Chapter 34 - Head and Spine Trauma Flashcards
Are the terms head trauma, head injury, and Traumatic brain injury (TBI) interchangeable?
No.
Head trauma is an umbrella term under which head injury and TBI are differentiated.
Pg 1713
Head injury definition
Injuries to soft tissues of scalp and/or bony structures of head and skull, NOT INCLUDING FACE
Traumatic Brain Injury
Impairment in brain function caused by an external force
Cranial vault is___________.
the cranial space that encases and protects the brain.
In addition to protecting the brain, what is another primary function of the cranial vault?
Hematopoises
the production of blood cells and platelets
In a basilar skull fracture, where is the most common place for CSF to drain from?
Nose
Pg 1714
Ears are less common
What is the most metabolically active organ of the body?
Brain
Pg 1714
Cerebral cortex controls_______.
Skeletal muscle movement
Frontal lobe controls______.
Voluntary motor action
Personality traits filtering raw emotional impulses
Parietal lobe controls________.
Processes sensory info from skin and joints.
Proprioception
Occipital lobe is responsible for______.
Processing visual info
Cerebellum is responsible for________.
Posture & equilibrium and coordinating skilled movements.
Branchial plexus is where?
C5 -T1 = controls upper extremities
Lumbar plexus is where?
L1 - L4 = supplies skin and muscles of abdominal wall
Sacral plexus is where?
L4 - S1 = supplies buttocks, perineum and most lower limbs
Origin of Pudendal and sciatic nerves
Pg 1718
Spinal injury at or above T6 can disrupt what kind of communication?
Sympathetic
Another name for the craniosacral system?
Parasympathetic nervous system
Is the vagal nerve affected by spinal injury?
No, it leaves the medulla within the carotid artery sheath and does not travel the spinal cord
Pg 1719
If the patient has a TBI, what else do they have until proven otherside?
C-Spine injury
Pg 1719
Repeatedly asking the same questions is
Perseveration
High risk velocity crash for vehicles occurs at > _____ mph.
For motorcycles, pedestrian vs vehicle, bicycle?
Greather than 40 mph
Motorcycle, et al = 20+ mph
What is the Brain Trauma Foundation’s 90-90-9 rule?
- A single drop of SpO2 below 90% dramatically increases death rate
- A single drop of systolic BP below 90 mmHg dramatically increases death rate
- A single drop of 2 points in GCS or GCS of less than 9 dramatically increases death rate
What is the brain’s respiratory center?
Pons and medulla
Where do the intercostal muscles innervate?
T2
Why do we NOT hyperventilate a patient with high intercranial pressure (ICP)?
- Causes vasoconstriction and shunt blood away from brain
- This drop cerebral perfusion pressure and the brain goes ischemic.
When does the Brain Trauma Foundation recommend hyperventilating a head injury?
For brief periods ONLY with signs of cerebral herniation.
Pg 1722
When ETCO2 drops below 25, what happens to the vasculature?
Vasoconstricts
With head injury = anoxia and brain ischemia
Pg 1722
Why is thermoregulation an issue with neurogenic shock?
There may be significant sensory loss, and the patient will take on the temperature of the environment.
Should we administer dextrose containing products to patients with cerebral edema?
Why or why not?
No, it can worsen the cerebral edema.
The exception is if their BGL is at 45 mg/dL or less.
Pg 1723
What is the cause of hypotension from neurogenic shock?
How can you tx that?
- The loss of sympathetic tone results in uninhibited vagal stimulation
- Atropine (vagolytic) or dopamine (vasopressor). Possible pacing for refractory bradycardia.
Fluids may bit be indicated.
Pg 1723
What does hypothermia do to oxygen in the body?
Impairs oxygen ability to unbind from hemoglobin
=coagulapathy and acidosis
What are petechial hemorrhages indicative of when located in the eye?
Red pinpoints in the sclera of the eye from ruptured tiny vessels.
This finding indicates that the baby was shaken, although this finding may not be present in every case of shaken baby syndrome.
What do petechial hemorrhages indicate in an infant?
Shaken baby syndrome
On a rigid backboard, how quickly does the tissue of the pressure points show signs of hypoxia in a healthy adult?
30 minutes - Skin breakdown will be faster in an unhealthy adult.
Is sluggish pupil response an early or late sign of increased ICP?
Early
pg. 1727
What else does a sluggish pupil response possibly indicate?
Cerebral hypoxia
pg 1727
Which nerve is being pressured when pupils are sluggish or fixed?
Oculomotor Nerve CN III
pg 1727
What is nystagmus?
A condition in which your eyes make rapid, repetitive, uncontrolled movements —
such as up and down (vertical nystagmus), side to side (horizontal nystagmus) or in a circle (rotary nystagmus).
What is it called when the patient is experiencing abnormal sensations such as “pins and needles,” hyperacute pain to touch, or electric shocks?
Hyperesthesia
What is the Babinski reflex?
Patient older than 2 years, the toes move upward in response to stimulation of the sole of the foot.
Does head injury include traumatic insults to the brain or face?
No.
It is an injury to the scalp or skull, not including the brain or face
pg. 1732
The leading cause of death relating to TBI from a fall is at which age?
65+
What causes bleeding to reoccur to a head laceration that is caused by body system and not additional trauma?
Re-evaluate the wound for signs of continued bleeding.
Bleeding can recur once vital signs return to normal and the sympathetic nervous system has receded.
pg 1733
What are the 4 types of skull fracture?
Linear
Depressed
Basilar
Open
Fracture of the___________ represents 75% of basilar skull fractures.
temporal bone
1734
Patients with leaking CSF are at risk for____________________.
bacterial meningitis
pg 1735
The Brain Trauma Foundation defines hypoxia in the setting of TBI as an oxygen saturation level of less than ____________%.
Hypoxia and hypotension (systolic blood pressure less than __________ mm Hg) are among the five most powerful predictors of poor outcomes in the patient with a TBI.
90%
90 mm HG
pg 1736
The patient is in a MVC and head hits the windshield. Rapid deceleration produces compression injury (or bruising) to the ___________ of the brain along with stretching or tearing of the____________
of the brain
anterior portion
posterior portion.
Of the Coup-Contrecoup, this is the Coup.
pg 1736
The normal ICP is ____ to ____ mm Hg, and the normal MAP is ____ to ____ mm Hg.
5 to 15 mm Hg (ICP)
85 to 95 mm Hg (MAP)
pg 1737
Does the pulse pressure narrow or widen with increased ICP?
Widens, as well as increased blood pressure both systolic and diastolic
Pg1737
When the Oculomotor nerve is impinged, does the pupil contract or dilate?
Dilate.
The oculomotor nerve (CNIII) delivers parasympathetic impulses. Without it, the eye dilates.
pg. 1738
Cushing triad
Bradycardia
Hypertension (widening pulse pressure)
Respiratory changes
A cerebral concussion occurs when the brain is jarred in the skull. This kind of mild, diffuse brain injury is usually caused by rapid _________-__________.
acceleration-deceleration
pg. 1738
The shearing angulated/rotational forces that cause a concussion release ___________ into the extracelluar space.
Potassium
pg. 1738
What is the effect of Potassium in the extracellular space of the brain?
Depresses neuronal activity
pg. 1738
Is the only way to receive a concussion by direct blow to the head?
No.
This may happen when the head changes direction quickly.
pg 1741
How long after the concussion may a patient experience signs and symptoms?
3 - 6 months after the initial concussion
This is Postconcussion Syndrome, and requires a physician evaluation.
pg 1741
Which is more deadly, Postconcussion Syndrome
or Secondary Concussion Syndrome?
Secondary Concussion Syndrome
Death can occur as quickly as 2 to 5 minutes after the injury, and children and young adults are the most likely to develop this condition.
Because of its rapid onset and high rate of mortality, a second concussion that occurs within 7 to 10 days of a previous concussion necessitates immediate transport to the closest facility with neurosurgical capability.
pg 1740
Is a concussion a focal or diffuse (general) injury?
Diffuse.
A cerebral concussion occurs when the brain is jarred in the skull. This kind of mild, diffuse brain injury is usually caused by rapid acceleration-deceleration.
pg 1738
In a cerebral contusion, brain tissue is _______ and ________ in a local area.
Bruised and damage
How long can an epidural hematoma remain in the lucid period before the patient relapses into unconsciousness?
1 hour to 24 hours
pg 1744
Most common intracranial hemorrhage?
a. Epidural
b. Subdural
c. Subarachnoid
b. Subdural
pg 1744-45
Blood🩸 mixing with the CSF causes meningeal irritation. What are two symptoms of this irritation?
Nuchal rigidity (neck)
Headache
pg. 1745
Where does CSF circulate?
a. Epidural Space
b. Subdural Space
c. Subarachnoid Space
c. Subarachnoid Space
pg. 1745
Blood🩸 mixing with the CSF causes meningeal irritation. What are two symptoms of this irritation?
Nuchal rigidity (neck)
Headache
pg. 1745
With head traumas, the ETCO2 should be maintained between _____ & _____ mm Hg unless signs of herniation are present, in which case it should be maintained between ____ & ____mm Hg.
35and 40
30 and 35
With head traumas, elevate the head of the stretcher or backboard about a ____ to ____ angle if possible to facilitate the drainage of CSF and venous blood from the cranial vault.
15° to 30°
Do patients with head trauma tend to go hypothermic or hyperpyrexia?
Hyperpyrexia
pg 1746
MAP = __________________
DBP + 1/3 (SBP − DBP)
pg. 1059
When the MAP exceeds __________ mm Hg, the pressure breaches the blood-brain barrier, and fluid leaks out, increasing intracranial pressure.
150 mm Hg
pg. 1059
