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Head Spine Injuries

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Head Spine Injuries

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    1. Head & Spine Injuries M. Jamous M.D Department of Neurosciences, JUST

    2. Multisystem injuries associated with Head & Spine injuries

    3. Trauma Team General Surgeon Orthopedic Surgeon Vascular Surgeon Cardiothoracic surgeon Neurosurgeon Anesthesiologist Critical Care

    4. Trauma management protocol Start treatment before HX and P/E Primary survey -Airway -Breathing -Circulation Secondary survey -Hx & complete system by system exam -X-rays (Chest, C-spine, Skeletal) -CT (Brain, C-Spine, Chest, Abdomen)

    5. Initial Neurological examination in head injury GCS Pupillary size and response to light Eye movements; -Occulocephalic (dolls eyes) -Oculovestibular (Caloric) Gross motor Gross sensory

    6. Head injury Glasgow coma score (GCS) -Eye opening (E); Spontaneous=4, to voice=3, to pain=2, None=1 -Verbal response (V); oriented=5, confused=4, inappropriate word=3, incomprehensive sounds=2, None=1 -Motor response (M); Obeys command=6, localize pain=5, withdraw=4, flexion=3, extension=2, None=1 13-15 (mild), 9-12 (moderate), 3-8 (severe)

    7. Protocol for mild HI (GCS 13-15) Initial work-up: -History: (mechanism of injury, hx of L.O.C, HA, neck or back pain, seizures) -Neurological exam -Physical exam (R/O systemic injuries) -Brain CT scan -C-Spine Xray -Blood alcohol level

    8. Protocol for mild HI Admit to hospital: -Significant amnesia -Hx of L.O.C (> 5 minutes) -Deteriorating L.O.C -Significant Alcohol-drug intoxication -Skull # -CSF leak -Significant associated systemic injuries -No reliable companion at home -Abnormal Brain CT. Discharge from ER if -Patient does not meet the above criteria for admission -Discuss the need to return if any problem developed (warning sheet)

    9. Moderate (GCS 9-12) and severe (GCS 3-8) HI Admit to hospital even with normal brain CT

    10. Mechanism of HI Closed; -High velocity (auto accident) -Low velocity (falls, assault) Penetrating; -Gunshot wounds -other open injuries

    11. Primary traumatic injuries Skull #; -Linear -Depressed -basal skull Diffuse brain lesion; -Brain concussion -Diffuse axonal injury (DAI) Focal lesion; -Epidural hematoma -Subdural hematoma -Intracerebral hgg -brain contusion, laceration

    12. Management of traumatic HI ABC Control ICP Treat specific lesion (epidural, subdural) Treat associated injuries Long term treatment for disabled patients

    13. ICP Monro-Kellie doctrine rule

    15. Management Of High ICP

    18. Clinical cases

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