Head, Face, Neck, & Spine Trauma

What is the cerebrum?

The “actual” brain itself

What is the function of the Reticular Activating System (RAS)?

Maintaining consciousness and the ability to respond to stimuli

What percentage of the body’s blood flow does the brain receive?

Approximately 20%

What percentage of the body’s glucose does the brain consume?

Approximately 25%

What are the functions of the frontal lobe?

Motor control, decision-making, and personality

What are the functions of the temporal lobe?

Hearing and memory

What are the functions of the parietal lobe?

Sensation and spatial awareness

What are the functions of the occipital lobe?

Vision

What is the function of the diencephalon (interbrain)?

Controls involuntary actions including temperature, sleep, water balance, and stress

What structures are contained in the mesencephalon (midbrain)?

The pons and medulla oblongata

What functions are controlled by the brainstem?

Respirations, blood pressure, and heart rate

What phrase is used to emphasize the importance of the brainstem?

We live and die in the brainstem

What is the cranium?

The rigid and fixed bony structure surrounding the brain

What is the foramen magnum?

The largest opening of the skull where the spinal cord exits

What is the significance of the foramen magnum?

It is the site of brainstem herniation

What is the cribriform plate?

The rough inferior aspect of the skull base

Why is the cribriform plate clinically significant?

The brain is easily injured in this area

What is the primary job of the meninges?

To protect or “PAD” the CNS

What is the pia mater?

The innermost meningeal layer directly on the CNS

What is the arachnoid mater?

The middle web-like meningeal layer

What is the dura mater?

The outermost durable meningeal layer

How many cervical vertebrae are there?

7

How many thoracic vertebrae are there?

12

How many lumbar vertebrae are there?

5

How many sacral vertebrae are there?

5

How many coccygeal vertebrae are there?

4

How many total vertebrae are in the spine?

33

What is autoregulation?

Compensation that occurs in response to changes in ICP

What happens to blood pressure when ICP increases?

Blood pressure increases

What is the Monroe-Kellie Doctrine?

An expanding mass inside the cranial vault displaces CSF and eventually brain tissue

What is the normal ICP range?

10-15 mmHg or less

What is a coup injury?

Injury at the site of impact

What is a contrecoup injury?

Injury on the opposite side from the impact

What is retrograde amnesia?

Inability to recall events before the injury

What is antegrade amnesia?

Inability to create new memories after recovery of consciousness

What is Battle’s Sign?

Retroauricular ecchymosis associated with basilar skull fracture

What is another name for Battle’s Sign?

Retroauricular ecchymosis

What does Battle’s Sign indicate?

Fracture of the auditory canal and lower skull

What are raccoon eyes?

Bilateral periorbital ecchymosis

What do raccoon eyes indicate?

Orbital fractures and basilar skull fracture

What is the Halo Sign?

CSF drainage around blood

What does the Halo Sign indicate?

Cerebrospinal fluid leakage

What is an epidural hematoma?

Blood collection between the cranium and dura

What type of bleed is an epidural hematoma?

Arterial

What artery is most commonly involved in epidural hematomas?

Middle meningeal artery

What is the classic presentation of an epidural hematoma?

LOC, lucid interval, then decreasing LOC

What are signs and symptoms of an epidural hematoma?

Headache, decreasing LOC, increased ICP, nausea/vomiting, coma, and posturing

What is a subdural hematoma?

Blood collection between the dura and arachnoid mater

What type of bleed is a subdural hematoma?

Venous

Which is more common, epidural or subdural hematoma?

Subdural hematoma

How do symptoms typically develop in a subdural hematoma?

Slowly

What is a subarachnoid hemorrhage?

Bleeding into the cerebrospinal fluid

What is the classic presentation of a subarachnoid hemorrhage?

Worst headache of my life

What are signs and symptoms of a subarachnoid hemorrhage?

Dizziness, neck stiffness, unequal pupils, vomiting, seizures, and decreasing LOC

What is Cushing’s Triad?

Bradycardia, irregular respirations, and increasing blood pressure

What does Cushing’s Triad indicate?

Severe increased ICP and possible herniation

What SpO₂ should be maintained in increased ICP?

Greater than 94%

What ETCO₂ target should be maintained in increased ICP?

35-40 mmHg

What ETCO₂ target should be maintained if herniation is evident?

30-35 mmHg

What findings indicate brain herniation?

Cushing’s Triad or bilateral dilated pupils with decerebrate posturing and no motor response to pain

What does AEIOU TIPS stand for?

Alcohol, Epilepsy, Insulin, Overdose, Uremia, Trauma, Infection, Psychogenic, Stroke/Syncope

What does a positive Babinski reflex indicate?

CNS dysfunction

What is a positive Babinski reflex?

Dorsiflexion of the great toe with fanning of the other toes

What mnemonic is used for the Glasgow Coma Scale?

Extra Value Meal $4.56

What does DERM stand for?

Depth of coma, Eyes, Respiratory pattern, Motor function

What is decorticate posturing?

Deep cerebral brainstem injury causing flexion toward the cord

What is decerebrate posturing?

More severe deep cerebral brainstem injury

Which posturing is more severe, decorticate or decerebrate?

Decerebrate

What airway devices should be avoided in LeFort fracture patients?

NPA, OPA, nasal ET tubes, and NG tubes

How many cervical vertebrae are there?

7

How many thoracic vertebrae are there?

12

How many lumbar vertebrae are there?

5

Which spinal fracture locations are generally stable?

Spinous process and transverse process fractures

Which spinal fracture locations are generally unstable?

Pedicle, laminae, and vertebral body fractures

What are common spinal injury locations?

C1/C2, C7, and T12/L1

What is a spinal cord concussion?

Temporary disruption of cord function

What is a spinal cord contusion?

Bruising of the spinal cord with swelling and vascular leakage

What can cause spinal cord compression?

Vertebral displacement, disc herniation, bone fragments, or swelling

What causes spinal cord laceration?

Bony fragments or penetrating injuries causing tearing of the cord

What is axial loading?

Vertical compression force transmitted down the spine

What injuries can axial loading cause?

Compression fractures or crushed vertebral bodies at T12-L2

What is central cord syndrome?

Hyperextension cervical injury causing greater upper extremity deficits than lower extremity deficits

What is sacral sparing?

Preservation of sensory or motor function of the perineum, buttocks, scrotum, or anus

What is anterior cord syndrome?

Flexion injury causing paralysis and loss of pain and temperature sensation below the lesion

What sensations remain intact in anterior cord syndrome?

Light touch and position sensation

What is Brown-Sequard syndrome?

Hemitransection of the spinal cord

What deficits occur with Brown-Sequard syndrome?

Ipsilateral weakness/paralysis and contralateral loss of pain and temperature sensation

What does hemitransection mean?

Half of the spinal cord has been transected

What is spinal shock?

Temporary loss of cord function below the level of injury

What functions are lost in spinal shock?

Movement, feeling, bowel and bladder control

What cardiovascular finding may occur in spinal shock?

Hypotension from vasodilation

Can complete cord injury be confirmed in the field?

No

What is the most important principle in spinal movement?

Move the patient as a unit

What movement should be avoided during spinal management?

Lateral pushing

Who directs all patient movements during spinal management?

The rescuer at the head

What is the loading dose of methylprednisolone for spinal cord injury?

30 mg/kg over 15 minutes

What is the maintenance dose of methylprednisolone for spinal cord injury?

5.4 mg/kg/hour for 23 hours

What is the mechanism of methylprednisolone in spinal cord injury?

Reduces capillary dilation and permeability

What is the dose of dexamethasone for spinal cord injury?

4-24 mg, occasionally up to 100 mg

How much more potent is dexamethasone than Solu-Medrol?

Five times more potent