Brain Injury

Question 1

What two things do you want to avoid after a TBI?

Answer 1

Hypotension and hypoxia

Question 2

What effect does CO2 have on blood vessels?

Answer 2

Dilation

Question 3

When do you orally intubate a trauma pt?

Answer 3

Any concern for nasal fx

Question 4

Why should you not hyperventilate a pt for first 24 hours after brain injury?

Answer 4

Causes cerebral ischemia

Question 5

What kind of fluid should be avoided when resuscitating a brain injury pt?

Answer 5

Anything containing dextrose

Question 6

Who needs a CTA?

Answer 6

Anyone w/concern for vascular injury or focal neuro deficits

Question 7

HTN, bradycardia and respiratory irregularity is suggestive of what?

Answer 7

Cushing’s triad

Question 8

Which pts should get hypertonic saline or mannitol?

Answer 8

Those with signs of herniation or neuro deterioration

Question 9

Epidural bigger than what should be evacuated?

Answer 9

Greater than 30

Question 10

What type of head bleed has a lucid interval?

Answer 10

Epidural hematoma

Question 11

Which type of head bleed is common in older pts?

Answer 11

Subdural hematoma

Question 12

For what type of head bleed is there no surgical intervention?

Answer 12

SAH

Question 13

What is a complication of SAH?

Answer 13

Vasospasm

Question 14

What type of brain injury may be missed on initial CT?

Answer 14

Cerebral contusions

Question 15

What type of bleed is not a risk factor for seizure?

Answer 15

SAH

Question 16

When do early post traumatic seizures occur?

Answer 16

Within 7 days

Question 17

Should prophylaxis be given for late (past 7 days) seizure?

Answer 17

No

Question 18

What is normally given for seizure prophylaxis?

Answer 18

Dilantin

Question 19

What is a side effect of dilantin?

Answer 19

Bradycardia

Question 20

What is the 2nd line tx for seizure prophylaxis?

Answer 20

Keppra

Question 21

Can dilantin be given in liver failure?

Answer 21

No

Question 22

GCS less than what should have intracranial monitoring?

Answer 22

Less than 8

Question 23

What is the gold standard for ICP monitoring?

Answer 23

EVD

Question 24

EVD places pt at risk for what?

Answer 24

Hemorrhage

Question 25

What is CPP goal if autoregulation is intact?

Answer 25

60-70

Question 26

What is CPP goal if autoregulation is absent?

Answer 26

50-60

Question 27

We should treat ICP above what?

Answer 27

22

Question 28

What two meds can be given for hyperosmolar therapy?

Answer 28

Mannitol and HTS

Question 29

Which hyperosmolar tx should not be given if pt hypotensive?

Answer 29

Mannitol

Question 30

Which hyperosmolar tx should be given if pt has brain contusion?

Answer 30

HTS

Question 31

What is the osmolality threshold for mannitol?

Answer 31

320

Question 32

Cannot give HTS at a sodium level above what?

Answer 32

160mEq

Question 33

Is craniectomy and early or late intervention for increased ICP?

Answer 33

Late

Question 34

What does barbiturate or propofol coma do?

Answer 34

Decreases metabolic demand of the brain

Question 35

What med is usually used for induced coma?

Answer 35

Pentobarbitol

Question 36

What is the temp goal for brain injury pt?

Answer 36

37 (normothermia)

Question 37

What is the gold standard for imaging the spine?

Answer 37

CT

Question 38

How to treat an occipital condyle fx?

Answer 38

Cervical collar for 6-8 weeks

Question 39

How to treat Jefferson fx?

Answer 39

Cervical collar for 6-8 weeks if stable; is unstable, surgical

Question 40

Flexion extension films can r/o what?

Answer 40

Jefferson (C1) fx

Question 41

What is atlanto occipital dislocation?

Answer 41

Internal decapitation

Question 42

How is an axis fx tx?

Answer 42

C-collar x 6-8 weeks

Question 43

What type of axis fx may need surgery?

Answer 43

Type 3

Question 44

How is a hangman's fx tx?

Answer 44

Bracing x 6-8 weeks, sometimes surgical

Question 45

Which type of teardrop fx is unstable?

Answer 45

Flexion

Question 46

Which type of teardrop fx is stable?

Answer 46

Extension

Question 47

Is anterior column fx stable?

Answer 47

Yes

Question 48

Are middle column fx stable?

Answer 48

No

Question 49

Are wedge or compression fx stable?

Answer 49

Yes, if loss of height is less than 50%

Question 50

How is wedge or compression fx tx?

Answer 50

With bracing

Question 51

Is burst fx stable or unstable?

Answer 51

Unstable

Question 52

How long after injury does spinal shock occur?

Answer 52

About 4 hours after

Question 53

Spinal or neurogenic shock involves the vasculate?

Answer 53

Neurogenic

Question 54

Brady w/hypotension is suggestive of what?

Answer 54

Neurogenic shock

Question 55

How is neurogenic shock tx?

Answer 55

Fluid resus and pressors

Question 56

What is the typical mechanism in central cord syndrome?

Answer 56

Hyperextension

Question 57

What type of spinal cord injury causes UE weakness >lower extremity?

Answer 57

Central cord syndrome

Question 58

Does central cord syndrome cause bowel/bladder dysfunction?

Answer 58

Yes

Question 59

Which spinal injury causes ipsilateral paralysis and contralateral sensory loss?

Answer 59

Brown-sequard

Question 60

Which syndrome causes complete motor paralysis?

Answer 60

Anterior cord syndrome

Question 61

Which cord syndrome has the worst prognosis?

Answer 61

Anterior cord syndrome

Question 62

Are steroids recommended for spinal cord injuries?

Answer 62

No

Question 63

MAP should be greater than what for 5-7 days after spinal injury?

Answer 63

85

Question 64

Pts with spinal cord injury are at extremely high risk for what complication?

Answer 64

DVT

Question 65

How often should spinal cord injury be cathed?

Answer 65

Q 4-6 hours

Question 66

At what level of spinal injury will pt not have anal sphincter reflex?

Answer 66

Below L1

Question 67

Autonomic dysreflexia occurs at injury at what and above?

Answer 67

T6 and above

Question 68

What pressor do we use in neurogenic shock?

Answer 68

Norepi