Chapter 8: Head Trauma Flashcards
Leading cause of TBI in the elderly population
Falls
Which cranial nerve controls pupillary constriction and provides an important tool in the assessment of a patient with a brain injury
CN III
The oculomotor nerve
Cerebral blood flow is maintained by what two things
- An adequate cerebral perfusion pressure
2. Autoregulation
CPP (Cerebral perfusion pressure)=
MAP-ICP
Normal CPP
70 to 80 mmHg
The most important factor for the brain is
Cerebral blood flow
Adequate CPP is
60-70 mmHg
SBP greater than ___ is desirable for neurologically injured patients
90
Primary focus in the management of TBI is to identify and limit or stop
Secondary injury mechanisms
Primary brain injury
Direct trauma to the brain and associated vascular injuries that occur at the time of the original insult
Ongoing injury processes that are set in motion by the primary brain injury
Secondary brain injury
Hematoma, Hypoxia, Hypotension
The process of forcing the posterior fossa contents into the foramen magnum is referred to as
Coning
Shallow breaths that become deeper and more rapid and then return to slow shallow breaths
Cheyene- Stokes ventilations
Consistently rapid, deep breaths
Central neurogenic hyperventilation
Erratic ventilatory efforts that lack any discernible pattern
Ataxic breathing
Cushing’s phenomenon
Increases BP
Decreases HR
Intracranial causes of secondary injury
- Mass affect and herniation (most often)
- Cerebral Edema
- Intracerebral hematomas
- Intracranial hypertension
- Ischemia
Leading cause of TBI in those under 65 years of age
MVA
Extracranial causes
- Hypotension
- Hypoxia
- Anemia
- Hypoglycemia and hyperglycemia
- Hypocapnia and hypercapnia
- Seizures
2 most significant predictors of poor outcome from TBI
- Amount of time spent with an ICP greater than 20
2. Amount of time spent with SBP less than 90
Maintain an SP02 above ___ in brain injured patients
Above 90%
95% is optimal
When examining the pupils, a difference of greater than ___ is considered abnormal
1 mm in pupil size
Patients whose GCS deteriorates by more than ____ points during transport are at particularly high risk for ongoing pathological process
More than 2 points
Most common facial bone fracture
Nasal bone
The second most common type of facial fracture
Mandibular fractures
Le Fort I fracture
Horizontal detachment of the maxilla from the nasal floor
Le Fort II fracture
Pyramidal fracture
Includes the right and left maxilla, the medial portion of the orbital floor, and nasal bones
Le Fort III
Involves facial bones being fractured off the skull
Craniofacial disjunction
Endotracheal intubation is generally contraindicated in the presence of a
Laryngeal injury
The hallmark of a concussion
Post Traumatic amnesia
All patients with a severe TBI should be considered for intubation. What GCS parameters requires intubation ?
GCS less than or equal to 8
Normal ventilatory rate should be used when assisting ventilation in patients with TBI
___/min for adults
___/min for children
___/min for infants
10/min for adults
20/min for children
25/min for infants
Warning signs of increased ICP and herniation
- Decline in GCS score of two points or more
- Sluggish or nonreactive pupil
- Hemiplegia or Hemiparesis
- Cushing’s phenomenon
Controlled therapeutic hyperventilation may be considered for obvious signs of herniation. Ventilatory rates of ___ should be used
___/min for adults
___/min for children
___/min for infants
20/min for adults
30/min for children
35/min for infants
