Head and Neck Trauma

Question 1

Management of Injury: Pre-hospital

Answer 1

ABC’s
neuro assessment
spine protection

Question 2

Management of Injury: Hospital

Answer 2

assess immediately and refer stat

Question 3

Describe AMPLE and when its performed:

Answer 3

As part of the secondary survey

allergies
medications
past medical history/pregnancy
last meal
events surrounding/environment

Question 4

“A”

Answer 4

Airway
MUST AVOID HYPOXIA

SOAPME
Suction
Oxygen 
Airway
Pharm
Monitoring 
Equipment

Question 5

What labs can help you assess “b”

Answer 5

ABGs and P02s

normal pc02 range is 35-45.
hypercapnea = increased MM
hypocapnea= decreased cerebral blood flow and perfusion

Question 6

What is the Cushing Reflex?

Answer 6

1. HTN
2. Bradycardia
   associated with increased intracranial pressure

Question 7

How can you evaluate “d”

Answer 7

establish a GCS score and perform it frequently

Question 8

You should look for reversible signs of altered mental state. What are they

Answer 8

AEIOU TIPS
alcohol, electrolytes, insulin, opiates/02, uremia, toxidromes/trauma/temp, infections, psych/polypharmacy, stroke/seizure/space occupying lesion

Question 9

What is a healthy GCS score?

Answer 9

15 (e4, m6, v5)

Question 10

what is a dead GCS score?

Answer 10

3

Question 11

if someone is intubated, what is their V score?

Answer 11

1T

Question 12

What is the sign of a basilar skull fracture?

Answer 12

“battle’s sign” –> bruising over mastoid process due to fracture of the middle cranial fossa

Question 13

How do you calculate a TBI GCS score’s severity?

Answer 13

mild: 13-15
mod: 9-12
sever: <8

Question 14

What is the difference between a focal and diffuse TBI?

Answer 14

focal = very specific part of brain
diffuse = problems with speech and cognition

Question 15

Epidural hematoma:

Answer 15

arterial bleed, most don’t have lucid period

Question 16

subdural

Answer 16

venous leed

Question 17

subarachnoid

Answer 17

worst headache of my life

Question 18

diffuse axonal injury

Answer 18

morbidity can be very severe

Question 19

What should you order if you suspect a skull fracture?

Answer 19

CT

Question 20

How should you treat skull fractures?

Answer 20

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

Question 21

What is the goal with minor head injuries:

Answer 21

determine if an intracranial mass lesion is present. R/o by CT

Question 22

What are some indications for a CT

Answer 22

1. amnesia prior to event
2. altered LOC
3. vomit
4. > 65
5. basilar fracture suggestions

Question 23

What is a concussion?

Answer 23

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.

Question 24

How do you know its safe to discharge the patient?

Answer 24

1. minor head injury
2. negative CT
3. neurologically normal (with or without headache)
4. care of a resonpsible adult is nearby

Question 25

how do you know if you should hospitalize?

Answer 25

1. persistent amnesia
2. persistent alterarion in level of consiouness
3. any abnormality on CT scan

Question 26

What should you do with all cervical traumas?

Answer 26

immobilize the neck. NEXUS criteria is used to determine if collar can be removed or not

Question 27

What imaging is REQUIRED for cervical spine injuries?

Answer 27

AP and Lat view from C1 to T1 and an Odontoid view.

Question 28

What is a “Swimmer’s” view?

Answer 28

paitent lies supine, one arm is abducted and extended. opposite arm is adducted and extended. X-ray shot through abducted axilla.