Head and Spine Trauma

Question 1

A GCS of 15 is considered _______ while a GCS of 8 indicates______?

Answer 1

15 is Mild TBI
8 means intubate

Question 2

A head CT is indicated in a head trauma PT with a GCS of less than ___?

Answer 2

13

Question 3

What is the appropriate tx for patients with mild TBI?

Answer 3

24H of observation at home; NSAIDS for pain

Question 4

What is the appropriate emergency treatment for moderate or severe TBI?

Answer 4

Get a CT and consult neuro once patient is stable; they aren’t leaving the hospital

Question 5

This classification of skull fracture goes through full skull thickness; no splintering or depression?

Answer 5

linear/non-displaced

Question 6

This skull fracture is classified as abnormal widening of the skull sutures & affects newborns & infants?

Answer 6

sutural diastasis

Question 7

This classification of skull fracture can be open/closed; feel or see step off; & might need surgery?

Answer 7

depressed

Question 8

This skull fracture is a variant of the comminuted fracture and is also associated with vertebral trauma?

Answer 8

Burst fracture

Question 9

This skull fracture is open to the air, and has the most concern for infection?

Answer 9

Open or compound

Question 10

What is the emergent treatment for open or compound fracture?

Answer 10

Give ABX to avoid infection and send to OR for irrigation

Question 11

Patients with this skull fracture Present with trauma explanation; rhinorrhea, otorrhea, racoon eyes, halo sign?

Answer 11

basilar

Question 12

This skull fracture causes a dural tear and has increased risk of infection and CN 3-5 can be damaged?

Answer 12

basilar

Question 13

This brain injury is when the head is hit and it causes the brain to smash into the skull; can be classified as contrecoup; what is the name and treatment?

Answer 13

Cerebral contusion or intracerebral hemorrhage
TX is admit to hospital

Question 14

This head injury is the most common type of brain bleed and causes blood to appear in the ventricles of the brain where only CSF should be?

Answer 14

subarachnoid hemorrhage

Question 15

What is the classic presenting sx of a subarachnoid hemorrhage?

Answer 15

thunderclap headache

Question 16

When a patient presents with a possible subarachnoid hemorrhage, what is the appropriate imaging and treatment (in the ED)?

Answer 16

CT is indicated
Supportive care and admit to hospital for decompression

Question 17

What artery is torn in an traumatic epidural hematoma?

Answer 17

middle meningeal artery

Question 18

Patients with this head trauma injury present with headache, & focal deficit that occur just hours after injury?

Answer 18

epidural hematoma

Question 19

What type of brain trauma injury can result in coma or death, and has the hallmark sign of a lucid, non-injured appearance immediately after the trauma?

Answer 19

epidural hematoma

Question 20

A patient present with headache, & confusion days after they received a head injury; CT shows crescent shaped collection of fluid and a shift in the midline of the brain. The patient is on warfarin. What is the dx and tx?

Answer 20

subdural hematoma
Elevated head of bed to 30 degrees
Reverse the anticoagulant medication
Admit and consult neurosurgery for craniotomy to evacuate fluid

Question 21

What is a brain herniation?

Answer 21

increased intercranial pressure that can cause damage to the spine

Question 22

What is the treatment for a brain/spine herniation?

Answer 22

emergency decompression surgery

Question 23

A patient Presents to the ED with sudden clinical deterioration, anisocoria, apnea, & Cushing’s triad (high systolic, low pulse, low respiration). What is the likely dx and what two interventions can be done in the ED while awaiting neurosurgery consult?

Answer 23

Brain/spine herniation
place in reverse Trendelenburg position & establish airway

Question 24

If a scalp laceration is above the galea or aponeurosis, it can be closed using what?

Answer 24

The patients hair

Question 25

In the case of a patient with minor head trauma, when is it recommenced that they return to full activity?

Answer 25

progressively return after all sx have subsided

Question 26

The first 10 days after the initial head trauma pose the highest risk for what?

Answer 26

second impact syndrome

Question 27

What are the four areas in the neuro assessment of a spinal injury?

Answer 27

reflexes, rectal exam, sensation, and motor function

Question 28

A complete spinal injury is defined as?

Answer 28

no sensory or motor function below level of injury

Question 29

What is temporary loss of function from injury area and below?

Answer 29

spinal shock

Question 30

What is the loss of reflex tachycardia and loss of vasomotor tone ?

Answer 30

neurogenic shock

Question 31

What are the three requirements for removing a c-collar in a spinal injury patient?

Answer 31

CT shows no midline tenderness No focal neuro deficits PT has 45 degrees rotation on both sides

Question 32

If a patient with a suspected spine injury has a normal CT but pain, should the C-collar be left on or removed?

Answer 32

left on

Question 33

This spinal cord syndrome is defined as is irreversible loss of both ascending and descending sensation and function below injury or lesion?

Answer 33

complete spinal cord lesion

Question 34

What senses are lost in Brown-Sequard syndrome, and what sides are they lost on?

Answer 34

- weakness, loss of vibratory and proprioception on ipsilateral side - Pain and temp loss on contralateral side

Question 35

WHat spinal syndrome presents with different levels of sensory motor and pain/temp loss?

Answer 35

brown-sequard syndrome

Question 36

This is the most common partial spinal injury with disproportionate motor impairment of upper libs compared to lower limbs?

Answer 36

central cord syndrome

Question 37

What spinal syndrome presents with loss of pain and temp in one dermatome, but everything above and below is normal?

Answer 37

central cord syndrome

Question 38

What is the deficit and where is it found in anterior cord syndrome?

Answer 38

Loss of pain, motor function, and temperature BILATERALLY below the level of injury

Question 39

Which spinal syndrome spares vibratory and proprioception below the level of injury?

Answer 39

anterior cord syndrome

Question 40

This spinal cord syndrome presents with complete motor paralysis; preservation of light touch?

Answer 40

anterior cord syndrome

Question 41

What is the cause of anterior cord syndrome (MOI)?

Answer 41

Cervical hyperextension causing thrombosis (clot) of anterior cerebral artery

Question 42

Which spinal cord syndrome presents with loss of light touch and proprioception, but preservation of motor function, and pain and/or temperature sensation?

Answer 42

posterior cord syndrome