This document discusses guidelines for treating head and cervical spine trauma. The key points are: 1) The primary goals for head trauma are to prevent secondary brain injury through oxygenation and prompt transfer to a trauma center, with CT scans not delaying transfer. 2) Cervical spine injury must be considered in multiple trauma patients and immobilized to prevent neurological worsening. Indications for immobilization include altered mental status, spinal symptoms, or concerning mechanism of injury. 3) Imaging of the cervical spine depends on clinical decision tools, with CT preferred if available from occiput to T1; if CT is unavailable, plain films from these regions including swimmer's and odontiod views may be obtained initially.

1. HEAD AND
CERVICAL SPINE TRAUMA
HAPPY FRIDAY KNIGHT
TRAUMA DAY

2. HEAD TRAUMA

3. • GOAL: PREVENT SECONDARY BRAIN INJURY
(HYPOXIA)
• CT BRAIN SHOULD NOT DELAY PATIENT
TRANSFER TO A TRAUMA CENTER
• TRAUMATIC BRAIN INJURY CLASSIFICATION:
• SEVERITY
• MORPHOLOGY
• INTRACRANIAL LESION

7. PAIN
STIMULATION

8. TREATMENT: PREOPERATIVE
• DEPENDS ON SEVERITY
• MILD HEAD INJURY: LOW, MODERATE, HIGH RISK
• MODERATE TO SEVERE HEAD INJURY
• ABCDES
• RESUSCITATION AND PROTECT AIRWAY IN SEVERE HEAD INJURY
• CT BRAIN WITH C-SPINE

14. • กรณีสังเกตอาการ: 24 HR
• กรณี CT BRAIN:
• OBSERVE 6 HR

15. OBSERVE 24
HR

20. MEDICATION: MANNITOL
• INDICATIOIN: SIGNS OF HERNIATION: ASYMMETRIC PUPIL OR POSTURE
• DOSE: 20% MANNITOL 0.25 – 1 G/KG IV IN 15 MIN, THEN 100 ML IV Q6H

21. ANTIEPILEPTIC DRUG: PHENYTOIN
• HISTORY OF EPILEPSY
• IMMEDIATE POSTTRAUMATIC SEIZURE
• POSTTRAUMATIC AMNESIA > 30 MIN
• GCS ≤ 10
• LINEAR OR DEPRESSED SKULL FRACTURE
• PENETRATING HEAD INJURY
• INTRACRANIAL BLEEDING: SDH, EDH, CONTUSION
• CHROINC ALCOHOLISMM
• PHENYTOIN: 15-20 MG/KG IV IN 30MIN, THEN 5 MG/KG/DAY

22. CERVICAL SPINE TRAUMA

23. • SPINE INJURY, EVEN WITHOUT NEURUODEFICIT, MUST ALWAYS BE CONSIDERED IN
MULTIPLE INJURY PATIENTS
• 55% OF SPINAL INJURY: CERVICAL
• INADEQUATE RESTRICTION + MANIPULATION: WORSENING NEUROLOGICAL
DAMAGE

24. RESTRICTION OF C-SPINE MOTION:
PRIMARY SURVEY
• ALTERATION OF CONSCIOUSNESS
• MIDLINE NECK TENDERNESS

25. SCREENING
• PARAPLEGIA/QUADRIPLEGIA: SUSPECTED
• USE DECISION TOOL: NEXUS AND CCR
• PUT PATIENT IN SUPINE POSITION:
• REMOVE COLLAR AND PALPATE SPINE
• ASK TO MOVE NECK FROM SIDE TO SIDE
• THEN FLEX AND EXTEND NECK

26. RADIOLOGIC EVALUATION
• DECISION TOOLS:
• NEXUS
• CANADIAN C-SPINE RULE (CCR)
• MODALITY:
• MDCT
• PLAIN FILM

29. RADIOLOGIC EVALUATION: MODALITY
• CT AVAILABLE: MDCT
• FROM OCCIPUT TO T1
• SAGITTAL AND CORONAL
RECONSTRUCTION
• CT UNAVAILABLE:
• PLAIN FILM
• FROM OCCIPUT TO T1
• LATERAL AND AP VIEW INCLUDING ALL C-
SPINE
• SWIMMER’S VIEW
• OPEN-MOUTH ODONTOID VIEW
• IF ALL NORMAL: OBTAIN FLEXION AND
EXTENSION VIEW

30. NEUROGENIC VS SPINAL SHOCK
NEUROGENIC SHOCK
• T6 AND ABOVE INJURY
• LOSS OF VASOMOTOR TONE AND
INNERVATION TO THE HEART
• VASODILATION
• HYPOTENSION
• BRADYCARDIA
• HEMORRHAGIC SHOCK MUST FIRST BE
RULED OUT
SPINAL SHOCK
• FLACCID
• HYPOREFLEXIA

37. SPINAL IMMOBILIZATION: INDICATIONS
• ALTERED LEVEL OF CONSCIOUSNESS
• SPINE SYMPTOMS:
• SPINAL PAIN/TENDERNESS
• NEUROLOGIC DEFICIT OR COMPLAINT
• ANATOMIC DEFORMITY OF SPINE
• CONCERNING MECHANISM OF INJURY
• COMMUNICATION BARRIERS:
• DISTRACTING INJURY
• EVIDENCE OF ALCOHOL/DRUGS
• INABILITY TO COMMUNICATE

38. SPINAL IMMOBILIZATION: COMPONENTS
• LONG SPINAL BOARD
• HARD COLLAR
• STRAPS
• HEAD IMMOBILIZERS (BLOCKS)

40. HARD COLLAR AND LONG SPINAL BOARD:
COMPLICATIONS
• NO NEED TO BE ON SPINAL BOARD FOR HOURS:
• LYING SUPINE OF FIRM SURFACE BED
• SPINAL PRECAUTION
• USE ONLY WHEN TRANSPORT
• PROLONGED HARD COLLAR USE:
• SEVERE DISCOMFORT
• DECUBITUS ULCER
• RESPIRATORY COMPROMISE

41. CONCLUSION
• RESTRICTION OF CERVICAL SPINE MOTION: PRIMARY THING TO DO
• CT BRAIN IS NOT AN ADJUNCT TO PRIMARY SURVEY!
• MODERATE TO SEVERE HEAD INJURY: RESUSCITATION, ETT, THEN CT BRAIN
• COMPLETE SPINAL IMMOBILIZATION WHEN SUSPECTED SPINAL INJURY AND
TRANSFER