trigger - trauma Flashcards
HTN, Bradycardia and decreased respiratory drive is indicative of what
cushings reflex, indicates increased ICP
observation only treatment as long as s/s are not severe
- concussion (obs in ER 2 hrs + 24 @ home)
- linear skull fracture (obs 4-6 in ED, 24 at home)
seizures, bleeding/anticoags, or recurrent vomiting are all indications of what in concussions
INDICATIONS FOR ADMISSION!!
also GCS <15 @ 2 hours, abnormal CT, no people to obs for 24 hrs
presents with short term mem loss, early dementia, impulsive behavior and depression
chronic traumatic encephalopathy
3+ concussions
vague neuropsych s/s starting 7-10 days after injury
post concussive syndrome
treat with tetnus shot, rocephin and vanc
depressed skull fracture
if the depression is greater than skull thickness than consult surg
MC bone affected here is temporal bone
basilar skull fx
Admit ALL patients with this
basilar skull fx
halo sign CSF leaking, battle sign, racoon eyes
hallmarks of a basilar skull fx
also see: haemotympanum and bump on head
haemotympanum and bump on head
hallmarks of a basilar skull fx
also see: racoon eyes, halo sign, battle sign
tx with ancef/cefazolin
open fractures
when should you order a pan-scan and what does this include
order for a skull fracture
order also for sig trauma
includes noncontrast CT brain and c spine with a CONTRAST CT chest, abdomen and pelvis
never place a nasal airway in these patients
basilar skull fx
between dura and arachnoid
subdrual hemorrhage
usually d/t vein tearing
subdural hematoma
MC tramatic intracranial lesion
what does it mean if hematoma on CT is darker
older subdural hematoma
classified by acute (<2 d), subacute (3-21 d), or chronic (>21 d)
Subdural hematoma
subDURal is labeled by DURation
MC in men
subdural hematoma
90% of these present with HA that is worse with straining (cough, sneezing, lifting). but this does NOT present with seizures!
subdural hematoma
presents MC with ipsilateral fixed dilated pupil
brain herniation
accumulation of blood dura mater and skull
epidural hematoma
trauma to temporal area
epidural hematoma
also associated with middle meningeal artery rupture
middle meningeal artery rupture
epidural hematoma
assocaited with blow to temporal area
lens shaped lesion on CT
epidural hematoma
presents with LOC followed by lucid interval where patients neuro exam is normal
epidural hematoma
this is followed by quick decompensation w sig worsening of s/s
blood in space between pia and arachnoid mater
subarachnoid hemorrhage
thunderclap HA
associated with SAH
sudden LOC in 45% pts and seizures in 25% patients
back pain and leg pain too
SAH s/s
also presents with thunderclap HA, back pain and BIL leg pain
xanthochromic (yellow) CSF
SAH
also see incerased opening pressure and increased RBC in CSF
gold standard is CTA of brain
SAH
what is the use of esmolol and labetalol in SAH
reducing MAP<130
What is the NEXUS criteria?
Midline posterior Spinal tenderness present
Painful distracting injury present
Intoxication present
Focal Neurological Deficits present
Encephalopathy (or ALOC) present
All must be negative to clear a patient without imaging.
restrict motion w SOFT collar
torticollis (C1 rotary subluxation)
odontoid fx and posterior element fracture are what level
C2
TLSO brace and pain meds
management of anterior wedge/compression fx of thoracic spine
Lower back pain, difficulty walking, saddle anesthesia
cauda equina syndrome
urinary retention, poor rectal tone, change in bowel/bladder
urinary retention, poor rectal tone, change in bowel/bladder
cauda equina syndrome
saddle anethesia, difficulty walking, LBP
