauma, or any number of other causes. The following are the more common types of headaches:
(1) Tension - These headaches are caused by spasm or contraction of muscles or adjacent structures, or they may be associated with fatigue or emotional stress. The muscles attached to the occiput and temple are the most frequently involved. These muscles will be tender to palpation
(a) Symptoms
(i) Feeling of pressure or a bandlike constriction around head. Pain is almost always bilateral
(ii) Not associated with vomiting. Nausea may be present
(iii) Patient with a tension headache will have a normal neurological examination
(b) Treatment - general measures consist of:
(i) Analgesics
(ii) Rest
(iii) Relaxation
(iv) Massage, and heat applied to the involved musculature
(v) Oral fluid hydration usually benefits headache patients- particularly in a field environment
(2) Migraine - this type of headache is characterized by a paroxysmal attack often preceded by psychological or visual disturbance that is followed by drowsiness. Migraine headaches are believed to be the result of inflammatory vascular changes.
NOTE: For Migraines: Diagnosis must be preexising. Diagnosis cannot be made by 91W. CT Scan is required to rule out masses and other causes of severe headache.
(a) Symptoms
(i) Specific symptoms vary with the type of migraine
(ii) Before the onset of a migraine headache, some patients experience a prodrome or aura. Visual auras are the most common (flashing lights or diminished vision)
(iii) Pain is usually unilateral- sometimes severe
(iv) Nausea, vomiting, photophobia (intolerance to light), phonophobia (intolerance to loud noise) may occur
(v) Patients may have an ill appearance
(vi) Other than an ill appearance, the physical examination are normal
(b) Often there is a family history of migraines, and the frequency of attacks may vary from daily to once every few years
(c) Treatment Overview
(i) Treatment of migraine is a three-faceted approach: abortive (at the immediate onset of headache); interval (during the headache) and prophylactic (to prevent future headaches
(ii) Abortive therapy is useful during the aura or at the start of a migraine. Various oral, nasal and subcutaneous medications (i.e. Cafergot, Imitrex) can be used as abortive therapy.
(iii) Interval therapy is directed at treating the migraine headache. Medications include analgesics (Toradol), antiemetics (Phenergan, Compazine) and abortive agents as above
(iv) Prophylactic therapy is aimed at prevention or reduction of the frequency and severity of headaches. Numerous categories of medications are used for this.
(d) Treatment of an Acute Migraine
(i) Place the patient on bed rest in a darkened room, withhold any food or drink and initiate IV hydration. Fluids are helpful in migraine headaches
(ii) Utilize the medications described above for abortive or interval therapy as ordered by a MD/PA
(iii) Serial neurological evaluations should be performed. Reassess the patient after each medication is given
(iv) Evacuate the patient to be evaluated by an MD/PA for assessment and management
A seizure is defined as the behavioral manifestation of abnormal neurologic activity. Seizures are usually accompanied by altered levels of consciousness. Epilepsy is a pattern of two or more recurrent seizures. In 75% of nontraumatic seizures the cause is unknown. There are two types of seizure classifications
(1) The two major classifications are:
(a) Generalized- bilateral foci that begin simultaneously
(b) Partial- single focus in cerebrum
(2) Generalized Seizures
(a) Most commonly encountered and include the petit mal and grand mal types
(b) Typical generalized seizure
(i) Signs and symptoms
* The patient may fall down and cry out, lose bladder and bowel control, and froth at the mouth
* There is convulsive movement of the body, dyspnea, and cyanosis
* Often the patient bites the tongue and, if not completely unconscious, will be confused and disoriented. The seizure usually lasts 2 to 5 minutes.
* A period of deep sleep is common after the seizure, and the patient will complain of muscle soreness and stiffness upon awakening
(ii) Treatment - immediate treatment is aimed at airway, breathing, and circulation (ABC's) while preventing the patient from injuring him or herself. The second goal is identification of the seizure cause
* Do not use rigid restraints (may cause fractures) or insert objects into the patient’s mouth during a seizure
* Never leave the patient alone. Protect the patient from further injury until seizure ends
* Loosen the clothing around the neck, and turn the head to the side to prevent aspiration of saliva and mucus
* Administer an anticonvulsant, such as Ativan 1-2 mg, or diazepam (Valium) 5-10 mg IV over 1-2 minutes. Give Valium only in the presence of active seizures. The objective of drug therapy is complete suppression of symptoms
* Refer the patient immediately to an MD/PA for evaluation. Perform serial neurological examinations during transport
Cerebrovascular Accident (Stroke)
(1) Strokes are caused by destruction of brain matter by intracerebral hemorrhage, thrombosis, embolism, or vascular insufficiency
(2) Stroke presentation is varied, depending on the area of brain that is involved. Symptoms include:
(a) Headache
(b) Nausea
(c) Vomiting
(d) Convulsions
(e) Coma
(f) Consciousness may not always be altered
(g) The patient may experience speech disturbances
(h) Confusion
(i) Loss of memory
(j) Reduction of sensation, and paralysis of extremities or of a complete side of the body
(k) The onset may be sudden and violent, with the patient falling into an immediate coma and exhibiting stertorous breathing
(l) Death from a serious stroke may result in a few minutes to a few days
(3) Treatment
(a) ABC's
(b) Administer IV fluids (TKO)
(c) Place the patient on immediate and strict bed rest
(d) Keep head elevated 30 degrees
(e) Evacuate the patient for hospitalization immediately
(f) Cardiac monitoring, if available
(g) Serial neurological examinations during transport
Characterized by sudden bleeding into the subarachnoid space that may be the result of trauma or a ruptured aneurysm
(1) Symptoms - before the aneurysm ruptures
(a) The aneurysm applies pressure to nerves that will manifest as headaches, ocular palsies, diplopia, facial pain, and a diminished visual field
(b) After rupture, severe headache
(c) Nausea
(d) Vomiting
(e) Stiffness of the neck
(f) Positive Kernig's sign
(i) A diagnostic meningeal sign marked by loss of the ability of a supine patient to completely straighten the leg when it is fully flexed at the knee and hip
(ii) Pain in the lower back and resistance to straightening the leg constitutes a positive Kernig’s sign
(g) Bilateral Babinski's reflex is usually present
(i) Dorsiflexion of the big toe with extension and fanning of the other toes elicited by firmly stroking the lateral aspect of the sole of the foot
(h) The consciousness of the patient may or may not be affected, and the blood pressure is often elevated
(2) Treatment
(a) ABC's
(b) Keep the patient at rest
(c) IV hydration (TKO)
(d) Avoid any medications
(e) Evacuate the patient immediately
(f) Cardiac monitoring
(g) Serial neurological examinations during transport
Caused by the rupture of a cerebral vein. They may be caused by trauma, tumors or a medication side effect (i.e. anticoagulants). There may be a loss of consciousness at the time of the injury followed by an asymptomatic period that may last for several hours to days
(1) Signs and symptoms the patient may have later
(a) Increased intracranial pressure as described above
(b) About one half of all persons with subdural hematoma will experience facial muscle weakness
(2) Treatment
(a) Ensure that the patient has a patent airway
(b) Oxygen, if available
(c) Cardiac monitoring, if available
(d) Serial neurological examinations during transport
(f) Evacuate the patient immediately
Result of blood collecting in the potential space between the skull and the dura mater. Most (80 to 90 percent) result from blunt trauma to the temporal of temporoparietal area with an associated skull fracture and middle meningeal arterial disruption.
(1) The classic history of an epidural hematoma is for the patient to experience immediate loss of consciousness after significant blunt head trauma. The patient then awakens and has a lucent period prior to again falling unconscious as the hematoma expands.
(2) This "classic“ syndrome occurs in only about 20 percent of cases. The majority of patients either never looses consciousness or never regains consciousness after the injury.
(3) Signs and Symptoms
(a) Increase intracranial pressure as previously described
(b) Neurological status/mental status may change rapidly due to the high pressure arterial bleeding of an epidural hematoma and can lead to herniation. The sequence of bleeding and herniation usually occurs within hours.
(4) Treatment
(a) Ensure open, patent airway
(b) Assist with ventilations, as needed
(c) Administer oxygen, if available
(d) Cardiac monitoring, if available
(e) Elevate head of body 30 degrees
(f) Serial neurological examinations during transport
(g) Evacuate the patient immediately
In most cases, herniation or rupture of an intervertebral disk is the result of trauma. It may occur with sudden straining of the back in an odd position or while lifting in the trunk flex position. Herniation may occur immediately (acute trauma) or may take years to occur (repetitive trauma). Most herniation occurs in the lumbosacral area but may also occur in the cervical or thoracic regions.
(1) Signs and symptoms
(a) Over 90 percent of all herniated disks occur at the fourth or fifth lumbar interspace
(b) There is pain upon palpation of the affected area
(c) The patient will have a limited range of motion
(d) The posture of the spine will be abnormal due to the loss of curvature of the spine
(e) The patient may exhibit mild weakness of the foot or extensor areas of the great toe
(f) There may be impaired sensations of pain or touch, and coughing or sneezing may cause radiation of the pain to the calf
(2) Treatment
(a) Place the patient on bed rest with a backboard and administer analgesics for pain
(b) Prevent the patient from using any physical effort
(c) Applications of heat to the area of tenderness is beneficial
(d) Definitive treatment of herniated disks will occasionally require surgery. Most herniated discs can be managed medically, with rest and medications.
(e) Evacuate the patient as soon as possible
Treatment for neurological symptoms
May take many forms, which are beyond the scope of the soldier medic
Several emergency medical procedures-,
Soldier medic can perform to minimize and or prevent further injury in trauma cases, and instances where the cause of injury is not obvious
(1) Ensure that the casualty is removed from the source of injury and is stabilized, focusing on the ABC's and that life threatening injuries are treated promptly
(3) Treat an unconscious casualty as having a potential neck or spinal injury. Immobilize and do not move the casualty unless absolutely necessary
(2) If fractures of the spine are suspected in-line stabilization of the spine is maintained and the casualty is immobilized as necessary
(4) If fractures of the skull are suspected that the casualty is placed in a position where the head is elevated at least 30 degrees unless other injuries prohibit that position
(5) Avoid the use of pain medications that are CNS depressants
(6) Evacuate the casualty a timely manner to the next level of care
(7) Provide on going care to maintain the casualty's condition or prevent the condition from getting worse
(8) As the situation permits document as much information as is available to send along with the casualty, so that more definitive medical care can be administered
As a soldier medic you have been taught how to treat and care for obvious trauma and recognize disease processes. It is vital for the medic to understand the effects of trauma and disease and their impact on the central nervous system to accurately assess the casualty/patient and provide the best possible care.