Neuro Trauma - Notes on Initial Assessment
- Standard ABC
- -Blood pressure
- -Oxygenation
- GCS
- Pupil exam
- Motor Strength
*Pay special attention to hypOtension and hypoxia for the following reasons:
- HypOtension = doubles mortality
- Hypoxia = increases mortality
- Both = 3x increase in mortality
AGGRESSIVELY RESUSCITATE
*HypOtension is rarely
attributable to head injury (I will not go into the few exceptions to this.)
Neurogenic Shock:
- Occurs in Spinal cord injuries above T1
- Due to interruption of sympathetics
o
Loss of vascular tone below the level of injury – incidence increases
with injuries above T6
- Parasympathetics are unopposed
o
Bradycardia
o
Venous pooling
o
Lower systemic vascular resistance
Initial Survey in Neurotrauma:
- Look for injuries to head, spine, eyes, TMs, and CSF leaks
Cranium:
- Look for basilar skull fx (NEVER insert NG tube if basilar fx is suspected!)
o
Raccoon eyes
o
Battle sign
o
CSF rhinorrhea/otorrhea
o
Pts describe salty or metallic taste
o
Collect fluid: quant glucose/beta2 transferrin (Ring sign at bedside)
- Look for facial fx
o
Lefort fx
o
Orital rim fx
- Periorital edema
- Cranio-cervical auscultation
o
Auscultate over the globe of the eye: bruits my indicate traumatic C-C
fistula
o
Auscultate over the carotid a.
GCS:
GCS of 8 or less = coma
SERIAL ASSESSMENT NEEDED!
Source: The Society of Neurological Surgeons - "Neurological and Neurotrauma Assessment"
http://www.youtube.com/watch?v=I_JCg8DHO2o&feature=channel&list=UL
Photo: http://www.thebarrow.org/Neurological_Services/Neurotrauma/index.htm
Photo: http://www.thebarrow.org/Neurological_Services/Neurotrauma/index.htm
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