Neuro - head injuries

Which C spine vertebrae are most commonly fractured?

1,2,6,7

What are 3 symptoms of c-spine injuries?

Headache

Neck pain

Paresthesia

Which age group is more susceptible to c-spine injuries?

Young children

Elderly

What is a dermatone?

An area of sensation that relates to a specific nerve

In which position do the spinal vertebrae match up with the dermatomes?

Standing up, touching toes

What should you palpate for in spinal injury?

Light touch

Pain

Temperature

What history is important to know in head injuries?

Behaviour the same before and after injury?

Amnesia - before, after event or both?

Symptoms getting better or worse?

What are the 3 types of amnesia?

Retrograde - before the event

Anterograde - after the event

Antero-retrograde - before and after

What are 5 reds flags in c-spine that should lead to immobilisation?

Over 65

Numbness or tingling in extremities

Pain on palpation

Dangerous MOI

Reduced ROM

How can cranial nerve 1 be tested?

Smell normally

How can CN 2 + 3 be tested?

2 - eye constricts to light

3- eye constrict to light being shone in the other eye and not that one itself

Snellens chart

Can you test CN 2 + 3 in blind people?

Depends of cause of blindness

How can cranial nerve 3, 4 + 6 be tested?

Eyes follow finger in H shape due to different muscles in eye working

How can CN5 nerve be tested?

Open jaw against resistance
Clench jaw
sensation on forehead, cheeky, jaw

How can you test CN 7

Facial expressions:

Smile

Eyebrow raise

Puff cheeks out

Scrunch eyes shut

How can you test CN 9 + 10?

Midline uvula

9 - gag reflex

10 - gag reflex, swallowing

How can CN 8 be tested?

Whisper test

Tuning fork - rinnes / weber test

Romeburgs test

How can you test CN 12?

Tongue moment and strength:

Tongue pushing out cheek

How can you test CN 11?

Trapezius:

Resisted shrug

Turn head resisted

How can you test co-ordination?

Nose to finger

Heel to shin on other leg

What does poor co-ordination suggest?

CVA

Parkinsons

MS

Tumour

What is Rhomeburgs test and what does it indicate?

Stand still with both feet on the floor with eyes shut

If fall either side = child - cerebellum tumour

adult - MS / head injury

What is the abbreviated mental test for ?

Congivnitve decline

How is the abbreviated mental test done?

Give pt address at start

Run through questions then ask to repeat address at the end

How many of the 10 questions does a pt have to get right to not be confused in the abbreviated mental test?

8 or more

What is the babinski reflex?

Run pen along sole of foot in middle from heel to toes to test for planter flexion of toes

What does a dorsi- flexion response of babinksi reflex show?

Disturbance of CNS motor response

Which age group do you not test babinskis reflex on?

Under 2 as don't have it yet

How is the doll's eye reflex test done?

Head should be able to move one way while the eyes look in the opposite direction

What is the doll's reflex testing?

Brainstem damage

When would you not do the doll's reflex test?

C-spine concern

What type of patient should the dolls reflex be tested on?

Unconscious pts

What should you look for if you suspect a fractured nose?

Inside for cartilage blocking nares

If you suspect an orbit fracture, what should you do?

Cover both eyes to prevent muscles moving

What do you do with a tooth that's been knocked out?

Put in milk or pts cheek

Where should facial lacerations be treated?

Plastics

How many grades are there in lefort fracture classification?

3

What are the 3 grades in the lefornt fracture classification?

1- upper jaw

2 - upper jaw and nose

3- upper jaw to mid-eyeline