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A3-CORD curriculum > Closed Head Injuries > Flashcards

Closed Head Injuries Flashcards

1
Q

Why should care be taken not to over ventilate the closed head injury patient?

A

Low PaCO2 levels may cause excess cerebral vasoconstriction and resultant hypoxemia

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2
Q

What is the mean arterial BP goal in a closed head injury pt?

A

More than 80 mmHg

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3
Q

What is an uncal herniation? s/sx?

A
  • Herniation of the medial temporal lobe through the falx cerebelli
  • Fixed dilated pupil + contralateral motor paralysis
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4
Q

What is a cingulate (subfalcine) herniation?

A

-Herniation of the parietal lobe through the falx cerebri

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5
Q

What is a transcalvarial herniation?

A

Herniation of the brain through the calvari

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6
Q

What are the three major parts of the exam in patients with a closed head injury?

A
  • Neuro exam
  • Pupil exam
  • Level of consciousness
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7
Q

Lens shaped hematoma on brain CT = ?

A

Epidural

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8
Q

What artery is classically involved in an epidural hematoma?

A

Middle meningeal

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9
Q

Which brain bleed has a “lucid interval”?

A

Epidural

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10
Q

What classically causes an epidural hematoma?

A

Truama

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11
Q

What classically causes a subdural hematoma?

A

Whiplash like injury

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12
Q

What is the etiology of the bleeding for a subdural hematoma?

A

Rupture of the bridging veins

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13
Q

Which crosses suture lines: an epidural or subdural hematoma?

A

Subdural

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14
Q

Crescent shaped bleed on head CT = ?

A

Subdural

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15
Q

How can you tell the difference between an acute and chronic head bleed on CT?

A 
Acute = hyperdense
Chronic = hypodense
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16
Q

Why is an epidural hematoma more acute than a subdural?

A

Subdural is a venous bleed so slowly progresses, as opposed to the arterial bleed of an epidural hematoma

17
Q

Where is the bleeding from with subarachnoid bleeds?

A

Subarachnoid vessels

18
Q

What does the CT look like with a subarachnoid bleed?

A

Blood in the CSF

19
Q

How might a subarachnoid bleed present as opposed to the other types of head bleeds?

A

meningeal s/sx

20
Q

What is the etiology of diffuse axonal injury?

A

Shearing forces on axonal fibers of the white matter tract, such as from a MVC

21
Q

What is the classic CT description of diffuse axonal injury?

A

Punctate hemorrhages along the gray-white matter junction

22
Q

True or false: any skull fracture with overlying laceration is considered an open fracture, and requires IV abx

A

True

23
Q

What are the three components of the Cushing’s reflex?

A
  • HTN
  • Bradycardia
  • Respiratory irregularity
24
Q

What is a central transtentorial herniation? S/sx?

A
  • Midline lesions of the frontal or temporal lobes with downwards displacement of the brain through the tentorium
  • Bilateral pinpoint pupils, bilateral babinski, increased tone
25
Q

What is an upward transtentorial herniation? S/sx?

A
  • Posterior fossa lesions displaced upward

- pinpoint pupils + cushing’s reflex

26
Q

What is the GSC score of a concussion?

A

14-15

27
Q

What is second impact syndrome?

A

Rapid onset of cerebral edema and death

28
Q

What are the general indications to obtain a head CT in pts with head injury?

A
  • GSC less than 15
  • Neuro deficits
  • anticoagulation issue/meds
29
Q

What are the new orleans criteria for getting a head CT in trauma pts? (7)

A
  • GSC less than 15 2 hours after injury
  • Suspected open or depressed skull fracture
  • Basilar skull fracture
  • Vomiting more than once
  • Retrograde amnesia more than 30 minutes
  • Dangerous mechanism
  • Age over 65
30
Q

What defines a dangerous mechanism according to the New Orleans head CT criteria?

A

Obvious + fall from more than 3 feet or 5 stairs

31
Q

What is the stabilizing treatment for increased ICP?

A
  • Elevate head of bed
  • Hyperventilate
  • Mannitol
32
Q

Mannitol should only be used if the patient is not hypotensive. What can be used instead if they are hypotensive?

A

Hypertonic saline

33
Q

What is the goal PaCO2 with hyperventilation of a increased ICP pt?

A

30-35 mmHg

34
Q

What do pts who are asymptomatic after a head injury need to be discharged home safely?

A

Someone to observe them at home

35
Q

What needs to be done prior to intubating a pt with a head injury?

A

Neuro exam before paralyzing them

36
Q

Who should have low thresholds for head imaging?

A

Elderly and alcoholics

A3-CORD curriculum (23 decks)

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