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ATLS-Head trauma Flashcards

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1
Q

What is the best way to prevent secondary brain injury in TBI?

A

Oxygenation and maintaining BP

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2
Q

For a patient with a TBI in a facility without neurosurgery, do you transfer or get CT first?

A

Just transfer

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3
Q

What is unique about scalp lacerations?

A

Because of venous supply, can bleed profusely and may even lead to hemorrhagic shock if left untreated

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4
Q

What are the steps of reporting a TBI to a neurosurgeon? (7)

A
  • Age of patient
  • Mechanism of injury
  • Respiratory and cardio status
  • Neuro exam
  • Associated injuries
  • Results of studies
  • Treatment performed
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5
Q

Where are meningeal arteries located (what two structures are they sandwiched between)?

A

Between skull and dura mater

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6
Q

Where does blood come from with subarachnoid hemorrhages?

A

Bridging veins

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7
Q

What usually fills the space between the pia and arachnoid mater?

A

CSF

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8
Q

What are the three components of the brainstem?

A

Midbrain
Pons
Medulla

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9
Q

Where does CN III run relative to the tentorium?

A

Runs on top of it

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10
Q

Where on CN III do parasympathetic fibers run (superficially or deep)?

A

Superficially

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11
Q

What part of the brain usually herniates through the tentorial notch?

A

Medical part of the temporal lobe (uncus)

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12
Q

What are the two classic signs of uncal herniation?

A
  • Contralateral paralysis

- Blown pupil

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13
Q

Why is contralateral asthenia/paralysis associated with uncal herniations?

A

Uncus compresses the pons, where the fibers cross

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14
Q

What is the usual ICP, and what is the pressure that above which results in severe damage?

A

10 mmHg usual

Over 20 = badness

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15
Q

What is the monro-Kellie doctrine?

A

The idea that the cranium is a rigid structure, and that the total volume must remain constant to have the same ICP

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16
Q

What is the equation for Cerebral perfusion pressure (CPP)?

A

CPP = MAP - ICP

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17
Q

What are the non-surgical means of relieving increased ICP?

A

Maintain normal:

  • Volume
  • MAP
  • Oxygenation
  • Normocapnia
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18
Q

A GCS of less than what is the definition of coma or severe brain injury?

A

8 or less

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19
Q

What GCS score defines mild moderate and severe TBIs?

A 
Mild = 13-15
Moderate = 9-12
Severe = 8 or less
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20
Q

In calculating GCS score, if there is a difference between sides (top/bottom or left/right), which side should be used?

A

The best one

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21
Q

Which CNs are usually affected with basilar skull fractures?

A

7 and 8

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22
Q

What should be done if a skull fracture traverses the carotid canals?

A

Cerebral arteriopgraphy

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23
Q

Why is any skull fracture significant?

A

Takes a lot of energy to break the skull

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24
Q

What are the GCS scores for eyes?

Study These Flashcards
A

Spontaneous = 4
To speech = 3
To pain = 2
None = 1

25
What are the GCS scores for verbal response?
``` Oriented = 5 Confused = 4 Inappropriate conversation = 3 Incomprehensible sounds = 2 None = 1 ```
26
What are the GCS scores for motor response?
``` 6 = obeys commands 5 = localizes pain 4 = flexes withdrawal to pain 3 = decorticate (abnormal flexion) 2 = Decerebrate = (abnormal extension) 1 = None ```
27
Why should patients with brain contusions undergo repeated CT scanning over the course of 24 hours?
Contusion can rapidly evolve into a hematoma or a coalescent contusion causing massive mass effect
28
True or false: even if a patient who appears or is intoxicated has a change in normal alertness, the TBI should be suspected first
True
29
What are the indications to perform a CT scan on mild TBI?
- over 65 years old - 2 or more episodes of vomiting - Suspected open or basilar skull fracture
30
A loss of consciousness for over how long is an indication for CT?
5 minutes
31
Retrograde amnesia more than how many minutes prior to event is an indication for a CT scan?
30 minutes
32
True or false: a CT scan is obtained and admission orders sent in all cases of moderate TBI
True
33
What labs should be obtained with TBIs?
- EtOH and drug levels | - (coags)
34
What are the therapeutic agents that should be administered to severe TBIs to prevent increased ICP?
Mannitol Hyperventilation Hypertonic saline
35
When performing hyperventilation to prevent increased ICP, what is the target pCO2 range? What level should it never go below?
32-35 | NEVER go below 28
36
Patients with TBI should be intubated early, and started on 100% FiO2. When can this be titrated down?
After ABGs are obtained
37
What is the oxygen saturation goal for severe TBI patients?
98%
38
When should hyperventilation be started to prevent increased ICP?
Only when neuro deterioration has occurred
39
True or false: hypotension is not due to brain injury itself
True, unless has progressed very far
40
True or false: intracranial hemorrhage cannot cause hemorrhagic shock
True
41
What is the role of a neuro exam in a hypotensive patient
Unreliable
42
What are the three main components of a brief neuro exam for TBI patients?
- GCS score - Pupillary light response - Focal deficits
43
If a patient has a bad TBI and hypotension, which issue is addressed first?
If under 100 mmHg AFTER resuscitation, then hypotension. If over, then TBI
44
Who performs the Doll's eye maneuver?
Neurosurgeon
45
What part of the neuro exam must be obtained prior to sedating for intubation?
Pupils GCS score Focal deficits
46
After the initial CT scan in a moderate to severe TBI patient, when should another be obtained?
If change in status or in 24 hours
47
A midline shift greater than or equal to how many mm indicates the need for neurosurgical intervention?
5 mm
48
What sort of fluids are NEVER used in TBI patients?
Hypotonic or glucose containing
49
What electrolyte abnormality needs to be serially monitored in patients with a TBI? Why?
Na to ensure no hyponatremia develops
50
What is the general rule of thumb when using hyperventilation?
Use only in moderation and for a limited period of time as possible
51
Why should mannitol never be given to patients with hypovolemia?
Worsens it
52
What is the usual concentration of mannitol for TBIs? Rate of administration?
20% (20 g in 100 mL) | 1g / kg over 5 minutes
53
When is mannitol indicated for TBIs?
- uncal herniation suspected - LOC - hemiparesis
54
What is the role of barbiturates in treating ICP?
Will lower it, but not to be used in hypovolemia/hypotensive patients, as this will worsen these
55
What must be ensured if you sedate a patient who had a seizure?
Monitor for continued seizures, since will not be able to tell once sedated/paralyzed
56
Patients with a penetrating injury involving what parts of the head should undergo angiography to identify a traumatic intracranial aneurysm?
Orbital Facial or pterional (pterygoid) regions
57
What are the four factors that are used to diagnose brain death?
- GCS = 3 - Nonreactive pupils - Absent brainstem reflexes - No spontaneous ventilatory effort on apnea testing
58
What are the indications to remove a helmet with a cast cutter? (2)
- Pain or paresthesias with attempted removal | - Evidence of cervical spine injury on x-ray film

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