#12: TBI

Question 1

How do you calculate cerebral perfusion pressure?

Answer 1

CPP=MAP-ICP

Question 2

Normal CPP values and where they are obtained?

Answer 2

60-150mmHg when measured in the internal jugular bulb

Question 3

Normal MAP values:

Answer 3

70-110mmHg

Question 4

Normal ICP values:

Answer 4

0-15mmHg

Question 5

When CPP levels drop below ________, brain ischemia and neuronal cell death occur secondary to these 2 changes:

Answer 5

CPP=60 mmHg

-increased ICP and decreased MAP

Question 6

The theorem demonstrates the mechanism for how the brain compensates for increases in ICP:

Answer 6

Monro-Kellie Hypothesis

Question 7

What do you give with traumatic HoTN and why?

Answer 7

aggressive IVF to prevent HoTN and secondary brain injury

Question 8

ICP is determined by the volume of these 3 compartments?

Answer 8

1- brain parenchyma (<1300 mL in the adult)
2- CSF (100-150 mL)
3- IV blood (100-150 mL)

Question 9

Pharm methods to control agitated pts in TBI management: (2)

Answer 9

Sedatives:
1- propofol
2- versed (midazolam)

Question 10

2 Main decision criteria for head CT in adult pts w/ mTBI:

Answer 10

1- New Orleans Criteria

2- Canadian CT Head Rule

Question 11

These pts much be avoided in decision criteria for head CT in adult pts w/ mTBI: (2)

Answer 11

• children

- antiplatelet/anticoagulant tx

Question 12

These 2 SXS are considered “entry point” for the use of the decision criteria for head CT in adult pts w/ mTBI:

Answer 12

LOC or AMS

Question 13

Canadian CT Head Rule Criteria: (7)

Answer 13

GCS: 13-15
1- GCS<15
2- more than 1 episode of vomiting
3- Retrograde amnesia >30 minutes
4- suspected open or depressed skull fracture
5- age>65
6- High risk mechanism (Fall >3ft or MVC)
7- any sign of basal skull fx

Question 14

New Orleans Criteria: (7)

Answer 14

GCS: 15
1- HA
2- Vomiting
3- SZ
4- Persistent antegrade amnesia
5- age>60
6- intoxicated
7- evidence of trauma above clavicles