KW Trauma Flashcards
What are the requirements for clearing Cspine
Pt must be awake and very low risk, free of distracting injuries
then:
1)normal cspine films: showing all 7 vertebrae
-ap, ondontoid, lateral views
2) can actively flex, extend, rotate the neck with no sx or signs of spasm guarding or tendernss
what are the mechanism and radiographic findings of aortic injury?
significant deceleration injury, apical cap, widened mediastinum
if you suspect aortic injury from hx and xray what do you do?
May need CT angiography
what injury to suspect with widening of mediastinum and fx ris
hemothorax or pneumothorax
extensive soft tissue swelling occuring several hours or days after the injury and commonly associated with skull fracture
subgaleal hematoma
NAT may result in what type of head probs
subdural hematoma, SAH, local or diffuse brain edema.
what’s an absnormal ICP?
> 15-20 mm HG
With an _______ hematoma the blood is on ___ of the dura and the ____ gets pushed down away from the skull creativing a biconcavity. WHile a ________ hematoma occurs between the ____ and arachnoid.
epidural
top
dura
subdural
List 1-6
- caput seccedaneum
- subgaleal hematoma
3.cephalohematoma
4 cyst ie leptomeningeal - epidural hematoma
- subdural hematoma
List layers of brain in order (outside in)
galea»subgaleal compartment»pericranium»skull»dura»subdural space»arachnoid»pia (both together equal leptomininges»subarachnoid space THEN THE BRAIN
herniation thru c. tonsils down in the Foramen Magnum causes medullary compression and clinical sx
bradycardia, resp arrest and death
What part of the brain is hurt in decorticate posturing?
white matter, basal ganglia
What part of the brain is hurt in deceribrate posturing?
midbrain
If less than two, what makes you high risk and NEEDS HEAD CT
GCS=14, AMS, palp skull fx
If less than two, what makes you low risk and you can OBS vs CT if any single criterion present (0.9% risk of ciTBI)
Any
Non-frontal hematoma
Not acting normally per parent
Severe mechanism
Fall >3 ft
MVC with ejection, death of passenger, or rollover
Unhelemeted pedestrian or bicyclist struck by vehicle
Head struck by high impact object
Avoid CT if no criteria present. <0.02% risk ciTB
High risk criteria: CT recommended if any single criterion present 4.3% risk ciTBI
GCS = 14
AMS
Signs of basilar skull fracture
Low risk criteria: Observation vs CT recommended if any single criterion present 0.9% risk ciTBI
History of LOC
History of vomiting
Severe headache
Severe mechanism
Fall >5 ft
MVC with ejection, death of passenger, or rollover
Unhelemeted pedestrian or bicyclist struck by vehicle
Head struck by high impact object
Avoid CT if no criteria present. <0.05% risk ciTBI
History of LOC
History of vomiting
Severe headache
Severe mechanism
Fall >5 ft
MVC with ejection, death of passenger, or rollover
Unhelemeted pedestrian or bicyclist struck by vehicle
Head struck by high impact object
Avoid CT if no criteria present. <0.05% risk ciTBI
If located on the _______ part of the skull, and with a hematoma, and pt is not symptomatic, CT is not needed and pt can be observed at home.
FRONT(AL)
What is the modest hyperventilation range
35-40
What does uncal herniation cause?
For example RIGHT
IPSILATERAL nonreactive pupil and
CONTRALATERAL hemiperesis
Right blown pupil, left sided hemiparesis
Which spinal cord injury + syndrome is this?
Flaccid below level of lesion
absent reflexes
decreased symp tone
autonomic dysfxn (hypotension)
sensation may not be preserved, if absent =total cord transection (poor prog)
Spinal shock
Diminised or absent UE fxn
Preserved LE fxn
Associated with EXTENSION injuries
Central Cord Syndrome
Hemisection
Ipsilateral loss of: motor, proprioception
Contralateral loss of sensation: pain temp
Brown Sequard
COMPLETE motor paralysis
Loss of pain and temp
preservation of position and vibration sesne
associated with severe flexion injury
anterior cord syndrome
