6: Management of head injury

Question 1

What is the concept of a secondary head injury?

Answer 1

All the stuff that happens to the brain after a primary insult

Question 2

What is the normal range of ICP?

Answer 2

9 - 11 mmHg

Question 3

What is the Monroe Kellie hypothesis?

Answer 3

Skull is a fixed volume, so if the volume of one part e.g blood increases the volume of something else must decrease, otherwise the pressure increases

Question 4

How is CPP calculated?

Answer 4

MAP - ICP

Question 5

What should CPP be kept above?

Answer 5

60 mmHg

Question 6

The body is able to ___ CPP to an extent.

Answer 6

autoregulate

Question 7

What is a classical appearance associate with anterior cranial fossa fracture?

Answer 7

Racoon eyes

Question 8

What is a classical appearance associated with posterior cranial fossa fracture?

Answer 8

Battle sign over mastoid

Question 9

Racoon eyes and the Battle sign are bruises associated with ___ ___ ___ fractures.

Answer 9

base of skull

Question 10

Base of skull fractures are usually ___ fractures.

Answer 10

compound

Question 11

Why type of herniation causes a third nerve palsy?

Answer 11

Transtentorial (Uncal) herniation

Question 12

Which type of brain herniation causes Cushing triad and imminent death?

Answer 12

Tonsilar herniation

Question 13

Which tool is used to assess head injury patients?

Answer 13

Glasgow Coma Score

Question 14

Where should you try to evoke a pain response when taking a patient’s GCS?

Answer 14

Supraorbital notch

Question 15

What are the possible scores for the GCS?

Answer 15

3 - 15

Question 16

Why is 3 the minimum GCS score?

Answer 16

1 is the minimum score for each of the three domains

Question 17

What are the criteria to say someone is in a coma?

Question 18

Which score or less equates to a coma on the GCS scale?

Answer 18

< 8

Question 19

All patients with a GCS less than 8 should be considered for ___.

Answer 19

intubation

Question 20

What social factors are involved in many mild head injuries?

Answer 20

Alcohol

Social isolation

Question 21

hypoxia

hypotension

raised ICP

Question 22

Which approach is used to treat patients with acute head injuries?

Answer 22

ABCDE

Question 23

Which investigation is used for patients with suspected head trauma?

Answer 23

CT scan

Question 24

Any patient taking ___ drugs should be scanned following a head injury.

Answer 24

anticoagulant

Question 25

look into extradural and intramural haemorrhages

Question 26

How is cerebral blood demand reduced in patients with acute head injuries?

Question 27

CPP needs to be kept above ___ mmHg in patients with acute head injuries.

Answer 27

> 60 mmHg

Question 28

Which drug can be given acutely to reduce ICP and treat symptoms of tonsilar herniation?

Answer 28

Hypertonic saline

used to be mannitol

Question 29

People who have had head injuries may develop which recurrent neurological disorder?

Answer 29

Epilepsy

Question 30

What may leak from the nose or ears in patients with acute head injury?

Answer 30

CSF

Question 31

Brain dead patients are prime candidates for which program (if they give their permission)?

Answer 31

Organ donation

Question 32

Brain dead patients with brain tumours can be considered for organ donation unused which circumstance?

Answer 32

No metastasis elsewhere

Question 33

look over brain stem death testing