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Acute care. > Brain injury and coma. > Flashcards

Brain injury and coma. Flashcards

1
Q

If someone presents with a head injury, what must we ask in the history?

A

Before: syncope, drinking etc.

During: mechanism.

After: LOC, Seizures, vomiting, headache, amnesia, neuro changes (tingling etc.) recovery time

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2
Q

What is it called when someone smacks a windscreen and it breaks on a circle?

A

bullseyed.

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3
Q

What PMH do we need to ask about in trauma?

A 
bleeding issues
previous disability
cognitive issues
epilepsy (they will seize every time hit head)
any trauma before
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4
Q

What drugs do we need to ask about in trauma?

A

anti-coags.

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5
Q

What goes with airway in trauma?

A

C-spine immobilisation.

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6
Q

When should we avoid guedels?

A

active vomiting.

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7
Q

What airways should we use in trauma?

A

oropharyngeal or advanced

avoid nasal if can.

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8
Q

What signs might we see that make us suspect a base of skull fracture in trauma?

A

bruising around the eyes and ears
blood from the nose and ears
CSF from the nose and ears.

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9
Q

In a patient with an immobilised C-spine and who has hit their head, what must we make sure we check?

A

Run hands over head to make sure there is no lumps etc we cant see.

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10
Q

What tube do we put BG in?

A

grey top

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11
Q

What should we look at the chest for in trauma, when assessing breathing and what problems can this cause?

A

flail chest - section of rib that has completely detached.

Causes ventilation problems as sucks in when breathes in and expands chest.

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12
Q

As part of A and C-spine, how should we immbolise the C-spine?

A

collar, bolster and tape.

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13
Q

When assessing C in trauma, what else should we check apart from the usual?

A 
The major bleeding sources which are: 
the chest (listen and CXR)
the abdomen (palpate)
the pelvis (look, feel and image)
the long bones (look, feel and image)

Take bloods for cross match and coags etc.

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14
Q

What should we do immediately as part of C if we suspect pelvic trauma?

A

put it in a binder.

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15
Q

What should we do in trauma immediately as part of C if we suspect long bone trauma and bleeding?

A

splint (with analgesia)

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16
Q

When assessing D in head trauma what should we do?

A 
AVPU
pupils
GCS
glucose
temperature
check full body for wounds
17
Q

When reporting GCS over the phone, how should we do it?

A

say the individual bits that the patient is doing as well as the score.

18
Q

What are the three parts of GCS?

A

eyes opening
verbal response
motor response

19
Q

How should we properly examine pupils?

A

observe size and shape at rest
observe direct response
consensual
accomodation

20
Q

What are special considerations we need to make to do GCS properly?

A

a motor response in any limb is valid.
check patients hearing acuity
look at notes for things that might affect the score e.g. CVA
Always use the best response

21
Q

What are the components of eyes in GCS?

A

4- spontaneous
3- speech
2- pain only
1- nothing

record C if cant open eye from swelling etc.

22
Q

What are the components of verbal in GCS?

A 
5- oriented
4- confused
3- inappropriate words
2- incomprehensible sounds
1- nothing

Record D if dysphasic and T if trachie

23
Q

What are the components of movement in GCS?

A

6- obeys commands (squeeze both hands)
5- localises to pain (grab rub)
4- withdraws from pain (tries to localise but doesn’t quite make it)
3- flexion to pain (claw - baby voldemert) (decorticate)
2- extension to pain (extend and externally rotate -
waiters tip) (decerberate)
1- nothing

24
Q

What painful stimuli should we use on GCS?

A

trapezius squeeze
supra-orbital ridge pressure
sternal rub (might not see biggest movement if do this one)

25
Q

What does decorticate posturing indicate?

A

cortex problems

26
Q

What does decerberate posturing indicate?

A

brainstem problem.

27
Q

What signs will we see with opiates upon ABCDE assessment?

A

small pupils and brady

28
Q

What signs will we see with speed upon ABCDE assessment?

A

large pupils and tachy

29
Q

What is another name for an extradural bleed?

A

epidural

30
Q

What type of bleeds are extradural bleeds?

A

arterial (D sign)

31
Q

What is the classic course of an extradural bleed?

A

fine then sudden deterioration

32
Q

What type of bleeds are subdural?

A

venous

33
Q

Where are subarach bleeds?

A

anywhere CSF is, commonly the circle of willis.

34
Q

What is Cushings reflex?

A

In raised ICP, brain drastically increases MAP (BP) to maintain perfusion as CPP= MAP-ICP.
See brady as well.

35
Q

What can we use for raised ICP in A and E?

A

mannitol which causes osmotic diuresis, but need to watch with fluid status.
tilt bed up or raise head to use gravity.

Acute care. (14 decks)

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