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Head and Spinal Trauma | Head & Neck

Head and Spinal Trauma

Anterior Neck Trauma: injuries to the base of the neck carry the highest mortality rate. Major vessels, lungs, esophagus, trachea, cervical spine. Laceration of major vessels >>> rapid exsanguinations, or significantly compromise the airway.
Assessment:

  • Penetrating Trauma
  • Shock
  • Active Bleeding Tenderness
  • Crepitus
  • Hematoma
  • Pulse deficit
  • Neurological deficit

Esophageal tears >>> subcutaneous emphysema, neck hematoma, oropharyngeal or nasogastric blood. Reflux = high mortality. Semi-Fowler’s may help prevent reflux. Management:

  • Secure airway, ventilate as necessary
  • Treat for shock
  • Control hemorrhage
  • Rapid transport

Head Trauma: assume spinal injury with any head trauma. Control bleeding with gentle pressure.
Open skull fracture = break in skin, closed = no broken skin.
Depressed = fragments forced inward, nondepressed = fragments retain normal alignment
Assessment:

  • History
  • Level of responsiveness >>> very important in the evaluation of brain injury! Pupils: sluggish to react
  • Obvious penetration, impalement, deformity Blood or CSF from nose or ears
  • Raccoon eyes (12 or more hours later)
  • Battle’s sign = occipital bone, basilar skull fracture (12 or more hours later)

Monitor closely to identify changes in level of responsiveness

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