Head and Neurologic Injuries

Question 1

What are the types of Fractures to the skull?

Answer 1

Linear fractures
Depressed fractures
Basilar Fractures (base of the skull)
Open Fractures

Question 2

A patient comes to the BAS after an MVA with a rollover with low blood pressure in clear shock. Initial vital signs are HR 55, BP 80/40, RR 14, Afebrile. What is the diagnosis and what should you be worried about?

Answer 2

Neurogenic shock.
This patient has disrupted their sympathetic chain, which means it’s probable that they have an injury to their cervical or thoracic spine. Do a full neuro, keep C-spine, and ensure they have no tenderness or step off.

Question 3

What are the indications for rigid spine board immobilization?

Answer 3

1. Blunt trauma and AMS
2. Spinal pain or tenderness
3. Neurologic complaints
4. Anatomic deformities
5. High energy MOI and distracting injuries, intoxication, or inability to communicate pain.

Question 4

What is the differential diagnosis for altered mental status?

Answer 4

STOPEATS
Sugar (hypoglycemia)
Temperature (heat stroke/hypothermia)
Oxygen (Hypoxia)
Pressure (increased intracranial pressure)
Electricity (neurologic conduction abnormalities)
Altitude (AMS/HACE)
Toxins/infection (CO, EtOH, illicit, encephalitis, meningitis)
Salt (Electrolyte abnormalities/hyponatremia)

Question 5

What are the steps to return to sport after a concussion?

Answer 5

24 hour physical/mental rest
Light exercise (stationary bike)
Sport-specific exercise
Non-contact drills
Full contact training
Return to full competition
*each level should have 24 at minimum between stages.  Stop and repeat that stage if there is any recurrent/worsening symptoms.

Question 6

What are the criteria for moderate TBI?

Answer 6

PTA 1-7 days
LOC 30 mins - 24 hours
GCS 9-12
Visible damage on CT/MRI

Question 7

What are the criteria for severe TBI?

Answer 7

PTA >7 days
Coma/unconscious >24 hrs
GCS 3-8

Question 8

What is Cushing’s Triad

Answer 8

Irregular/reduced respirations
Systolic HTN/widened pulse pressure
bradycardia

Question 9

What type of hematoma is caused by middle meningeal artery rupture from a fall with a lucid interval of 45mins-1 hour with subsequent deterioration?

Answer 9

Epidural Hematoma.