Trauma | Brain Injury

Head and Spinal Trauma

Brain Injury: Concussion, contusion, open injuries, hematoma and hemorrhage Signs and Symptoms:

  • Headache
  • Unequal, dilated or nonreactive pupils Loss of consciousness
  • Retrograde amnesia = no recall of events before injury
  • Antegrade amnesia = no recall of events immediately after recovery of consciousness
  • Decorticate posturing = arms flex in to the core
  • Decerebrate posturing = arms extended, rotated internally Hemiplegia = paralysis on one side of the body
  • Paraplegia = paralysis of lower extremities
  • Quadriplegia = paralysis of all four extremities

Intracranial Pressure (ICP): pressure within the intracranial compartment> increases lead to further brain injury and death. ICP is rising when:

  • Level of responsiveness drops
  • Progressive paralysis
  • Projectile vomiting
  • Unequal pupils
  • Cheyne-Stokes respirations (early sign) Cushing reflex or triad (late sign)
    • Increasing BP, especially systolic
    • Increasing respirations
    • Decreasing pulse rate


  • Maintain cerebral oxygenation and perfusion Protect the cervical spine
  • Elevate the head
  • Hyperventilate (1 breath every 3 seconds) Allow leakage of fluid from nose or ears
  • Document current level of responsiveness, previous loss of responsiveness, on going status, memory deficits
  • Intubate GCS less than 8
  • Glasgow Coma Scale – know it, love it, rate your friends for fun









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