Head and C spine injury Flashcards
What is normal ICP?
5-15 mmHg
What is the equation for cerebral perfusion pressure?
CPP = mean arterial pressure - ICP
What are signs of basilar skull fracture?
Blood in ear canal, hemotympanum, rhinorrhea, otorrhea, ‘battle’s sign’ (retro-auricular hematoma), ‘raccoon eye’ (periorbital ecchymoses)
What is a basilar skull fracture?
basilar skull fractures include breaks in the posterior skull base or anterior skull base. The former involve the occipital bone, temporal bone, and portions of the sphenoid bone; the latter, superior portions of the sphenoid and ethmoid bones. The temporal bone fracture is encountered in 75% of all basilar skull fractures
What tests can be used to assess brainstem function?
Look at respiratory pattern, pupil size and reactivity and eye function including the corneal reflex, Doll’s eye reflex (oculocephalic reflex), caloric test (oculovestibular test)
What are the components of the GCS score?
E: 4 open, 3 open to command, 2 pain, 1 closed.
V: 5 normal, 4 confused, 3 wrong words, 2 incomprehensible, 1 nothing
M: 6 command, 5 localizes to pain, 4 withdraws pain, 3 decorticate, 2 decerebrate, 1 limp
How is a head injury classified as mild, mod or severe based on GCS?
Mild: 14-15
Moderate: 9-13
Severe: 8 or less
Which head injury patients are EXCLUDED from the CT head rules? (7)
1) penetrating trauma, 2) obvious depressed skull #, 3) acute neuro deficit, 4) seizure, 5) bleeding d/o or on anticoagulation, 6) pregnant pts, 7) <16 yrs
Which pt population do the CT head rule guidelines apply to?
pts with ‘minor head injury’: Amnesia, LOC, disorientation, GC 13-15 as a result of HI in the past 24 hrs
What are the ‘high risk’ (5) and ‘medium risk’ (2) criteria in the CT head rules?
High risk: GCS <15 2 hrs after injury, suspected open or depressed skull #, signs basilar skull #, vomiting >2x, Age >65.
Medium risk: amnesia >30 min, dangerous mxn (pedestrian struck by vehicle, occupant ejected, fall >3ft or 5 stairs).
What is the sens and sp of the CT head rules?
for high risk criteria: sens 100%, sp 69%.
For all 7 factors: sens 98%, sp 50%
What is a concussion?
Characterized by transient cognitive change or neurologic function with no CT findings.
What symptoms may suggest concussion?
confusion, amnesia, disorientation, LOC, restlessness, lethargy, irritability, brief seizure immediately after insult.
What is the SCAT2?
Sport cognitive assessment tool 2 which can be used for concussion assessment.
When discharging a pt with a concussion, what symptoms should they return to the ED for?
Problems could arise over the first 24-48 hours. You should not be left alone and must go to a hospital at once if you:
• Have a headache that gets worse
• Are very drowsy or can’t be awakened (woken up)
• Can’t recognize people or places
• Have repeated vomiting
• Behave unusually or seem confused; are very irritable
• Have seizures (arms and legs jerk uncontrollably)
• Have weak or numb arms or legs
• Are unsteady on your feet; have slurred speech