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Semester 3 > Case 10 - acute head trauma > Flashcards

Case 10 - acute head trauma Flashcards

1
Q

how many people per 100000 of the population will suffer a head trauma

A

453 per 100,000

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2
Q

what is the percentage that are considered moderate to severe

A

10.9%

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3
Q

how many admissions throughout the year

A

350,000

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4
Q

what are the risk factors for a head trauma

A

male
young (15-30) and old (65+ tend to be more low impact and falls )
urban areas
substance misuse including alcohol

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5
Q

what are primary preventions put in place

A

seat belts
helmets
alcohol prevention and limits
health and safety

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6
Q

what is the first aid carried out for suspected head trauma

A

ABC + C-spine

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7
Q

what is pHEMS

A

pre hospital emergency medicine

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8
Q

what is ATLS

A

trauma protocol

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9
Q

what is involved in the history part of the assessment

A

From patient and collateral (passersby or paramedics or family)
Time - when did it occur and was patient just found
Mechanism - high impact or fall form standing?
Conscious level - at worst: this is very important as can be a worrying sign
Seizures
PMHx (past medical history) / DHx (drug history)

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10
Q

what is the A-E of the assessment protocol

A

Patency
Other injuries, apnoea, hypoxia
Other injuries, hypotension, heart ray
GCS, pupils, C-spine (10% of head injury patients have a c spine injury as well)
Primary survey (entire body)

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11
Q

what are the signs of a base of skull fracture

A

racoon eyes
battle sign
haemotypanum - bleeding behind the ear drum
- CSF leak - clear fluid from the nose

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12
Q

what percentage have a concurrent C-spine injury

A

5-10% have a concurrent C spine injury

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13
Q

glasgow coma score diagram

A
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14
Q

what are the NICE guidelines for a CT

A

perform a CT head within 1 hour of the risk factor being identified

GCS less than 13 on initial assessment in the emergency department

GCS less than 15 after 2 hours after the injury on assessment in the ED

Suspected open or depressed skull fracture

Any sign of basal skull fracture - panda eyes, fluid leaking or Battle’s sign

Post traumatic seizure

Focal neurological deficit

More than 1 episode of vomiting

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15
Q

what adults who have had loss of consciousness or amnesia since the injury would have a CT within 8 hours of the head injury

A

age 65 or older
any history of bleeding or clotting disorders
dangerous mechanism of injury
more than 30 mins retrograde amnesia of events immediately before the head Injury

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16
Q

what is the primary in brain injury

A

the original insult

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17
Q

what is the secondary in brain injury

A

the damaged caused after

caused by:
hypoxia
hypotension/hypertension
raised inter cranial pressure

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18
Q

types of head trauma diagram

A
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19
Q

what is a diffuse axonal injury

A

when the brain moves back and forth in the skull cavity - ricochets

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20
Q

what is an extradural haematoma

A

any bleeding that happens within the potential space between the skull and the dura

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21
Q

what is the bleeding usually from in an extradural haematoma

A

middle meningeal artery

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22
Q

what is the conscious pattern in an extradural haematoma

A

usually lose consciousness immediately but then regain consciousness

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23
Q

what are the other symptoms of extradural haematoma

A

ongoing headache and then become increasingly drowsy after some hours

24
Q

CT scan of an extradural haematoma

A
25
Q

when do sub dural haematomas usually occur

A

these occur following trauma but more frequently from falls

26
Q

what is the consciousness pattern with sub dural haematomas

A

gradual loss of consciousness

27
Q

where is the bleeding from in a sub dural haematoma

A

venous bleed and between venous bridging veins

28
Q

sub dural haematoma on CT scan

A
29
Q

effects of secondary brain injury

A
30
Q

what is the murno Kellie

A

everything managed in the brain must be done so in equilibrium

31
Q

what are the three components to the murno Kellie

A

brain
CSF
blood (venous and arterial)

32
Q

can there be a degree of compensation

A

yes but only for so long

33
Q

pathophysiology diagram

A
34
Q

diagram explaining how to measure the CPP needed

A
35
Q

what is normal ICP in the brain

A

10mmHg

36
Q

when does autoregulation stop working

A

when blood pressure drops below 50

37
Q

when will cerebral vasculature start to dangerously constrict

A

when BP is over 150

38
Q

how do you measure inter cranial pressure

A

neurosurgeons place inter cranial pressire wires in parenchymal or intra dural space

39
Q

what is normal range for ICP

A

5-12mmHg

40
Q

what happens if you have a higher ICP than the mean arterial pressure

A

means that there is no blood flow going into the brain - no pressure to push blood into the brain

41
Q

diagram showing the left being normal and right being abnormal

A
42
Q

what is the equation for cerebral perfusion pressure

A

MAP - ICP

43
Q

what is MAP

A

the number in brackets beside BP

44
Q

what is the bit we are most concerned about

A

CPP

45
Q

what is the importance of venous drainage

A

if we can ensure there is adequate venous pressure this can improve overall pressure

46
Q

what are the signs of schema

A

hypoxia
Hypotension
Loss of auto regulation
raised ICP
Oedema
Haematoma
Hydrocephalus - when haematoma obstructs the ventricular system: no ability to drain CSF and increase pressure
Vasospasm
Microvascular pathology

47
Q

what is cytotoxic oedema

A

initial mechanism
Fluid retained in cytoplasm
Loss of NaK ATPase
Glutamate gated Ca channels open
Ca draws water in

48
Q

what is vasogenic cytotoxic

A

delayed mechanism (48 hours) gets worse after 48 hours
Breakdown of blood brain barrier
Fluid and protein extravasation into parenchyma

49
Q

what is a subfalcine herniation syndrome

A

midline shift on CT

50
Q

what is a transtentorial herniation syndrome

A

pressure on the brainstem
oculomotor nerve - pupils

51
Q

what is tonsillar herniation syndrome

A

through foremen magnum
medulla - cardiorespiratory centre

52
Q

what is the medical management Maintain physiology:

A

MAP >90 or CPP >60
Normocapnia
Normothermia
Avoid hypoxia

Improve venous drainage
head up
No restrictions

Reverse coagulopathy

Anti-epileptics if indicated

53
Q

what does the prognosis rely on

A

age
presenting GCS
co-morbities
episodes of hypoxia or hypotension
pupillary response
duration ICP >20
country

54
Q

what is the website you can use for head injure prognosis

A

CRASH website

very overall and average and not individual to the patient

55
Q

GCS outcome score diagram

A

Semester 3 (94 decks)

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