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Head and cervical spine trauma

Content from Trauma Day, January 8th 2021

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Head and cervical spine trauma

  1. 1. HEAD AND CERVICAL SPINE TRAUMA HAPPY FRIDAY KNIGHT TRAUMA DAY
  2. 2. HEAD TRAUMA
  3. 3. • GOAL: PREVENT SECONDARY BRAIN INJURY (HYPOXIA) • CT BRAIN SHOULD NOT DELAY PATIENT TRANSFER TO A TRAUMA CENTER • TRAUMATIC BRAIN INJURY CLASSIFICATION: • SEVERITY • MORPHOLOGY • INTRACRANIAL LESION
  4. 4. PAIN STIMULATION
  5. 5. TREATMENT: PREOPERATIVE • DEPENDS ON SEVERITY • MILD HEAD INJURY: LOW, MODERATE, HIGH RISK • MODERATE TO SEVERE HEAD INJURY • ABCDES • RESUSCITATION AND PROTECT AIRWAY IN SEVERE HEAD INJURY • CT BRAIN WITH C-SPINE
  6. 6. • กรณีสังเกตอาการ: 24 HR • กรณี CT BRAIN: • OBSERVE 6 HR
  7. 7. OBSERVE 24 HR
  8. 8. MEDICATION: MANNITOL • INDICATIOIN: SIGNS OF HERNIATION: ASYMMETRIC PUPIL OR POSTURE • DOSE: 20% MANNITOL 0.25 – 1 G/KG IV IN 15 MIN, THEN 100 ML IV Q6H
  9. 9. ANTIEPILEPTIC DRUG: PHENYTOIN • HISTORY OF EPILEPSY • IMMEDIATE POSTTRAUMATIC SEIZURE • POSTTRAUMATIC AMNESIA > 30 MIN • GCS ≤ 10 • LINEAR OR DEPRESSED SKULL FRACTURE • PENETRATING HEAD INJURY • INTRACRANIAL BLEEDING: SDH, EDH, CONTUSION • CHROINC ALCOHOLISMM • PHENYTOIN: 15-20 MG/KG IV IN 30MIN, THEN 5 MG/KG/DAY
  10. 10. CERVICAL SPINE TRAUMA
  11. 11. • SPINE INJURY, EVEN WITHOUT NEURUODEFICIT, MUST ALWAYS BE CONSIDERED IN MULTIPLE INJURY PATIENTS • 55% OF SPINAL INJURY: CERVICAL • INADEQUATE RESTRICTION + MANIPULATION: WORSENING NEUROLOGICAL DAMAGE
  12. 12. RESTRICTION OF C-SPINE MOTION: PRIMARY SURVEY • ALTERATION OF CONSCIOUSNESS • MIDLINE NECK TENDERNESS
  13. 13. SCREENING • PARAPLEGIA/QUADRIPLEGIA: SUSPECTED • USE DECISION TOOL: NEXUS AND CCR • PUT PATIENT IN SUPINE POSITION: • REMOVE COLLAR AND PALPATE SPINE • ASK TO MOVE NECK FROM SIDE TO SIDE • THEN FLEX AND EXTEND NECK
  14. 14. RADIOLOGIC EVALUATION • DECISION TOOLS: • NEXUS • CANADIAN C-SPINE RULE (CCR) • MODALITY: • MDCT • PLAIN FILM
  15. 15. RADIOLOGIC EVALUATION: MODALITY • CT AVAILABLE: MDCT • FROM OCCIPUT TO T1 • SAGITTAL AND CORONAL RECONSTRUCTION • CT UNAVAILABLE: • PLAIN FILM • FROM OCCIPUT TO T1 • LATERAL AND AP VIEW INCLUDING ALL C- SPINE • SWIMMER’S VIEW • OPEN-MOUTH ODONTOID VIEW • IF ALL NORMAL: OBTAIN FLEXION AND EXTENSION VIEW
  16. 16. NEUROGENIC VS SPINAL SHOCK NEUROGENIC SHOCK • T6 AND ABOVE INJURY • LOSS OF VASOMOTOR TONE AND INNERVATION TO THE HEART • VASODILATION • HYPOTENSION • BRADYCARDIA • HEMORRHAGIC SHOCK MUST FIRST BE RULED OUT SPINAL SHOCK • FLACCID • HYPOREFLEXIA
  17. 17. SPINAL IMMOBILIZATION: INDICATIONS • ALTERED LEVEL OF CONSCIOUSNESS • SPINE SYMPTOMS: • SPINAL PAIN/TENDERNESS • NEUROLOGIC DEFICIT OR COMPLAINT • ANATOMIC DEFORMITY OF SPINE • CONCERNING MECHANISM OF INJURY • COMMUNICATION BARRIERS: • DISTRACTING INJURY • EVIDENCE OF ALCOHOL/DRUGS • INABILITY TO COMMUNICATE
  18. 18. SPINAL IMMOBILIZATION: COMPONENTS • LONG SPINAL BOARD • HARD COLLAR • STRAPS • HEAD IMMOBILIZERS (BLOCKS)
  19. 19. HARD COLLAR AND LONG SPINAL BOARD: COMPLICATIONS • NO NEED TO BE ON SPINAL BOARD FOR HOURS: • LYING SUPINE OF FIRM SURFACE BED • SPINAL PRECAUTION • USE ONLY WHEN TRANSPORT • PROLONGED HARD COLLAR USE: • SEVERE DISCOMFORT • DECUBITUS ULCER • RESPIRATORY COMPROMISE
  20. 20. CONCLUSION • RESTRICTION OF CERVICAL SPINE MOTION: PRIMARY THING TO DO • CT BRAIN IS NOT AN ADJUNCT TO PRIMARY SURVEY! • MODERATE TO SEVERE HEAD INJURY: RESUSCITATION, ETT, THEN CT BRAIN • COMPLETE SPINAL IMMOBILIZATION WHEN SUSPECTED SPINAL INJURY AND TRANSFER

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