Chapter 6 - Head Trauma

Question 1

what is the primary goal of treatment for patients with TBI

Answer 1

preventing secondary barin injury

Question 2

Should we perform CT scan prior to transfer?

Answer 2

No, CT scan should not delay transfer to centre where immediate ind definitive treatment can happen

Question 3

Are scalp lacerations serious

Answer 3

because of the generous blood supply to the scalp, lacs can result in major haemorrhage and death

Question 4

what are epidural haematomas

Answer 4

meningeal arteries lie in epidural space - between the dura and the internal surface of the skull. fractures and lacerations here can cause big arterial bleeds, most commonly the middle meningeal artery. These spread in a convex shape.

Question 5

what are subdural bleeds

Answer 5

the subdural space is a potential space between the dura and the arachnoid layers. bridging veins may tear causing subdural bleeds which extend in a convex fashion

Question 6

what are subarachnoid bleeds

Answer 6

occur under the waterproof arachnoid layer and the pia mater. Follows the contours of the brain on CT

Question 7

What is normal ICP

Answer 7

10mmHg

Question 8

What is the monroe-kellie doctrine of ICP dynamics

Answer 8

the total volume of intracranial contents must remain constant as the cranium is rigid. When normal intracranial volume is increased, ICP increases. Venous blood and CSF can be compressed out of the container providing a degree of buffering. Contents of the skull can become squashed and brain can herniate out of the foramen magnum

Question 9

what equation links ICP MAP and CPP

Answer 9

Cerebral perfusion pressure CPP is MAP - ICP

Question 10

How can we classify severity of head injury

Answer 10

using GCS
13 -15: mild
9 - 12: moderate
<8: severe

Question 11

What clinical signs indicate basal skull fracture

Answer 11

periorbtal ecchymosis
retroauricular ecchymosis
CSF leak from nose or ear
dysfunction of CN VII or NIII - facial paralysis and hearing loss

Question 12

what is concussion

Answer 12

transient loss of neurological function following a head injury

Question 13

what are indications for CT scan in patients with mild TBI

Answer 13

GCS <15 2 hours after injury 
suspected open or depressed skull fracture 
any sign of basilar skull fracture
vomiting >2x
age >65
anticoagulant use
loss of consciousness >5mins 
amnesia >30 mins before impact
dangerous mechanism

Question 14

what fluids should we use for resuscitation

Answer 14

normal saline or hartmanns

avoid hypotonic solutions and dextrose

Question 15

what drugs / fluids can we use to reduced ICP

Answer 15

mannitol
hypertonic saline
barbiturates (thiopentone)