Flashcards in Head and Neck Trauma Deck (28):
Management of Injury: Pre-hospital
Management of Injury: Hospital
assess immediately and refer stat
Describe AMPLE and when its performed:
As part of the secondary survey
past medical history/pregnancy
MUST AVOID HYPOXIA
What labs can help you assess "b"
ABGs and P02s
normal pc02 range is 35-45.
hypercapnea = increased MM
hypocapnea= decreased cerebral blood flow and perfusion
What is the Cushing Reflex?
associated with increased intracranial pressure
How can you evaluate "d"
establish a GCS score and perform it frequently
You should look for reversible signs of altered mental state. What are they
alcohol, electrolytes, insulin, opiates/02, uremia, toxidromes/trauma/temp, infections, psych/polypharmacy, stroke/seizure/space occupying lesion
What is a healthy GCS score?
15 (e4, m6, v5)
what is a dead GCS score?
if someone is intubated, what is their V score?
What is the sign of a basilar skull fracture?
"battle's sign" --> bruising over mastoid process due to fracture of the middle cranial fossa
How do you calculate a TBI GCS score's severity?
What is the difference between a focal and diffuse TBI?
focal = very specific part of brain
diffuse = problems with speech and cognition
arterial bleed, most don't have lucid period
worst headache of my life
diffuse axonal injury
morbidity can be very severe
What should you order if you suspect a skull fracture?
How should you treat skull fractures?
closed: no specific treatment, observe
open: high risk of infection. tx with abx and surgery
depressed : found on palpation, admit for observation and surgical eval
basilar skull: Hemotympanu; battle sign' raccoon's eyes. CSF leaking from ear to nose, hearing loss. 7th cranial nerve palsy. Treatment: IV abx, hospitalize, neuro consult
What is the goal with minor head injuries:
determine if an intracranial mass lesion is present. R/o by CT
What are some indications for a CT
1. amnesia prior to event
2. altered LOC
5. basilar fracture suggestions
What is a concussion?
injury to the brain that results in a temporary loss of normal brain function. usually caused a blow to the head. most people NEVER lose consciousness with a concussion.
How do you know its safe to discharge the patient?
1. minor head injury
2. negative CT
3. neurologically normal (with or without headache)
4. care of a resonpsible adult is nearby
how do you know if you should hospitalize?
1. persistent amnesia
2. persistent alterarion in level of consiouness
3. any abnormality on CT scan
What should you do with all cervical traumas?
immobilize the neck. NEXUS criteria is used to determine if collar can be removed or not
What imaging is REQUIRED for cervical spine injuries?
AP and Lat view from C1 to T1 and an Odontoid view.