My Elective in Neurosurgery

So I am about to embark on my elective rotation - Neurosurgery. I can't wait. I am lucky enough to be doing my elective at a Level 1 Trauma Center in a Neurosurg Dept that does not have residents. This means that PAs get to DO a ton (first assist on surgeries, do most of the on-floor procedures, etc). In honor of my elective I wanted to post something with a neurosurgical flair...

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


*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
  •        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


Source: The Society of Neurological Surgeons - "Neurological and Neurotrauma Assessment" 
Photo: http://www.thebarrow.org/Neurological_Services/Neurotrauma/index.htm

1 comment:

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