Neuro Trauma Trevor

Question 1

How to assess for neuro disability in ER

Answer 1

Ask patient name/date/what happened

Assess motor function by asking the patient to do movements

When assess for edema and peripheral wounds, ask patient if they can feel you touching them (sensation)

Assess level of consciousness via glass cow coma scale

Question 2

Glasgow come scale review

Answer 2

Takes into account the 3 criteria

1) eye opening response (4/4 possible)
2) verbal response (5/5 possible)
3) motor response (6/6 possible)
* minor brain injury = 13/15 points

** moderate brain injury = 9-12/15 points

*** severe brain injury = 3-8/15 points

8 and under requires intubation

Question 3

Proper imaging of the cervical spine

Answer 3

3 xrays view

• lateral (must see superior aspect fo T1)
• open mouth odontoid
• anterior-posterior
• good for low risk patients

CT cervical spine
* used for high risk patients

• dont use MRI since it doesnt get bone well*

Question 4

Should you always assume someone has a spinal cord injury?

Answer 4

Yes until proven not

Question 5

When to use and remove a cervical collar

Answer 5

Use:
- patient is in accident and presumed to have a cervical spine injury

Remove:

• must get CT/xray scans that show no injury
• patient has normal neurological exam

Question 6

What are major differences in neurogenic shock vs hypovolemic/hemorrhagic?

Answer 6

Both will show low BP

Neurogenic however will show Brady cardia, the other two will show tachycardia

Question 7

Neurogenic shock

Answer 7

Impairment of the descending sympathetic pathways in the cervical or upper thoracic spinal cord (T6 and above)

• causes loss of vasomotor tone and sympathetic innovation to the heart
• blood pools in the veins so the arteries have less blood to get out to the system

shows hypotension, Bradycardia and normal- lowered breathing with warm/dry skin

is a diagnosis of exclusion only (NEVER assume this first)

Treatment via IV fluids and vasopressors (usually norepinephrine/ phenylepphrine)

Question 8

Are steroids recommended in spinal cord injuries and/or neurogenic shock?

Answer 8

NO

Question 9

Nexus criteria

Answer 9

Determines whether an xray/CT is recommended for a potential cervical spine injury

1) posterior midline cervical spine tenderness?
2) evidence of intoxication?
3) abnormal level of alertness?
4) any focal neurologic defect?
5) any painful distracting injuries (injuries in other areas that are painful to the point where they are reducing potential pain on the neck)
* if all of the following is NO, then no radiography is needed. If YES on 1 or more, get radiography*