Head Injuries
A patient with head trauma doesn't open their eyes, makes incomprehensible sounds, and withdraws from pain. What is their GCS and what does this indicate?
Doesn't open eyes(1), incomprehensible sounds(2), withdraws from pain(4)= GCS 7. A GCS less than 8 indicates likely need for advanced airway management.
Why is detailed assessment important in spinal cord injuries?
The patient will have different symptoms based on the level of injury. A detailed report of symptoms/deficits can help determine where the injury is and anticipate complications
What are the 2 main signs of neurogenic shock?
Hypotension: systolic less than 90
Bradycardia (<60) with signs of hypo-perfusion
Name 2 components of scene size up.
BSI
Scene safety
Number of patients
Mechanism of injury
Consider additional resources
Who should spinal immobilization be considered for?
Any patient with blunt traumatic injuries with mechanism concerning for spinal injury.
State 2 important assessment questions to ask a patient(or bystanders) with head trauma?
Blood thinners?
Any loss of consciousness?
Seizure activity?
Time of injury/last known well time
Baseline mental status/A&O status
What is the biggest concern with spinal cord injuries above the level of C6
Respiratory compromise
True or False: Spinal shock and neurogenic shock are the same
False
Name 1 additional measure that can be used to control hemorrhage if direct pressure is ineffective?
Pressure dressings
Hemostatic agents
Tourniquet
Name 3 pieces of equipment used for spinal immobilization.
C-collar
Longboard
Scoop stretcher
KED device
Head blocks
Blanket roll
Name 2 symptoms of basilar skull fracture
Raccoon eyes: bruising around the eyes
Battle sign: bruising behind the ear
CSF leakage from ears or nose
What is something to consider in regards to transporting patients with SCI?
These patients meet criteria for a trauma center. Consider flight for life especially if prolonged extrication anticipated.
What category of shock does neurogenic belong to?
Distributive
Name 2 airway management interventions.
Positioning: jaw thrust, no head tilt in trauma
Suction/remove foreign objects
Oral airway if no gag reflex
Nasal airway not recommended in head/facial trauma
When should a patient with penetrating trauma be immobilized?
Only if focal neurological deficits are noted on physical exam
What is Cushing's Triad?
3 classic signs of increased intracranial pressure
1. Widening pulse pressure(increased systolic and decreased diastolic)
2. Irregular respirations(Cheyne-Stokes)
3. Bradycardia
Name 3 assessment findings seen in SCI patients.
Loss of sensation/numbness/tingling
Paralysis/weakness
Loss of bowel/bladder function
Priapism
Respiratory compromise
Pain on palpation of spine
Spinal deformity/step-offs
What type of patient is most at risk for neurogenic shock?
Any patient with a spinal cord injury above the level of T6
A patient presents with an open chest wound. After an occlusive dressing is applied and taped on 3 sides, the patient starts showing signs of increased respiratory distress and shock. What steps should be taken next?
Temporarily lift side of occlusive dressing to allow for trapped air to escape.
Apply supplemental O2 as needed
What should you do as an EMS provider if a patient refuses a c-collar?
If the patient is decisional, they have the right to refuse any aspect of care. This includes spinal immobilization.
Inform patient of risks such as permanent paralysis.
Document patient's refusal in report and relay to hospital in report.
What is the classic presentation of an epidural hematoma?
Patient will typically have loss of consciousness at time of injury followed by a "lucid interval" and rapid neurological deterioration back to unconsciousness
Name the type of spinal cord injury where a patient might experience more significant weakness in upper extremities than lower extremities.
Central cord syndrome.
What is the prehospital treatment for neurogenic shock?
Fluid bolus in 500 ml increments up to 2L
Atropine for bradycardia(paramedic): 1 mg rapid IVP q3 minutes until max 3 mg
You arrive on scene of a single vehicle MVC to find the sole occupant unresponsive, pulseless, and not breathing with significant trauma evident. What are the next steps in caring for the patient?
Do not start resuscitation.
Contact law enforcement and the medical examiner.
Name 2 of the 7 conditions that must be met before spinal immobilization can be omitted.
Conscious, cooperative, and able to communicate effectively
No major mechanism of injury(criteria for transport to high level trauma center)
No new or temporary neurological deficit(extremity weakness or numbness)
No evidence of intoxication or altered mental status
No distracting injuries(fractures, major burns, crush injuries, sever pain)
No midline back or neck tenderness with palpation