Chapter 6 - HEAD trauma Flashcards
Meninges
3 layers <PAD></PAD>
Pia matter
Aracnoid membere
Dura matter
12 cranial nerves
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Olfactory nerve: Sense of smell.
Optic nerve: Ability to see.
Oculomotor nerve: Ability to move and blink your eyes.
Trochlear nerve: Ability to move your eyes up and down or back and forth.
Trigeminal nerve: Sensations in your face and cheeks, taste and jaw movements.
Abducens nerve: Ability to move your eyes.
Facial nerve: Facial expressions and sense of taste.
Auditory/vestibular nerve: Sense of hearing and balance.
Glossopharyngeal nerve: Ability to taste and swallow.
Vagus nerve: Digestion and heart rate.
Accessory nerve (or spinal accessory nerve): Shoulder and neck muscle movement.
Hypoglossal nerve: Ability to move your tongue.
Brain stem elements
Midbrain
Pons
Medulla oblongata
BBB
network of capillaries and cells surrounding the brain - act as a filter for the CNS
Controls exchange if oxygen, co2 and metabolites between the blood and the brain
TBI = cause this to become dysfunctional
Normal ICP
ICP normal = 0-15 mmHg
Sustained ICP > 20 mm HG is considered abnormal.
CPP (cerebral perfusion pressure)
Normal 60-100 mmHg
Acceptable = 50-70 mm Hg
This is the pressure gradient across the brain tissue, a measure of the adequacy of cerebral blood flow.
DETERMINED BY - difference between MAP and ICP
MAP
NORMAL 50-150 mmhg
SBP + 2 x SBP divided by 3
Goals of treatment for severe TBI
Sp02 > 95%
ICP < 15 mmHg
Serum sodium 135-145
Pa02 > 100 mmHg
Pbto2 (brain tissue oxygen tension) >15 mmhg
INR <1.4
Pac02 35-35
CPP > 60 mmHg
Platlets > 75 x 10
SBP > 100
Temp 36-38
HB >7 g/dl
Ph 7.35-7.45
Glucose 80-100 mg/dl
Four score elements
eye response
motor response
brain stem reflexes
respirartion
Signs of a basilar skill fracture
racoon eyes
battle sign (behind ear)
Intra ocular pressure
IOP is fairly stable. however, production of adequous humor exceeds the outflow in cases such as glaucoma or hyphema. IOP is increased.
NORMAL = 10 - 20 mm HG
ABNORMAL > 20 mmhg **Need opthal consult
OVER 30 mmHg = emergency
Selected head injury
when the head strikes a solid object the sudden decrease in force may result in a bony deformity and injury cracil contents.
CROUP = brain hits
Counter croup = brain hits back of skull
FOCAL BRAIN INJRUY
caused by lesions
cerebral conution
caused by blunt trauma, mostly between frontal and temporal lobes
EPI dural H
between dura and skull
Herniation syndrome
shifting of the brain tissue within displacement into another comrtment of the brain as a result of bleeding and odema
Eye injury - corneal
ASSESSMENT
photophobia
pain
redness
lid swelling
foreign body in the eye
TREATMENT
topical anesthesia
tropical ophthalmic
NSAID
Tropical AB
Remove foreign body
*NO EYE PATCH
FOLLOWUP
Opthal 24-48 hours
or consult
Eye injury - orbital fracture
ASSESSMENT
facial swelling
diplopia
enphathmous
ptosis
periorbital ecchymosis
TREATMENT
nasal decongestant
ice packs to orbit for 48 hours
oral AB
FOLLOW UP
large will need opthal
follow up in 1-2 weeks
avoid ; blowing nose, sneezing etc.
Eye injury - globe rupture
ASSESSMENT
irregular or teardrop shaped pupils
decreased visual activity
severe subconjunctival hemorrhage
deep eye pain
nausea
periorbital ecchymosis
TREATMENT
avoid pressure
apply shield
consider tetanus vaccine
NBM
Assess and treat pain
Antiemetics (stop IOP)
avoid drops
Use AB
FOLLOW UP
Emergency consult
prepare for CT and OT
Eye injury - retrobulbar hematoma
ASSESSMENT
severe pain
decreased vision or loss of vision
reduction in eye movement
diplopia
IOP > 40 mmHg
TREATMENT
meds to decrease IOP
Emergency decopression
FOLLOW UP
Emergency consult w opthal
Eye injury - ocular burns
ASSESSMENT
severe swelling of the sclera
conjunctival irritation
corneal clouding
TREATMENT
determine baseline ph
topical anesthesia
IMMEDIATE irrigation (then re-check ph) may require more then 2L
FOLLOW UP
Opthal consult
