This document discusses various types of head and spinal injuries including focal brain injuries like cerebral contusions and epidural hematomas. It covers signs of herniation and treatments for head injuries like maintaining proper blood pressure and endotracheal intubation. Diffuse axonal injuries and concussions are discussed. Spinal injuries from various mechanisms like hyperflexion and hyperextension are outlined. Medications used in spinal immobilization and rapid sequence intubation are listed.

1. Head & Spinal Trauma
Chapter 34

2. Stuff you (should’ve)
learned in A & P

11. Blood Brain Barrier

12. More Math
•MAP
•ICP
•CPP

13. Monroe-Kelly Doctrine

17. C-1

18. C-2

19. Ribs & Vertebrae

20. Cauda Equina

31. Focal Brain Injuries

32. Cerebral Contusion

33. Epidural Hematoma
Bleeding above Dura
Arterial Bleed
Lucid Interval
Fast !

35. Epidural Hematoma

36. Subdural Hematoma
Bleeding below Dura
Venous Bleed
Slower

37. Superior Sagittal Sinus

38. Subdural Hematoma

39. Intracerebral Hemorrhage
Similar to
Stroke
Ruptured Blood
Vessel

40. Intracerebral Hemorrhage

43. La Fort Skull Fractures
I II III

44. Herniation

45. Cranial Nerve # 3
ipsilateral (same side) dilation
contralateral (opposite side) motor dysfuction

49. Signs of Herniation
• Pupil changes (CN III)
• Posturing
• Cushing’s Triad

52. Treatment of Head Injuries
• Determine GCS (before managing airway)
• Manage the airway
• Treat hypoglycemia
• Maintain EtCO2 of 35-40 mmHg if no signs of
herniation
• Maintain EtCO2 of 30-35 mmHg if signs of
herniation
• Maintain BP > 90 mmHg (or 110 mmHg)

53. Diffuse Axonal Injury
• Concussion
• Moderate diffuse axonal injury
• Severe diffuse axonal injury

55. Concussion
• Retrograde amnesia
• Anterograde (posttraumatic amnesia)

56. Spinal Injuries

58. Hyperflexion

59. Hyperflexion
Teardrop
Fracture
Unstable!

60. Hyperextension
Stable in Flexion
Unstable in Extension

61. Hyperextension
Stable in Flexion
Unstable in Extension

62. Jefferson Fracture
Due to Hyperextension or Axial
Loading
Unstable!

63. Whiplash

64. Vertical Compression
Axial Loading- Stable fx

65. Rotation with Flexion
Very Unstable

66. Hangman’s
Fracture
Distraction Injury
C1 and C2
Tears Spinal Cord

67. When to perform SMR

73. Weird Stuff

74. SCIWRA
Spinal Cord Injury Without Radiographic Abnormality
Seen in kids

75. Internal Decapitation

76. Brown-Sequard Syndrome
Due penetrating trauma to the spine

77. Anterior Cord Syndrome
Due to extreme
flexion

78. Central Cord Syndrome
more common in the elderly

82. Insert spine board rant…

83. Is there a better way?

84. Medications
• Oxygen
• Mannitol
• Dextrose
• Versed/Valium
• RSI

85. RSI
• Lidocaine
• Fentanyl
• Etomidate
• Succinylcholine
• Rocuronium
• Versed