Closed Head Trauma Flashcards
What are important to check with the scalp in closed head trauma
stepoff
crepitus
What are components of ICP
80% brain
20% CSF & blood
What is Cerebral blood flow affected by
Hypercapnia (retaining CO2) cerebral vasodilation
Hypocapnia (loosing CO2) cerebral vasoconstriction
Hypoxia (loosing O2) cerebral vasodilation
What is CPP
Mean arterial BP (systolic+2xdiastolic/3) - ICP
CPP 45-160 mmHg
Transtentorial Herniation summary
aka uncal
Def:
rise in ICP cause uncus (temporal lobe portion) through tentorium opening
SS: compresses CN III and corticospinal (motor) tract ipsilateral fixed, dilated pupil contralateral weakness of arm/leg deteriorating LOC
Concussion summary
Def: Transient LOC or alteration conciousness SS: Duration secs to hours Post-concussive syndrome SS - HA - memory - anxiety - insomnia - dizziness
Diffuse Axonal Injury summary
Def: tearing/shearing of nerve fibers (axons) at time of impact
Eval:
CT normal despite neurological deficit
Manifestations: prolonged, possibly permanent coma
Skull fractures gen char
Linear nondepressed - no treatment Depressed - open or closed - feel for crepitus/stepoff - surgery/abx
Basilar skull fracture gen char
Def: across base temporal bone SS: hemotypanum raccoon's eyes battle's sign CSF rhinorrhea/otorrhea Txt: Observe
Cerebral Contusion summary
Def: focal hemorrhagic area on brain surrounded by edema
SS:
occur on side of impact or contrecoup lesion
Eval:
CT white areas
Intracerebral Hemorrhage summary
aka parenchymal hemorrhage
Def: torn blood vessels
Cause: usually continuation from contusion
What is cushing’s reflex
hypertension and bradycardia in head injury pt
Evals for Closed Head injuries
C-spine
CT
Severe head injury mgmt
ABC c-spine immobilize intubate/hyperventilate elevate head of bed to 30 degrees correct hypotension CT neurosurgical evacuation?
Mild/moderate head injury mgmt
observe admit: - LOC - focal neuro deficit - seizures - unreliable pt
