A spinal injury should be suspected in all trauma victims with altered level of consciousness, neck, back or limb pain, head or facial trauma, or alteration in peripheral movement or sensation. Trauma may include motor vehicle collisions, falls, altercations, and sports. Any patient with a potential for cervical spine injury must be immobilized at the scene. This includes those who are awake and complain of neck pain or tenderness on palpation, and anyone who is incapable of reporting pain in his neck, such as an intoxicated patient or one with decreased level of consciousness. Immobilization should include using a hard cervical collar, sandbags on either side of the head, and taping of the head and torso to the backboard or stretcher. This should be done at the scene as early as possible by paramedics. If a patient arrives at the emergency room by private vehicle and has potential for a neck injury, they should be immobilized on admission. This is very restrictive, preventing the patient from turning on his side or turning his head. The healthcare provider must be prepared in case of episodes of vomiting. The patient may need to be turned as a unit while maintaining traction on the head and stabilizing the neck. Suction should always be available.
The patient should remain immobilized until cervical spine injury is ruled out. There should be no movement of either the head or the torso. Patients should not be allowed to turn to assist in removing clothing or obtaining information from hip pockets. Care must be taken in articles of clothing from the arms, legs, and feet. Movement of the head or body can cause increased trauma or swelling to the injured site.
Postconcussion syndrome is a collection of symptoms that may occur after a mild head injury and last for weeks or years. The symptoms include headache, irritability, insomnia, dizziness, anxiety, depression, fatigue, and hearing and visual disturbances. Headache is the most common complaint and may be characterized as severe. There are several types of postconcussive headaches. The most common is muscle contraction headaches. These headaches are complicated by strain of the neck muscles or cervical disc disease and can be referred from trigger points in these areas. Another type of headache is migraine, which are throbbing and frequently associated with nausea. Seizures and tremors may also be symptoms included in the postconcussion syndrome.
Patients may have no neurological dificits, but have psychological complaints, such as personality change, irritability, anxiety, fatigue, and depression. They may also have cognitive impairment, such as inability to concentrate, memory dysfunction, and slowed information processing.
Testing of patients with these complaints may include computerized tomography (CT) scans, magnetic resonance imaging (MRI) studies, and electroencephalograms, as well as sensory testing for hearing and visual impairment. A neuropsychological evaluation may be used to diagnose the cognitive deficits related to reasoning, information processing, and verbal learning.
Medication used in treatment of postconcussive syndrome includes Elavil and nonsteroidal anti-inflammatory drugs for the muscle contraction headaches. Nerve blocks with a local anesthetic and physical therapy may be helpful in some cases.
NSAIDS includes a group of drugs that may be used for their anti- inflammatory, analgesic, or antipyretic capabilities. That is, they reduce inflammation or swelling, relieve pain, and reduce fever. The most common side effect is gastrointestinal problems and they should be taken with food to minimize these effects. Even if taken with food, the gastrointestinal problems sometimes prevent many people from taking these drugs as directed. Drugs in this group that are commonly ordered for injured patients include Voltaren, Lodine, Motrin (Advil, Ibuprofen), Relafen, Naprosyn, Daypro, and Feldene.
