head & neck trauma Flashcards
Hard sign of aerodigestive trauma:
air bubbling from neck
Most common cervical fractures in elderly population:
- odontoid fx (C2)
2. C1 fx
Does violation of the platysma mandate neck exploration?
no, but they should at least be evaluated with ct angio
What is the test of choice to evaluate penetrating neck trauma in a hemodynamically stable patient with suspected neurovascular or aerodigestive injury?
CT angio of neck
findings consistent with nonaccidental head injuries in children:
subdural hemorrhage, cerebral ischemia, retinal hemorrhage, skull fx in conjunction with intracranial injury, apnea, seizures, long bone fx, metaphyseal fx
findings consistent with accidental head injuries in children:
epidural hemorrhage, scalp swelling, isolated skull fx, head and neck bruising
criteria for ICP monitoring:
pts with GCS<9 after resuscitation with abnormal head CT defined as hematoma, contusion, herniation, or compressed basal cisterns
components of Cushing reflex:
hypertension and bradycardia from brainstem ischemia; sign of impending herniation
contraindications to percutaneous dilational tracheostomy:
FiO2>60%, PEEP >12 mm Hg
B/c of risk of respiratory decompensation during bronchoscopy
first line therapies to maintain cerebral perfusion pressure in TBI
elevate head of bed to 30 degrees exclude and tx seizure activity maintain PCO2 of 35mm Hg maintain normothermia correct hypotension maintain sedation
facial nerve trauma medial to the lateral canthus of the eye tx:
observation
facial nerve trauma lateral to the lateral canthus of the eye tx:
operative exploration within 72 hours of presention
at what age is cricothyrotomy the preferred surgical emergency airway
over age 12
indications for operative evacuation of SDH:
SDH>10mm
midline shift >5mm
GCS change of 2 or more points from time of injury to time of admission
clinical signs of elevated ICP (unequal or fixed pupils)
