Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ATLS > Chapter 6- Head Trauma > Flashcards

Chapter 6- Head Trauma Flashcards

1
Q

should obtaining a CT scan in a head injury delay transfer to a trauma center?

A

No, patient should be transferred to a trauma center capable to definitive neurosurgical intervention as first priority

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Things to include in OCP of patient with TBI

A 
Age
MOI and time
BP and Oxygen saturation
GCS score, emphasis on motor response/ pupils
focal neuro deficits
associated injuries
results of CT scan 
treatment of HPOTN/ hypoxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what fossa houses the frontal lobe

A

anterior fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what fossa houses the temporal lobes

A

middle fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what fossa houses the lower brain stem and cerebellum

A

posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the three layers of the meninges

A

dura mater
arachnoid mater
pia mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

meningeal layer that adheres firmly to the internal surface of the skull

A

dura mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

layer that is firmly attached to teh brain

A

pia mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what fills the space between the arachnoid mater and pia mater

A

cerebrospinal fluid (CSF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what separates the hemispheres

A

falx cerebri

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

which side of the brain typically contains the language center

A

left hemisphere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

contained in the midbrain and upper pons, responsible for the state of alertness

A

reticular activating system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

where is the vital cardiorespiratory center

A

medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

this divides the intracranial cavity into the supratentorial and infratentorial compartments

A

tentorium cerebelli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what type of herniation may compress the oculomotor nerve which may lead to pupillary dilation (blown pupil)

A

temporal lobe herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

part of the brain that usually herniates through the tenorial notch

A

medial part of the temporal lube (uncus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

classic sign of uncal herniation

A

ipsilateral pupillary dilation and contralateral hemiparesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the normal ICp at resting state

A

10 mm Hg. Pressures >20 mm Hg are associated w/ poor outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

states that the total volume of the intracrnail contents must remain constant because the cranium is a rigid, nonexpansible container

A

monro-kellie doctrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CPP (cerebral perfusion pressure) =

A

MAP- ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What MAP is “autoregulated” to maintain constant cerebral blood flow

A

50-150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

GCS score associated w/ coma or severe brain injury

A

8 or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

GCS for a moderate brain injury

A

9-12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

GCS for minor brain injury

A

13-15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Max GCS score for eye opening

A

4 (spontaneous)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

eye GCS score for opening eyes to pain

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

eye GCS score for opening eye to speech

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

eye GCS score for no eye opening

A

1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Verbal GCS score for confused conversation

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Verbal GCS score for inappropriate words

A

3

31
Q

verbal GCS score for no speech

A

1

32
Q

verbal GCS score for incomprehensible sounds

A

2

33
Q

verbal GCS score for oriented

A

5

34
Q

motor GCS score for extension (Decerebrate)

A

2

35
Q

motor GCS score for localizes pain

A

5

36
Q

motor GCS score for flexion withdrawal to pain

A

4

37
Q

motors GCS for abnormal flexion (decorticate)

A

3

38
Q

Biconvex or leticular hematoma that push adherent dura away from inner table of the skull. Often in temporal region

A

Epidural hematoma

39
Q

are subdural or epidural hematomas more common

A

subdural

40
Q

where do the majority of cerebral contusions occur

A

frontal and temporal lobes

41
Q

why do patients with cerebral contusions need repeat CT scans w/i 24 hours

A

evolve to form an intracerebral hematoma and have a mass effect so they may need surgical evacuation

42
Q

History of disorientation, amnesia, or transient loss of consciousness.

A

minor brain injury (GCS 13-15)

43
Q

amnesia before the event

A

retrograde

44
Q

amnesia after the even

A

anterograde

45
Q

Whom should CT scan be obtained in with minor brain injury

A

open skull fracture, sign of basilar skull fracture, >2 episodes of vomiting, >65 years old, LOC > 5 minutes, retrograde amnesia for >30 minutes, severe HA, focal neuro deficit

46
Q

Are patients with a GCS of 9-12 discharge home?

A

No, they should be admitted to the ICU and ahve frequent repeat neuro checks and consider f/u CT in 24 hours

47
Q

One thing to especially monitor with moderate brain injury

A

airway/ breathing- can have hypoventilation. want to avoid hypercapnia. may need to intubate if they deteriorate

48
Q

patient is unable to follow simple commands

A

severe brain injury (GCS 3-8)

49
Q

priorities with severe brain injury

A

ABCDEs
once BP normal- GCS and pupillary rxn
Establish cause of HPOTN if not >100 (may need laparotomy- CT after this/ or Burr hole in OR)

50
Q

Can intracranial hemorrhage cause hemorrhagic shock?

A

No

51
Q

What should be done prior to sedating a patient with a brain injury

A

GCS score and pupillary exam

52
Q

What is a well known early sign of temporal lobe (uncal) herniation

A

dilation of the pupil and loss of pupillary response to light

53
Q

A shift of ___ mm or greater on head CT is often indicative of the need for surgery to evacuate the blood clot or contusion causing the shift

A

5 mm

54
Q

medical therapies for brain injuries

A

IV fluids, temporary hyperventilation, mannitol, hypertonic saline, barbiturates, anticonvulsants

55
Q

what type IV fluids should be used in a TBI

A

ringer’s lactate or normal saline

56
Q

what is the preferable level for PaCO2

A

35 mm Hg (low end of normal which is 35-45) a this promotes vasoconstriction

57
Q

how does hyperventilation help

A

will low ICP in a deteriorating patient with expanding intracranial hematoma until emergent craniotomy can be performed

58
Q

indications for administration of mannitol in a euvolemic patient

A

acute neuro deterioration (dilated pupil, hemiparesis, LOC)

59
Q

how much mannitol should be given

A

1g/kg bolus over 5 minutes then transport patient to CT or OR

60
Q

What is mannitol used for?

A

reduce elevated ICP

61
Q

why can’t mannitol be given to patients with hypotnesion

A

it doesn’t lower ICP w/ hypovolemia and is a potent osmotic diuretic

62
Q

Preferable agent to reduce ICP in a hypotensive patient

A

hypertonic saline

63
Q

used when need to reduce ICP when other methods are ineffective

A

barbiturates

64
Q

when should barbiturates not be used

A

presence of hypovolemia or hpotn

65
Q

why are barbiturates rarely used

A

lead to HPOTN
long 1/2 life
prolong time to brain death determination

66
Q

why should anticonvulsants only be used when necessary

A

may inhibit brain recovery

early anticonvulsant doesn’t change long term seizure outcome

67
Q

agents of choice in acute phase of seizures

A

phenytoin and fosphenytoin (Loading dose is 1 g phenytoin IV no faster than 50 mg/min)

68
Q

phenytoin maintence dose

A

100 mg/8 hours

69
Q

meds frequently used in addition to phenytoin until seizure stops

A

diazepam or lorazepam

70
Q

Do muscle relaxants (like succinylcholine or vecuronium) control seizures?

A

No, the only mask the tonic/ clonic aspect of them. try to control seizures before initiating these drugs

71
Q

What does CSF leakage with a scalp wound indiate

A

there is a dural tear

72
Q

tx for depressed skull fractures

A

operative elevation if depression is greater than the thickness of the adjacent skull

73
Q

Brain death

A

GCS=3
nonreactive pupils
absent oculocephaic, corneal, doll’s eyes, no gag reflex
no spontaneous ventilatory effort

74
Q

what are the C’s of increased density on head CT

A

contrast, clot, cellularity (tumor), calcification (pineal gland, choroid plexus)

ATLS (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions