45 - head and cervical trauma

Question 1

what determines cerebral perfusion pressure (CPP)

Answer 1

MAP-ICP

Question 2

5 signs of basal skull fracture

Answer 2

1. hemotympanum
2. blood in ear canal
3. rhrinrrhea
4. battle’s sign
5. raccooon eyes

Question 3

3 parts of GCS

Answer 3

1. eye opening (4)
2. verbal (5)
3. motor (6)

Question 4

3 classes of head injury

Answer 4

mild - 14-15
mod - 9-13
severe - 8 or less

Question 5

what is CT rules def. of minor head injury

Answer 5

• presence of amnesia
• LOC
• disorientation
• GCS 13-15

Question 6

5 high risk cat. and 2 mod risk

Answer 6

high
1. GCS2 episodes
5. age >65
mod
1. amnesia >30min
2. dangerous mech

Question 7

def. concussion

Answer 7

after direct or indirect blow to head characterized by transient change in cog or neuro function

Question 8

in major injury what is important for ABC

Answer 8

• if GCS 90

Question 9

other things to ensure in major

Answer 9

• analgesia
• normothermia and lyte imbalances
• look for coag states
• NO steroids

Question 10

8 steps in intial ther. for high ICP

Answer 10

1. elevate bed
2. keep head midline
3. sedate
4. avoid unecc. stim
5. analgesia
6. manitol
7. neuromuscular bloack
   8 .mild hyperventilation

Question 11

4 secondary ther. for ICP

Answer 11

1. barbituates or propofol
2. hypertensive ther
3. mod. hyperventilation
4. decompressive craniotomy

Question 12

part of Phx for c-spine

Answer 12

• protect
• palpate spinous processes
• do neuro exam

Question 13

intial radiology used

Answer 13

Xray

- AP, lateral, odontoid

Question 14

ABCs approach to interpret

Answer 14

Alignment
- anterior and post contour lines
- look for tranlation >3.5cm or angle >11
Bone
- follow cortex of bone looking for breaks
Cartilage
- look for equal disk spaces
- pre-dental space

Question 15

what to look for on AP

Answer 15

• trace bony contour

- look for alignment of spinous processes