Neurology: Technician's role in the management of the head and spinal trauma Patient (Proceedings)

Neurology: Technician's role in the management of the head and spinal trauma Patient (Proceedings)

Aug 01, 2008

Initial evaluation

If the owner calls your clinic first, and states that the animal is recumbent, instruct them to transport the animal on a plywood stretcher or similar firm support system if at all possible. This is to avoid further damage to the spinal cord if spinal fractures also exist.

Upon arrival at your clinic evaluate the ABCs (airway, breathing, cardiac function) and perform a rapid but thorough physical examination (PE) and TPR.

Address and manage any non-neurologic life-threatening problems such as hypovolemic shock, excessive hemorrhage, or pneumothorax, etc.

Obtain a brief history as soon as possible. Items to focus on include:

1. Time since trauma occurred

2. Type/description of trauma

3. Status immediately after trauma (conscious? ambulatory?)

4. Method and manner of transport to clinic

5. Previous medical or surgical problems

6. Vaccination status (esp. Rabies vacc.)

Once life-threatening emergencies have been managed an initial neurologic evaluation can be done. Observations that can be made by the technician include:

1. Observation for hemorrhage in nasal cavity, ear canals, orbits, and nasopharyngeal regions

2. Palpation for presence of skull fxs

3. Specific neurologic observations include:

Level of Consciousness (best to worst)

- Normal – Bright, alert, responsive to environment

- Obtunded, depression – Lethargic, despondent but capable of responding to environment in a normal manner

- Delirium – Disoriented, irritable, fearful; capable of responding but usually response is inappropriate. Overreacts to minimal handling.

- Stupor (semi comatose) – Responsive only to noxious stimuli, otherwise animal is unaware of surroundings

- Coma – unconscious and unresponsive to even repeated noxious stimuli

*Note! Seizures which appear soon after trauma many times indicate intraparenchymal cerebral hemorrhage.

Pupillary size/response: Assess for symmetry, size, and response to light. This assessment should preferably be done every 30 minutes during the initial 3 hours of hospitalization and then every 1-2 hrs. for the remainder of the 1st 24 hours. Unilateral, slowly progressing pupillary abnormalities are characteristic of brain stem compression and/or herniation. Acute onsets of bilateral pupillary abnormalities are more suggestive of brain stem hemorrhage.

Oculocephalic/tonic eye/doll's head reflex: This test is performed by holding the animal's head in a normal position (with the nose pointed forward) and them moving the head to the right and left briskly and observing for an initial deviation of the globes in a direction opposite to the movement of the head. This initial slow deviation is the tonic eye reflex. This reflex tests the integrity of the vestibular input to cranial nerves 3, 4, and 6, and, if absent, points to brain stem (medulla) damage, which is a poor sign.