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Assessment & Diagnosis > Brain Injury > Flashcards

Brain Injury Flashcards

1
Q

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

A

Hypotension and hypoxia

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2
Q

What effect does CO2 have on blood vessels?

A

Dilation

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3
Q

When do you orally intubate a trauma pt?

A

Any concern for nasal fx

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4
Q

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

A

Causes cerebral ischemia

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5
Q

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

A

Anything containing dextrose

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6
Q

Who needs a CTA?

A

Anyone w/concern for vascular injury or focal neuro deficits

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7
Q

HTN, bradycardia and respiratory irregularity is suggestive of what?

A

Cushing’s triad

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8
Q

Which pts should get hypertonic saline or mannitol?

A

Those with signs of herniation or neuro deterioration

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9
Q

Epidural bigger than what should be evacuated?

A

Greater than 30

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10
Q

What type of head bleed has a lucid interval?

A

Epidural hematoma

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11
Q

Which type of head bleed is common in older pts?

A

Subdural hematoma

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12
Q

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

A

SAH

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13
Q

What is a complication of SAH?

A

Vasospasm

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14
Q

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

A

Cerebral contusions

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15
Q

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

A

SAH

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16
Q

When do early post traumatic seizures occur?

A

Within 7 days

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17
Q

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

A

No

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18
Q

What is normally given for seizure prophylaxis?

A

Dilantin

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19
Q

What is a side effect of dilantin?

A

Bradycardia

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20
Q

What is the 2nd line tx for seizure prophylaxis?

A

Keppra

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21
Q

Can dilantin be given in liver failure?

A

No

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22
Q

GCS less than what should have intracranial monitoring?

A

Less than 8

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23
Q

What is the gold standard for ICP monitoring?

A

EVD

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24
Q

EVD places pt at risk for what?

A

Hemorrhage

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25
Q

What is CPP goal if autoregulation is intact?

A

60-70

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26
Q

What is CPP goal if autoregulation is absent?

A

50-60

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27
Q

We should treat ICP above what?

A

22

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28
Q

What two meds can be given for hyperosmolar therapy?

A

Mannitol and HTS

29
Q

Which hyperosmolar tx should not be given if pt hypotensive?

A

Mannitol

30
Q

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

A

HTS

31
Q

What is the osmolality threshold for mannitol?

A

320

32
Q

Cannot give HTS at a sodium level above what?

A

160mEq

33
Q

Is craniectomy and early or late intervention for increased ICP?

A

Late

34
Q

What does barbiturate or propofol coma do?

A

Decreases metabolic demand of the brain

35
Q

What med is usually used for induced coma?

A

Pentobarbitol

36
Q

What is the temp goal for brain injury pt?

A

37 (normothermia)

37
Q

What is the gold standard for imaging the spine?

A

CT

38
Q

How to treat an occipital condyle fx?

A

Cervical collar for 6-8 weeks

39
Q

How to treat Jefferson fx?

A

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

40
Q

Flexion extension films can r/o what?

A

Jefferson (C1) fx

41
Q

What is atlanto occipital dislocation?

A

Internal decapitation

42
Q

How is an axis fx tx?

A

C-collar x 6-8 weeks

43
Q

What type of axis fx may need surgery?

A

Type 3

44
Q

How is a hangman’s fx tx?

A

Bracing x 6-8 weeks, sometimes surgical

45
Q

Which type of teardrop fx is unstable?

A

Flexion

46
Q

Which type of teardrop fx is stable?

A

Extension

47
Q

Is anterior column fx stable?

A

Yes

48
Q

Are middle column fx stable?

A

No

49
Q

Are wedge or compression fx stable?

A

Yes, if loss of height is less than 50%

50
Q

How is wedge or compression fx tx?

A

With bracing

51
Q

Is burst fx stable or unstable?

A

Unstable

52
Q

How long after injury does spinal shock occur?

A

About 4 hours after

53
Q

Spinal or neurogenic shock involves the vasculate?

A

Neurogenic

54
Q

Brady w/hypotension is suggestive of what?

A

Neurogenic shock

55
Q

How is neurogenic shock tx?

A

Fluid resus and pressors

56
Q

What is the typical mechanism in central cord syndrome?

A

Hyperextension

57
Q

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

A

Central cord syndrome

58
Q

Does central cord syndrome cause bowel/bladder dysfunction?

A

Yes

59
Q

Which spinal injury causes ipsilateral paralysis and contralateral sensory loss?

A

Brown-sequard

60
Q

Which syndrome causes complete motor paralysis?

A

Anterior cord syndrome

61
Q

Which cord syndrome has the worst prognosis?

A

Anterior cord syndrome

62
Q

Are steroids recommended for spinal cord injuries?

A

No

63
Q

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

A

85

64
Q

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

A

DVT

65
Q

How often should spinal cord injury be cathed?

A

Q 4-6 hours

66
Q

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

A

Below L1

67
Q

Autonomic dysreflexia occurs at injury at what and above?

A

T6 and above

68
Q

What pressor do we use in neurogenic shock?

A

Norepi

Assessment & Diagnosis (5 decks)

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