Trauma Flashcards
Head Injury
*Presence of any one finding indicates need for CT scan.
Canadian CT head rule
“BRASM - GV”
Age ≥ 65 years
Vomiting > 2 episodes
Suspected open or depressed Skull Fracture
Signs suggesting basal skull fracture:
- Hemotympanum
- Racoon eyes
- CSF otorrhea or rhinorrhea
- Battle’s sign (bruising around mastoid process)
GCS < 15 at 2 hours post injury
Retrograde Amnesia > 30min
Dangerous mechanism
- Pedestrian struck by vehicle
- Ejection from motor vehicle
- Fall from elevation >3 feet or 5 stairs
Nexus 2 CT head rule
Age ≥ 65yr
Evidence of significant Skull Fracture
Scalp hematoma
Neurologic deficit
Altered Level of Alertness
Abnormal behaviour
Coagulopathy - haemophilia, warfarin
Recurrent or forceful vomiting
b)
Nexus II C-spine rules: “NSAID”
- Midline SPINAL tenderness
- Focal NEUROLOGICAL deficit
- ALTERED conscious state
- INTOXICATION
- Painful DISTRACTING injury
92-94% sensitive
Canadian C-spine mechanism rules:
- Fall from height greater than or equal to 1 metre (5 stairs)
- Axial load to head (e.g. diving)
- MVA high speed (greater than 100 km/hr), rollover, ejection
- Motorised recreational vehicles
- Bicycle struck or collision
99.8% sensitive
d) Ref: Tintinalli’s
Anticipate difficult intubation due to potential c-spine injury/in line immobilisation
Blunt sympathetic response from laryngeal manipulation - pre medication with fentanyl
Prevent raised ICP - raise head of bed 30 degrees
Age Group Intracranial Pressure (mm Hg)
Adults <10–15
Young children 3–7
Infants 1.5–6.0
Intubate for airway protection - likely to deteriorate
Maintain SaO2 >90%, PCO2 35-40
Prevent hypotension - have vasopressors on stand by
Treat raised ICP:
- 3% NS 3-5ml/kg IV following by infusion 0.1ml/kg/hr to maintain Na+ 155-165
OR
- Mannitol 0.5–1 gram/kg
Maintain normothermia 36-37
BSL monitoring - treat hypo or hyperglycemia
Maintain SBP >70 + (age x2)
Seizure prophylaxis:
levetiracetam 15-40mg/kg IV
Immediate Neurosurgical attendance to facilitate decompressive craniectomy
Maintain cervical spine precautions
