Chapter 7, Head Trauma Flashcards
What does the mnemonic SCALP stand for?
Skin
Connective tissue
Aponeurosis
Loose areolar tissue
Pericranium
What does the mnemonic PAD stand for?
Pia mater
Arachnoid membrane
Dura mater
What are the 12 Cranial Nerves?
Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Vestibulocochlear
Glossopharyngeal
Vagus
Accessory
Hypoglossal
What conditions cause cerebral vasodilation?
What conditions cause cerebral vasoconstriction?
Hypotension, hypercarbia, and acidosis.
Hypertension, hypocarbia, and alkalosis.
What cerebral vessel changes occur win PaO2 is less than 50 mmHg?
Cerebral vasodilation and increased blood flow.
What is a normal ICP?
0-15 mmHg
What is the Monro-Kellie doctrine?
As the volume of one component of the cranial vault triad expands, the volume of one or both of the other components must decrease to maintain a constant ICP (Brain, Blood, CSF).
What is the threshold for treatment of increased ICP?
22 mmHg
(Normal: 0-15 mmHg)
What is the primary determinant of CBF?
CPP = MAP - ICP
Normal CPP: 60-80 mmHg
Normal MAP: ≥ 60 mmHg
What SBP should be maintained to support CBF?
SBP ≥ 100 mmHg; 50-69 years
SBP > 110 mmHg; 15-49 years, ≥ 70 years
What makes up the Cushing Triad?
Widening pulse pressure
Reflex bradycardia
Irregular, decreased respiratory effort
What is an essential component of the prehospital report?
Anticoagulation or antiplatelet medications
How is adequate oxygenation and ventilation maintained in the patient with head trauma?
SpO2 ≥ 95%
ETCO2 35-45 mmHg
What are the components of the GCS?
Best eye opening
Best verbal response
Best motor response
How are TBIs classified using the GCS score?
Mild 13-15
Moderate 9-12
Severe 3-8
What are three signs of a basilar skull fracture?
Periorbital ecchymoses (raccoon eyes); anterior fossa fracture
Mastoid process ecchymoses (battle sign); middle fossa fracture
Hemotympanum; temporal bone fracture
How can a tear in the dura mater be assessed during inspection?
Halo sign: a pink ring around red blood
Test for glucose: CSF high in glucose
How should the standard-distance Snellen chart be positioned?
20 ft from the patient.
What are normal intraocular pressure readings?
10-21 mmHg
Pressure > 21 mmHg requires ophthalmologist
Pressure > 30 mmHg requires rapid treatment
Why do epidural hematomas develop rapidly?
The source of bleeding is arterial (middle meningeal artery)
What type of posturing is associated with brain stem herniation and poor outcomes?
Extension
Why may diffuse injuries related to a TBI not be visible on CT?
Damage involves contusions or shearing and stretching of the axons, rather than a localized hematoma, contusion or laceration.
How long do changes in neurologic status last following mild TBI?
For a very brief period (LOC < 30 minutes).
When does postconcussive syndrome typically manifest?
Several days or months after the head trauma.
How should penetrating injuries be addressed when a protruding object is in place?
Leave in place and stabilize.
What are the types of skull fractures?
Linear skull fracture (nondisplaced fracture goes through the entire thickness of the skull)
Depressed skull fracture (pieces of the fractured bones extend below the surface of the skull)
Basilar skull fractures
What is the main concern with Le Fort fractures?
Problems with airway obstruction and bleeding.
What is the antidote for benzodiazepines?
Flumazenil
How is mannitol administered to control elevated ICP?
0.25 to 1g/kg rapidly over 5 min (20% solution)
