-field of view
Head Trauma -observe pt is visually attentive
- Closed Head Injuries -clearly command tell me your name
- Traumatic Intracranial Hematomas -lift up two fingers on each side sequentially, And wiggle
Spine Trauma the toes.
- Patterns of Injury
- Neurologic Syndromes Visually or verbally unresponsive
-assess for response to peripheral stimuli
CLOSED HEAD INJURY - Nail bed pressure
- Deep central stimulation
Primary Injury
-firm twisting pinch to supraclavicular skin
-Immediate injury to neurons from transmission of the
Note for external signs of head injury
force of impact
-bleeding, deformation of the skull
Secondary Injury
- Subsequent neuronal damage due to the sequelae of
Medical management
trauma
-CHI and IC hemorrhage or depressed skull fracture
- hypoxia, hypotension, hydrocephalus, IC Hpn, hematoma
-phenytoin
-17 mg/kg loading does
Initial assessment
-300-400 mg/d maintenance
-ABCDs of resuscitation
-Blood glucose monitor, control by sliding scale insulin
-hypoxia & hypotension -> worsen outcome
-Fever antipyretic
-intubation pt who cant follow commands
-hyperglycemia + hyperthermia
-GCS
may contribute to 2nd ry injury
-Head injury increase prevalence to peptic ulcer, GI bleed
-compression stocking or athrombic pumps
-pt who cant be mobilized rapidly
Classification
Low risk for intracranial injury:
- Head trauma patients who are asymptomatic:
headache, dizziness, or scalp lacerations, (-)
consciousness
- May be discharged home without a head CT scan
- Printed discharge instructions
- should return to ER for symptoms: Confusion,
Persistent nausea, Weakness, or Speech difficulty
COMPRESSION FRACTURE
- compression/flexion injury anterior column only
- stable and not asc. w/ neurologic deficit
4. Injury to the ventral half of the
cord results in the anterior cord
BURST FRACTURE syndrome, with paralysis and loss
- pure axial compression anterior and middle column of nociception and thermoception
- unstable bilaterally.
- half of pt have neurologic deficit due to compression of The typical mechanism is an acute
disc herniation or
cauda equine from fragments retropulsed to spinal canal ischemia from anterior spinal
artery occlusion.
CHANCE FRACTURE
- flexion/distraction middle and posterior, rare ant wedge
- lap seatbelt hyperflexion
- unstable and associated with neurological deficit
FRACTURE-DISLOCATION
- flexion/distraction, shear, or compression forces
- anterior, middle, posterior columns
- neurological deficit can result from retropulsion of mid.
Column bone fragments into spinal canal, or from
subluxation causing decreased canal diameter