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Signs and symptoms
Head injury
- Altered mental status.
- Poor PMS.
- Lack of consensual reflex indicates increased pressure in the brain.
- Unequal or fixed pupils.
- Irregular breathing pattern.
- Raccoon sign (dark around the eye) is a delayed sign of skull fracture.
- Battle's sign (dark behind the ear) is a late sign of basilar skull fracture.
- Cushing's reflex (increasing systolic blood pressure, decreasing heart rate, changes in breathing pattern) is a sign of severe head injury.
- Flexion or extension.
- Amnesia.
Spinal injury
- Numbness and loss of sensation.
- Paralysis.
- Pain that may be independent of movement.
- Loss of bowel or bladder control.
- Priapism.
- Impaired breathing.
- Drop in blood pressure with flushed skin from neurogenic shock.
Treatment
- Spinal immobilization if injury to the spine is suspected (leave helmet and shoulder pads on for football players as removing them could cause spinal movement).
- Manage injuries that compromise the airway.
- Oxygen administration to perfuse the brain.
- PPV if breathing is inadequate.
- Control bleeding.
- For severe head injuries: hyperventilation at a rate of 20 breaths per minute. Signs for severe head injury include unequal pupils, increased systolic pressure, irregular or absent breathing, Cushing's reflex, absent PMS, seizures, flexion or extension.
- Assess for PMS.
- Pulse: radial for upper extremities and pedal for lower extremities.
- Motor:
- Flex arms tests the function of C6 vertebrae.
- Extending the arms (and wrists) tests for C7.
- Spreading fingers apart tests for T1.
- Pushing down with the feet into a tip-toe position tests for S1 and S2.
- Pulling up with the feet tests for L5.
- Sensation: test for both touch and pain and let the patient locate the source of the touch or pain.
Trauma and mechanisms
- Scalp injuries: the scalp is highly vascular, and can bleed very heavily. Also, bleeding can occur under the skin, giving the appearance and feel of deformities.
- Skull injuries: the thinnest portion of the skull is the temporal region, which is prone to fracture. Basilar skull fracture when the base of the skull fractures.
- Brain injuries
- Hypoperfusion to the brain.
- Contusions and lacerations.
- Closed and open head injuries.
- Diffuse axonal injury: shearing, tearing, and stretching of nerve fibers.
- CSF leakage can be confirmed by a glucose content analysis. CSF contains glucose, while tears and nasal secretions do not.
- Concussion: injury resulting from the stretching, tearing and shearing of brain tissue. Can cause amnesia, confusion, and altered mental status. May lead to contusions.
- Contusion: bruising and swelling of the brain tissue.
- Coup-contrecoup injury: contusion caused by rapid acceleration or deceleration, such as in a car crash, where the brain bounces back and forth against the skull.
- Subdural hematoma: venous bleeding between the dura mater and the arachnoid layer of the brain.
- Epidural hematoma: bleeding between the skull and dura. Often associated skull fracture. Usually bleeding is severe, and can drastically increase intracranial pressure.
- Spinal injuries
- Flexion: excessive curvature forward.
- Extension: excessive curvature backward.
- Compression: injury from compressing.
- Distraction: injury from pulling.
- Rotation: injury from rotating.
- Lateral bending: excessive curvature sideward.
- Penetration: injury from penetration.
- Inury to the C3 and C5 verbebrae can cause respiratory failure.
- Priapism: a persistent erection, a classical sign of cervical spine injury.
Terms
- Consensual reflex: light shone in one eye stimulates both eyes to constrict.
- Diplopia: double vision.
- Retrograde amnesia: forgetting things before the incident.
- Anterograde amnesia: forgetting things after the incident.
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