Content from Trauma Day, January 8th 2021

1. HEAD AND
CERVICAL SPINE TRAUMA
HAPPY FRIDAY KNIGHT
TRAUMA DAY

2. HEAD TRAUMA

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

7. PAIN
STIMULATION

8. 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

14. • กรณีสังเกตอาการ: 24 HR
• กรณี CT BRAIN:
• OBSERVE 6 HR

15. OBSERVE 24
HR

20. 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

21. 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

22. CERVICAL SPINE TRAUMA

23. • SPINE INJURY, EVEN WITHOUT NEURUODEFICIT, MUST ALWAYS BE CONSIDERED IN
MULTIPLE INJURY PATIENTS
• 55% OF SPINAL INJURY: CERVICAL
• INADEQUATE RESTRICTION + MANIPULATION: WORSENING NEUROLOGICAL
DAMAGE

24. RESTRICTION OF C-SPINE MOTION:
PRIMARY SURVEY
• ALTERATION OF CONSCIOUSNESS
• MIDLINE NECK TENDERNESS

25. 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

26. RADIOLOGIC EVALUATION
• DECISION TOOLS:
• NEXUS
• CANADIAN C-SPINE RULE (CCR)
• MODALITY:
• MDCT
• PLAIN FILM

29. 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

30. 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

37. 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

38. SPINAL IMMOBILIZATION: COMPONENTS
• LONG SPINAL BOARD
• HARD COLLAR
• STRAPS
• HEAD IMMOBILIZERS (BLOCKS)

40. 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

41. 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