Use this quick-reference guide to recognise, treat and hand over Head & Spinal Trauma on the NREMT and on the call. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Avoid
SpO2 under 90
Hypotension
Routine hyperventilation
📌 Targets
ETCO2 35–40
Herniation signs → mild hyperventilation
📌 Rising Icp
High BP + wide pulse pressure
Slow HR · irregular breathing
Blown pupil · posturing
📌 Spine
Restriction by criteria
Low BP + slow HR + warm skin → neurogenic
📚 Head & Spinal Trauma — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what changes the plan, and what to hand over.
Secondary brain injury — from hypoxia, hypotension and hyperventilation — is what EMS can prevent. The exam checks recognition of rising intracranial pressure, the ventilation and perfusion targets, and selective spinal motion restriction.
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Key points
Understand these first
Avoid hypoxia (SpO2 below 90), hypotension and routine hyperventilation — each worsens brain injury.
Ventilate to an ETCO2 of about 35–40; mild hyperventilation only for active herniation signs.
Cushing's triad: rising blood pressure with a wide pulse pressure, bradycardia, irregular respirations.
Herniation signs: a blown pupil, posturing, or a falling GCS.
Neurogenic shock: hypotension with a normal or slow heart rate and warm, dry skin below the injury.
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Treatment priorities
What to do, in order
Serial GCS and pupils — the trend matters more than one number.
A long board is an extrication tool, not a transport device.
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Red flags — report now
Escalate immediately
GCS drop of 2 or more
Unequal pupil with decreasing responsiveness
Lucid interval then decline (epidural hematoma)
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Patient teaching
What patients must know
Spinal shock is a temporary loss of cord function; neurogenic shock is the hemodynamic picture.
❓ Head & Spinal Trauma: NREMT FAQs
What are the priority actions for Head & Spinal Trauma in the field?
Serial GCS and pupils — the trend matters more than one number. Spinal motion restriction by criteria (altered, intoxicated, deficit, spine pain, distracting injury). A long board is an extrication tool, not a transport device.
What findings in Head & Spinal Trauma change your plan or your transport decision?
GCS drop of 2 or more. Unequal pupil with decreasing responsiveness. Lucid interval then decline (epidural hematoma).
What do I need to know about Head & Spinal Trauma for the NREMT?
Avoid hypoxia (SpO2 below 90), hypotension and routine hyperventilation — each worsens brain injury. Ventilate to an ETCO2 of about 35–40; mild hyperventilation only for active herniation signs. Cushing's triad: rising blood pressure with a wide pulse pressure, bradycardia, irregular respirations. Herniation signs: a blown pupil, posturing, or a falling GCS.
What should the crew communicate or document for Head & Spinal Trauma?
Spinal shock is a temporary loss of cord function; neurogenic shock is the hemodynamic picture.
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Quick Tip
Avoid hypoxia (SpO2 below 90), hypotension and routine hyperventilation — each worsens brain injury.