Head and Spine Trauma Flashcards
A GCS of 15 is considered _______ while a GCS of 8 indicates______?
15 is Mild TBI
8 means intubate
A head CT is indicated in a head trauma PT with a GCS of less than ___?
13
What is the appropriate tx for patients with mild TBI?
24H of observation at home; NSAIDS for pain
What is the appropriate emergency treatment for moderate or severe TBI?
Get a CT and consult neuro once patient is stable; they aren’t leaving the hospital
This classification of skull fracture goes through full skull thickness; no splintering or depression?
linear/non-displaced
This skull fracture is classified as abnormal widening of the skull sutures & affects newborns & infants?
sutural diastasis
This classification of skull fracture can be open/closed; feel or see step off; & might need surgery?
depressed
This skull fracture is a variant of the comminuted fracture and is also associated with vertebral trauma?
Burst fracture
This skull fracture is open to the air, and has the most concern for infection?
Open or compound
What is the emergent treatment for open or compound fracture?
Give ABX to avoid infection and send to OR for irrigation
Patients with this skull fracture Present with trauma explanation; rhinorrhea, otorrhea, racoon eyes, halo sign?
basilar
This skull fracture causes a dural tear and has increased risk of infection and CN 3-5 can be damaged?
basilar
This brain injury is when the head is hit and it causes the brain to smash into the skull; can be classified as contrecoup; what is the name and treatment?
Cerebral contusion or intracerebral hemorrhage
TX is admit to hospital
This head injury is the most common type of brain bleed and causes blood to appear in the ventricles of the brain where only CSF should be?
subarachnoid hemorrhage
What is the classic presenting sx of a subarachnoid hemorrhage?
thunderclap headache
When a patient presents with a possible subarachnoid hemorrhage, what is the appropriate imaging and treatment (in the ED)?
CT is indicated
Supportive care and admit to hospital for decompression
What artery is torn in an traumatic epidural hematoma?
middle meningeal artery
Patients with this head trauma injury present with headache, & focal deficit that occur just hours after injury?
epidural hematoma
What type of brain trauma injury can result in coma or death, and has the hallmark sign of a lucid, non-injured appearance immediately after the trauma?
epidural hematoma
A patient present with headache, & confusion days after they received a head injury; CT shows crescent shaped collection of fluid and a shift in the midline of the brain. The patient is on warfarin. What is the dx and tx?
subdural hematoma
Elevated head of bed to 30 degrees
Reverse the anticoagulant medication
Admit and consult neurosurgery for craniotomy to evacuate fluid
What is a brain herniation?
increased intercranial pressure that can cause damage to the spine
What is the treatment for a brain/spine herniation?
emergency decompression surgery
A patient Presents to the ED with sudden clinical deterioration, anisocoria, apnea, & Cushing’s triad (high systolic, low pulse, low respiration). What is the likely dx and what two interventions can be done in the ED while awaiting neurosurgery consult?
Brain/spine herniation
place in reverse Trendelenburg position & establish airway
If a scalp laceration is above the galea or aponeurosis, it can be closed using what?
The patients hair
In the case of a patient with minor head trauma, when is it recommenced that they return to full activity?
progressively return after all sx have subsided
The first 10 days after the initial head trauma pose the highest risk for what?
second impact syndrome
What are the four areas in the neuro assessment of a spinal injury?
reflexes, rectal exam, sensation, and motor function
A complete spinal injury is defined as?
no sensory or motor function below level of injury
What is temporary loss of function from injury area and below?
spinal shock
What is the loss of reflex tachycardia and loss of vasomotor tone ?
neurogenic shock
What are the three requirements for removing a c-collar in a spinal injury patient?
CT shows no midline tenderness
No focal neuro deficits
PT has 45 degrees rotation on both sides
If a patient with a suspected spine injury has a normal CT but pain, should the C-collar be left on or removed?
left on
This spinal cord syndrome is defined as is irreversible loss of both ascending and descending sensation and function below injury or lesion?
complete spinal cord lesion
What senses are lost in Brown-Sequard syndrome, and what sides are they lost on?
- weakness, loss of vibratory and proprioception on ipsilateral side
- Pain and temp loss on contralateral side
WHat spinal syndrome presents with different levels of sensory motor and pain/temp loss?
brown-sequard syndrome
This is the most common partial spinal injury with disproportionate motor impairment of upper libs compared to lower limbs?
central cord syndrome
What spinal syndrome presents with loss of pain and temp in one dermatome, but everything above and below is normal?
central cord syndrome
What is the deficit and where is it found in anterior cord syndrome?
Loss of pain, motor function, and temperature BILATERALLY below the level of injury
Which spinal syndrome spares vibratory and proprioception below the level of injury?
anterior cord syndrome
This spinal cord syndrome presents with complete motor paralysis; preservation of light touch?
anterior cord syndrome
What is the cause of anterior cord syndrome (MOI)?
Cervical hyperextension causing thrombosis (clot) of anterior cerebral artery
Which spinal cord syndrome presents with loss of light touch and proprioception, but preservation of motor function, and pain and/or temperature sensation?
posterior cord syndrome
