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Head & Spine InjuriesHead & Spine Injuries
Waleed DabbasWaleed Dabbas
Multisystem injuries Multisystem injuries associated with Head & associated with Head &
Spine injuriesSpine injuriesHeadHead SpineSpine
ChestChest 78%78% 10%10%
AbdomenAbdomen 53%53% 3%3%
CardiacCardiac 3%3% 2%2%
musculoskeletalmusculoskeletal 43%43% 18%18%
SpineSpine 6%6%
HeadHead 16%16%
Trauma TeamTrauma Team
General SurgeonGeneral Surgeon Orthopedic SurgeonOrthopedic Surgeon Vascular SurgeonVascular Surgeon Cardiothoracic surgeonCardiothoracic surgeon NeurosurgeonNeurosurgeon AnesthesiologistAnesthesiologist Critical CareCritical Care
Trauma management protocolTrauma management protocolStart treatment before HX and P/EStart treatment before HX and P/E
Primary surveyPrimary survey
-Airway-Airway
-Breathing-Breathing
-Circulation-Circulation Secondary surveySecondary survey
-Hx & complete system by system exam-Hx & complete system by system exam
-X-rays (Chest, C-spine, Skeletal)-X-rays (Chest, C-spine, Skeletal)
-CT (Brain, C-Spine, Chest, Abdomen)-CT (Brain, C-Spine, Chest, Abdomen)
Initial Neurological Initial Neurological examination in head examination in head injuryinjury GCSGCS Pupillary size and response to lightPupillary size and response to light Eye movements;Eye movements;
-Occulocephalic (dolls eyes)-Occulocephalic (dolls eyes)
-Oculovestibular (Caloric)-Oculovestibular (Caloric) Gross motor Gross motor Gross sensoryGross sensory
Head injuryHead injury
Glasgow coma score (GCS)Glasgow coma score (GCS)-Eye opening (E); -Eye opening (E); Spontaneous=4, to voice=3, to pain=2, None=1Spontaneous=4, to voice=3, to pain=2, None=1
-Verbal response (V); -Verbal response (V); oriented=5, confused=4, inappropriate word=3, incomprehensive oriented=5, confused=4, inappropriate word=3, incomprehensive
sounds=2, None=1sounds=2, None=1
-Motor response (M); -Motor response (M); Obeys command=6, localize pain=5, withdraw=4, flexion=3, Obeys command=6, localize pain=5, withdraw=4, flexion=3,
extension=2, None=1extension=2, None=1
13-15 (mild), 9-12 (moderate), 13-15 (mild), 9-12 (moderate), 3-8 (severe)3-8 (severe)
Protocol for mild HI Protocol for mild HI (GCS 13-15)(GCS 13-15)
Initial work-up:Initial work-up:
-History: (mechanism of injury, hx of -History: (mechanism of injury, hx of L.O.C, HA, neck or back pain, L.O.C, HA, neck or back pain, seizures)seizures)
-Neurological exam-Neurological exam
-Physical exam (R/O systemic injuries)-Physical exam (R/O systemic injuries)
-Brain CT scan -Brain CT scan
-C-Spine Xray-C-Spine Xray
-Blood alcohol level-Blood alcohol level
Protocol for mild HIProtocol for mild HI
Admit to hospital:Admit to hospital:-Significant amnesia-Significant amnesia-Hx of L.O.C (> 5 minutes)-Hx of L.O.C (> 5 minutes)-Deteriorating L.O.C-Deteriorating L.O.C-Significant Alcohol-drug intoxication-Significant Alcohol-drug intoxication-Skull # -Skull # -CSF leak-CSF leak-Significant associated systemic injuries-Significant associated systemic injuries-No reliable companion at home-No reliable companion at home-Abnormal Brain CT.-Abnormal Brain CT.
Discharge from ER ifDischarge from ER if-Patient does not meet the above criteria for -Patient does not meet the above criteria for
admissionadmission-Discuss the need to return if any problem developed -Discuss the need to return if any problem developed
(warning sheet)(warning sheet)
Moderate (GCS 9-12) and Moderate (GCS 9-12) and severe (GCS 3-8) HIsevere (GCS 3-8) HI
Admit to hospital even with Admit to hospital even with normal brain CTnormal brain CT
Mechanism of HIMechanism of HI
Closed; Closed;
-High velocity (auto accident)-High velocity (auto accident)
-Low velocity (falls, assault)-Low velocity (falls, assault)
Penetrating;Penetrating;
-Gunshot wounds-Gunshot wounds
-other open injuries-other open injuries
Primary traumatic Primary traumatic injuriesinjuries Skull #;Skull #;-Linear-Linear-Depressed-Depressed-basal skull -basal skull
Diffuse brain lesion;Diffuse brain lesion;-Brain concussion-Brain concussion-Diffuse axonal injury (DAI)-Diffuse axonal injury (DAI)
Focal lesion;Focal lesion;-Epidural hematoma-Epidural hematoma-Subdural hematoma-Subdural hematoma-Intracerebral hgg-Intracerebral hgg-brain contusion, laceration-brain contusion, laceration
Management of traumatic Management of traumatic HIHI
ABCABC Control ICPControl ICP Treat specific lesion (epidural, Treat specific lesion (epidural,
subdural)subdural) Treat associated injuriesTreat associated injuries Long term treatment for disabled Long term treatment for disabled
patientspatients
ICPICP
Monro-Kellie Monro-Kellie doctrine ruledoctrine rule
Management Of High ICPManagement Of High ICP
ICPICP
Clinical casesClinical cases
Skull base fracture
Depressed skull fractures
Epidural hematoma
Subdural hematoma