Trauma

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    Head Trauma

    Canadian CT Head Rules

    High Risk Criteria

    • GCS <15 two hours after injury
    • Suspected open/depressed skull fracture
    • Signs of basilar skull fractures
    • Vomiting >2 episodes
    • Age >65

    Medium Risk Criteria

    • Amnesia >30min
    • Dangerous Mechanism
      (pedestrian vs vehicle, ejected, fall >3ft or >5stairs)

     

     

    Clearing C-spine

    Clear C-spine Rules:

    • Must rule out bony and ligamentous injury
    • Can clear clinicaly w/o xrays
    • Cannot clear w xrays, w/o clinical exam  b/c clinical exam is best for ligamentous injury
    • Clinical clearance:
      1. N sensorium
        1. No head injuries, no intoxication
      2. No midline spine pain/tenderness
        1. Patient reported
        2. Palpate along spinal processes
      3. No neurologic signs/symptoms
        1. Check motor + sensory deficits
      4. No distracting injuries
        1. Severe pain elsewhere, does not pay attention to spine
      5. If all 4 cleared, try to take through ROM
      6. If all normal, do not need CT
    • Plain films:
      • Hard to see upper/lower segments
      • C6/7 – 2ndmost common injury esp. in muscular people
      • Need Lateral + AP films, ensure visualize C1 and T1, can also shoot odontoid (C2), but not often.
    • If cannot clear clinically:
      • Leave collar on until wakes up (sometimes done)
      • Take collar off and reapply if wakes up w/ pain or sx (most common)
      • Dynamic flex/ext views (not done)
      • MRI – not routine
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