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A1 > ATLS-Head trauma > Flashcards

ATLS-Head trauma Flashcards

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?

A

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

25
Q

What are the GCS scores for verbal response?

A 
Oriented = 5
Confused = 4
Inappropriate conversation = 3
Incomprehensible sounds = 2
None = 1
26
Q

What are the GCS scores for motor response?

A 
6 = obeys commands
5 = localizes pain
4 = flexes withdrawal to pain
3 = decorticate (abnormal flexion)
2 = Decerebrate = (abnormal extension)
1 = None
27
Q

Why should patients with brain contusions undergo repeated CT scanning over the course of 24 hours?

A

Contusion can rapidly evolve into a hematoma or a coalescent contusion causing massive mass effect

28
Q

True or false: even if a patient who appears or is intoxicated has a change in normal alertness, the TBI should be suspected first

A

True

29
Q

What are the indications to perform a CT scan on mild TBI?

A
  • over 65 years old
  • 2 or more episodes of vomiting
  • Suspected open or basilar skull fracture
30
Q

A loss of consciousness for over how long is an indication for CT?

A

5 minutes

31
Q

Retrograde amnesia more than how many minutes prior to event is an indication for a CT scan?

A

30 minutes

32
Q

True or false: a CT scan is obtained and admission orders sent in all cases of moderate TBI

A

True

33
Q

What labs should be obtained with TBIs?

A
  • EtOH and drug levels

- (coags)

34
Q

What are the therapeutic agents that should be administered to severe TBIs to prevent increased ICP?

A

Mannitol
Hyperventilation
Hypertonic saline

35
Q

When performing hyperventilation to prevent increased ICP, what is the target pCO2 range? What level should it never go below?

A

32-35

NEVER go below 28

36
Q

Patients with TBI should be intubated early, and started on 100% FiO2. When can this be titrated down?

A

After ABGs are obtained

37
Q

What is the oxygen saturation goal for severe TBI patients?

A

98%

38
Q

When should hyperventilation be started to prevent increased ICP?

A

Only when neuro deterioration has occurred

39
Q

True or false: hypotension is not due to brain injury itself

A

True, unless has progressed very far

40
Q

True or false: intracranial hemorrhage cannot cause hemorrhagic shock

A

True

41
Q

What is the role of a neuro exam in a hypotensive patient

A

Unreliable

42
Q

What are the three main components of a brief neuro exam for TBI patients?

A
  • GCS score
  • Pupillary light response
  • Focal deficits
43
Q

If a patient has a bad TBI and hypotension, which issue is addressed first?

A

If under 100 mmHg AFTER resuscitation, then hypotension. If over, then TBI

44
Q

Who performs the Doll’s eye maneuver?

A

Neurosurgeon

45
Q

What part of the neuro exam must be obtained prior to sedating for intubation?

A

Pupils
GCS score
Focal deficits

46
Q

After the initial CT scan in a moderate to severe TBI patient, when should another be obtained?

A

If change in status or in 24 hours

47
Q

A midline shift greater than or equal to how many mm indicates the need for neurosurgical intervention?

A

5 mm

48
Q

What sort of fluids are NEVER used in TBI patients?

A

Hypotonic or glucose containing

49
Q

What electrolyte abnormality needs to be serially monitored in patients with a TBI? Why?

A

Na to ensure no hyponatremia develops

50
Q

What is the general rule of thumb when using hyperventilation?

A

Use only in moderation and for a limited period of time as possible

51
Q

Why should mannitol never be given to patients with hypovolemia?

A

Worsens it

52
Q

What is the usual concentration of mannitol for TBIs? Rate of administration?

A

20% (20 g in 100 mL)

1g / kg over 5 minutes

53
Q

When is mannitol indicated for TBIs?

A
  • uncal herniation suspected
  • LOC
  • hemiparesis
54
Q

What is the role of barbiturates in treating ICP?

A

Will lower it, but not to be used in hypovolemia/hypotensive patients, as this will worsen these

55
Q

What must be ensured if you sedate a patient who had a seizure?

A

Monitor for continued seizures, since will not be able to tell once sedated/paralyzed

56
Q

Patients with a penetrating injury involving what parts of the head should undergo angiography to identify a traumatic intracranial aneurysm?

A

Orbital Facial or pterional (pterygoid) regions

57
Q

What are the four factors that are used to diagnose brain death?

A
  • GCS = 3
  • Nonreactive pupils
  • Absent brainstem reflexes
  • No spontaneous ventilatory effort on apnea testing
58
Q

What are the indications to remove a helmet with a cast cutter? (2)

A
  • Pain or paresthesias with attempted removal

- Evidence of cervical spine injury on x-ray film

A1 (32 decks)

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