Brain Injury Flashcards
What two things do you want to avoid after a TBI?
Hypotension and hypoxia
What effect does CO2 have on blood vessels?
Dilation
When do you orally intubate a trauma pt?
Any concern for nasal fx
Why should you not hyperventilate a pt for first 24 hours after brain injury?
Causes cerebral ischemia
What kind of fluid should be avoided when resuscitating a brain injury pt?
Anything containing dextrose
Who needs a CTA?
Anyone w/concern for vascular injury or focal neuro deficits
HTN, bradycardia and respiratory irregularity is suggestive of what?
Cushing’s triad
Which pts should get hypertonic saline or mannitol?
Those with signs of herniation or neuro deterioration
Epidural bigger than what should be evacuated?
Greater than 30
What type of head bleed has a lucid interval?
Epidural hematoma
Which type of head bleed is common in older pts?
Subdural hematoma
For what type of head bleed is there no surgical intervention?
SAH
What is a complication of SAH?
Vasospasm
What type of brain injury may be missed on initial CT?
Cerebral contusions
What type of bleed is not a risk factor for seizure?
SAH
When do early post traumatic seizures occur?
Within 7 days
Should prophylaxis be given for late (past 7 days) seizure?
No
What is normally given for seizure prophylaxis?
Dilantin
What is a side effect of dilantin?
Bradycardia
What is the 2nd line tx for seizure prophylaxis?
Keppra
Can dilantin be given in liver failure?
No
GCS less than what should have intracranial monitoring?
Less than 8
What is the gold standard for ICP monitoring?
EVD
EVD places pt at risk for what?
Hemorrhage
What is CPP goal if autoregulation is intact?
60-70
What is CPP goal if autoregulation is absent?
50-60
We should treat ICP above what?
22
What two meds can be given for hyperosmolar therapy?
Mannitol and HTS
Which hyperosmolar tx should not be given if pt hypotensive?
Mannitol
Which hyperosmolar tx should be given if pt has brain contusion?
HTS
What is the osmolality threshold for mannitol?
320
Cannot give HTS at a sodium level above what?
160mEq
Is craniectomy and early or late intervention for increased ICP?
Late
What does barbiturate or propofol coma do?
Decreases metabolic demand of the brain
What med is usually used for induced coma?
Pentobarbitol
What is the temp goal for brain injury pt?
37 (normothermia)
What is the gold standard for imaging the spine?
CT
How to treat an occipital condyle fx?
Cervical collar for 6-8 weeks
How to treat Jefferson fx?
Cervical collar for 6-8 weeks if stable; is unstable, surgical
Flexion extension films can r/o what?
Jefferson (C1) fx
What is atlanto occipital dislocation?
Internal decapitation
How is an axis fx tx?
C-collar x 6-8 weeks
What type of axis fx may need surgery?
Type 3
How is a hangman’s fx tx?
Bracing x 6-8 weeks, sometimes surgical
Which type of teardrop fx is unstable?
Flexion
Which type of teardrop fx is stable?
Extension
Is anterior column fx stable?
Yes
Are middle column fx stable?
No
Are wedge or compression fx stable?
Yes, if loss of height is less than 50%
How is wedge or compression fx tx?
With bracing
Is burst fx stable or unstable?
Unstable
How long after injury does spinal shock occur?
About 4 hours after
Spinal or neurogenic shock involves the vasculate?
Neurogenic
Brady w/hypotension is suggestive of what?
Neurogenic shock
How is neurogenic shock tx?
Fluid resus and pressors
What is the typical mechanism in central cord syndrome?
Hyperextension
What type of spinal cord injury causes UE weakness >lower extremity?
Central cord syndrome
Does central cord syndrome cause bowel/bladder dysfunction?
Yes
Which spinal injury causes ipsilateral paralysis and contralateral sensory loss?
Brown-sequard
Which syndrome causes complete motor paralysis?
Anterior cord syndrome
Which cord syndrome has the worst prognosis?
Anterior cord syndrome
Are steroids recommended for spinal cord injuries?
No
MAP should be greater than what for 5-7 days after spinal injury?
85
Pts with spinal cord injury are at extremely high risk for what complication?
DVT
How often should spinal cord injury be cathed?
Q 4-6 hours
At what level of spinal injury will pt not have anal sphincter reflex?
Below L1
Autonomic dysreflexia occurs at injury at what and above?
T6 and above
What pressor do we use in neurogenic shock?
Norepi