Brain injury and coma. Flashcards
If someone presents with a head injury, what must we ask in the history?
Before: syncope, drinking etc.
During: mechanism.
After: LOC, Seizures, vomiting, headache, amnesia, neuro changes (tingling etc.) recovery time
What is it called when someone smacks a windscreen and it breaks on a circle?
bullseyed.
What PMH do we need to ask about in trauma?
bleeding issues previous disability cognitive issues epilepsy (they will seize every time hit head) any trauma before
What drugs do we need to ask about in trauma?
anti-coags.
What goes with airway in trauma?
C-spine immobilisation.
When should we avoid guedels?
active vomiting.
What airways should we use in trauma?
oropharyngeal or advanced
avoid nasal if can.
What signs might we see that make us suspect a base of skull fracture in trauma?
bruising around the eyes and ears
blood from the nose and ears
CSF from the nose and ears.
In a patient with an immobilised C-spine and who has hit their head, what must we make sure we check?
Run hands over head to make sure there is no lumps etc we cant see.
What tube do we put BG in?
grey top
What should we look at the chest for in trauma, when assessing breathing and what problems can this cause?
flail chest - section of rib that has completely detached.
Causes ventilation problems as sucks in when breathes in and expands chest.
As part of A and C-spine, how should we immbolise the C-spine?
collar, bolster and tape.
When assessing C in trauma, what else should we check apart from the usual?
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.
What should we do immediately as part of C if we suspect pelvic trauma?
put it in a binder.
What should we do in trauma immediately as part of C if we suspect long bone trauma and bleeding?
splint (with analgesia)
When assessing D in head trauma what should we do?
AVPU pupils GCS glucose temperature check full body for wounds
When reporting GCS over the phone, how should we do it?
say the individual bits that the patient is doing as well as the score.
What are the three parts of GCS?
eyes opening
verbal response
motor response
How should we properly examine pupils?
observe size and shape at rest
observe direct response
consensual
accomodation
What are special considerations we need to make to do GCS properly?
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
What are the components of eyes in GCS?
4- spontaneous
3- speech
2- pain only
1- nothing
record C if cant open eye from swelling etc.
What are the components of verbal in GCS?
5- oriented 4- confused 3- inappropriate words 2- incomprehensible sounds 1- nothing
Record D if dysphasic and T if trachie
What are the components of movement in GCS?
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
What painful stimuli should we use on GCS?
trapezius squeeze
supra-orbital ridge pressure
sternal rub (might not see biggest movement if do this one)
What does decorticate posturing indicate?
cortex problems
What does decerberate posturing indicate?
brainstem problem.
What signs will we see with opiates upon ABCDE assessment?
small pupils and brady
What signs will we see with speed upon ABCDE assessment?
large pupils and tachy
What is another name for an extradural bleed?
epidural
What type of bleeds are extradural bleeds?
arterial (D sign)
What is the classic course of an extradural bleed?
fine then sudden deterioration
What type of bleeds are subdural?
venous
Where are subarach bleeds?
anywhere CSF is, commonly the circle of willis.
What is Cushings reflex?
In raised ICP, brain drastically increases MAP (BP) to maintain perfusion as CPP= MAP-ICP.
See brady as well.
What can we use for raised ICP in A and E?
mannitol which causes osmotic diuresis, but need to watch with fluid status.
tilt bed up or raise head to use gravity.
