33. Head Injuries Flashcards
In what cases should a head injury be transferred to hospital?
Unequal pupils Unequal motor examination Open/exposed brain CSF leaking Neuro deterioration Depressed skull fracture
What management should be done to a patient with a head injury before reaching hospital?
Prevent hypoxia and hypotension
How is a patient with a head injury assessed once they get to hospital?
Glasgow coma scale
Pulse and BP
Pupils and focal neuro deficits
What type of injury would cause a linear skull fracture?
Simple fall
What kind of fracture would result from a depressed skull fracture?
Focused, direct blow
What kind of accident would cause a basilar skull fracture?
Fall from height or RTA
What group of people can have ping-pong fractures?
Neonates
What is a diastatic skull fracture?
Along suture lines
What complications might arise from a skull fracture?
CSF leakage
Infection
Extradural haemorrhage
Black eyes
What bone and artery are most often damage in an extra-dural haemorrhage?
Petrous temporal bone
What does the lucid interval describe?
A person with an extradural haemorrhage will be conscious for a period of time, and collpase a few hours later
What blood vessels are sub-dural haemorrhages usually caused by?
Bridging vein, venous sinus
What groups of people are sub-dural haemorrhages most common in?
Elderly
Alcholics
‘Shaken baby’
Whiplash
What is a significant sub-arachnoid haemorrhage usually caused by?
Severe trauma
Damage to the neck
Rupture of aneurysm
What does a basal sub arachnoid haemorrhage with no existing pathology suggest?
Blunt impact which tore the vertebral artery
What are the primary forms of brain injury?
Cortical contusions and lacerations
Diffuse axonal or vascular injury
What are the early secondary causes of brain injury?
Hypoxia
Ischaemia
Swelling
Intracranial haematoma
What are the late secondary causes of brain injury?
Epilepsy
Infection
What is the difference between a coup or contra-coup injury?
Coup is at side of blow: contusions with no fracture
Contra-coup is at opposite side of blow
What causes diffuse axonal or vascular injury?
Acceleration/deceleration and rotational forces
What is a gliding contusion?
Brain rubs against a projecting surface
Causes haemorrhage of corpus collosum and brain stem
Which cranial nerve is the first one stretched in high intracranial pressure?
3
What are the symptoms of raised intracranial pressure?
Headache
Vomiting
Papilloedema
What effect does alcohol have on head injuries?
Causes an increase in muscle laxity which can increase the force of a rotational injury
Longer period of post-injury apnoea
What types of injury can lead to post traumatic epilepsy?
Contusions, depressed fractures
What types of injury can lead to post traumatic encephalopathy?
Repeated small injuries eg. sports related
What effect can blows to the neck have?
Vagal inhibition
Fracture larynx
Subarachnoid haemorrhage
What might happen if a patient sustains. a stab wound to the neck?
Bleeding into airways and possibility of air embolism
