Disorders of Trauma Flashcards
(120 cards)
1
Q
What is ICP
A
fluid at rest as measured in the brain
2
Q
contents of the skull (3)
A
brain and vascular tissue
CSF (cerebral spinal fluid)
3
Q
what is normal ICP amount
A
0-15 mm Hg
4
Q
what is normal ICP influenced by
A
changes in arterial and venous pressure, posture, temp, blood gases (esp. CO2)
5
Q
where can you measure ICP
A
ventricles, subdural space, epidural space, and the brain tissue itself
6
Q
what are the 3 cranial contents
A
brain
cerebral spinal fluid
blood
7
Q
what is the Monroe-Kellie hypothesis
A
any increase in 1 of the cranial contents results in IICP
8
Q
what is dynamic equilibrium
A
everything in the brain stays the same
9
Q
when can the brain expand
A
in infancy - suture lines aren’t’ sealed yet (hydrocephalus)
skull fractures - herniation through fracture line
10
Q
where is CSF displaced to in ICP?
A
the spinal cord
11
Q
Compensatory mechanisms of CSF
A
vasoconstriction - decreases pressure
CSF shunted to spinal cord
brain slows down CSF production - expands
12
Q
what % of body’s oxygen is used by the brain
A
20
13
Q
what % of body’s glucose is used by the brain
A
25
14
Q
the brain HAS TO HAVE these 2 things
A
oxygen and glucose
15
Q
the blood flow to our brain is maintained by
A
auto regulation
16
Q
what does auto regulation do
A
adjusts cerebral blood vessels to maintain constant blood flow during changes in arterial BP
17
Q
what do vessels in the brain do when a pt. is hypotensive
A
dilate - to increase pressure (auto-regulation)
18
Q
what do vessels in the brain do when a pt. is hypertensive
A
constrict - to decrease pressure (auto-regulation)
19
Q
when does auto regulation not work
A
If MAP 150 mm Hg
20
Q
what s/s will we see in pt. whose oxy. level drops
A
**altered LOC (most sensitive indicator)
21
Q
what is a late sign of ICP
A
**Cushing’s Triad
22
Q
what is Cushing’s Triad
A
widening pulse pressure
Brady w/full and bounding pulse
change in resp.
23
Q
which vital sign is most indicative of ICP
A
widening pulse pressure, bradycardia
24
Q
what other factors in our body affect CBF (cerebral blood flow)
A
CO2 - it dilates the vessels
high co2 - dilate vessels
low co2 - constriction of vessels (decrease ICP)
25
oxygen
causes vessels to dilate to get oxygen to the brain
26
what causes IICP
mass lesions - hematoma, abscess, tumor, hemorrhage
| metabolic insult - lead/arsenic intoxication, uremia
27
2 major problems of ICP
inadequate cerebral perfusion
| cerebral herniation
28
what population(s) have head injuries
children
geriatrics
adolescents (male)
29
types of head injuries
scalp lacerations - bleed profusely
| skull fractures
30
questions to ask w/skull fractures
open or closed
linear (along line of bone) or depressed (dented in)
simple (no fragments), comminuted (lots of pieces of bone), or compound (communicating down to intracranial cavity)
31
what is the worst type of skull fracture
compound
32
how do we test drainage from nose we suspect as CSF
glucose test tape to see if sugar is in it
| blood causes false +
33
the location of the fracture alters the presentation of the manifestations, t or f
true
34
damage to the frontal lobe you will see changes in
executive function
35
damage to the occipital lobe you will see changes in
vision
36
a basilar skull fracture is where
back of the head - hard hit to break bone
37
CSF leaking from the nose is called
rhinorrhea
38
typically in a basilar skull fracture you have a tear in the
Dura and leak CSF (through nose, ear)
39
when CSF leaks from nose or ear it increases risk of
infection
40
which assessment finding is most indicative of ICP in a pt. admitted with a basilar skull fracture
papilledema
41
2 ways to classify a brain injury
diffuse or generalized (can't localize to certain area of brain)
OR
focal or localized (mass lesion)
42
classifying a brain injury w/GCS
minor (13-15)
moderate (9-12)
severe (3-8)
43
when does post concussion syndrome occur
2 weeks to 2 months after injury
44
what is the most important thing in concussions to have a full return to normal
rest - no tv
45
a contusion can also be referred to as
coup contracoup
46
do you have to have an impact to sustain coup contracoup
no (shaken baby, seat belt restraint prevents impact)
47
if you are on this medicine and sustain coup contracoup it is a death sentence
coumadin - difficult to stop brain bleed
48
contusions are usually closed head injuries, t or f
true
49
classification for contusions on GCS
8 or lower
50
what happens to the brain tissue in lacerations
tearing
51
lacerations typically occur with these type of fractures
depressed/open fractures
52
can we surgically repair lacerations
no - sutures would create more damage
53
lg intracerebral lacerations have very poor outcomes, t or f
true
54
diffuse axonal injury are considered general injuries to the brain, t or f
true - theory is axons are sheared
55
lg intracerebral lacerations have very poor outcomes, t or f
true
56
what part of the brain is not working in a vegetative state
frontal lobe (executive fxn, speech, recognition)
57
majority of pt w/diffuse axonal injury are in a veg state, t or f
true - most don't recover
58
what part of the brain is not working in a vegetative state
frontal lobe exectuive fxn
59
majority of pt w/diffuse axonal injury are in a veg state, t or f
true
60
what happens in a epidural hematoma
bleeding between dura and inner surface of the skull
61
**an epidural hematoma is an emergent condition, t or f
true
62
what will we do for pt w/epidural hematoma
cat scan - prepare for OR
63
most life threatening head injury
epidural hematoma - bleeding wont stop w/o surgical intervention
64
what will we do for pt w/epidural hematoma
prepare for surgery
65
most life threatening head injury
epidural hematoma - bleeding wont stop w/o surgical intervention
66
s/s of a acute subdural hematoma occur within the first
24-48 hrs LOC
67
what vessel bleeds in a subdural hematoma
venous bleed - mostly
68
population with chronic subdural hematomas
elderly - brain shrinks=more space between brain/skull
| alcoholics
69
3 types of subdural hematomas
acute
sub-acute
chronic
70
population with chronic subdural hematomas
elderly - brain shrinks more space between brain/skull
71
s/s of chronic hematoma
forgetful
weird feeling in arm
confusion
somnolent (sleepy)
72
what kind of lesion is an intracerebral hematoma
mass lesion
73
dx of intracerebral hematoma
CT scan for rapid results
| cervical spine x-ray
74
s/s of intracerebral hematoma
ICP (stroke, trauma, aneurysm)
75
after CT scan, assess pt for
urine passage - allergic reaction - encourage fluids
76
what are emergency nurse actions for pt with head injury after a fall from a 3rd floor roof
stabilize c-spine
assess airway
assess respiration
77
how many chest x-rays are in a CT scan
about 20 - cancer causing
78
what are emergency nurse actions for pt with head injury after a fall from a 3rd floor roof
stabilize c-spine
assess airway
assess respiration
79
spinal cord ends between which 2 vertebrae
1 and 2
80
*ascending spinal cord track does what
sensory - carry info to the brain - pain/temp/body position
81
spinal cord ends between
1 and 2
82
upper motor neurons never leave the
CNS
83
lower motor neurons go to the
skeletal muscles
84
what do lower motor neurons do
goes out to skeletal muscles
85
s/s of upper motor neurons
spasticity/hyper-reflexia
86
s/s of lower motor neurons
hyporeflexia/flaccidity
87
reflexes are wired in the
CNS
88
reflexes are wired in the
CNS
89
tough layer around spinal cord
dura
90
spinal cord is rarely transected, t or f
true
91
primary spinal cord injury is
what happened
92
secondary injury of the spinal cord is
what damage after the injury - progressive
93
events occurring in spinal cord injury/prognosis
*injury
edema - compressed cord = decreased blood flow (within 24hrs perm damage occurs)
above and below injury there is ischemic damage
prognosis cant be determined for 72 hours
94
spinal shock is life threatening, t or f
false - experienced by half of those with acute spinal cord injury
95
s/s of spinal shock
temp loss of reflexes, sensations
| flaccid paralysis below injury
96
how long does spinal shock last?
days - months (temporary) - may return w/hyper-reflexia (erection,etc)
97
what happens in neurogenic shock
unopposed parasympathetic stimulation
massive vasodilation
sympathetic impulses don't counteract it
98
s/s of neurogenic shock
hypo-tension and bradycardia - can have hypothermia
99
neurogenic shock can be life-threatening, t or f
true
100
how would you differentiate neurogenic shock from hypovolemic shock
hypovolemic shock = hypotensive/tachycardia
| neurogenic shock = hypotensive/bradycardia
101
classification of SCI
mechanism of injury - how did it occur
skeletal level of injury -
neurological level of injury
completeness or degree of injury
102
which classification of SCI is the most unstable injury
flexion-rotation (Christopher reeve)
103
when a spinal cord injury comes into the ER, Dr will do a rectal exam, why?
muscle tone - sphincter
104
where is the level of the injury in SCI- 2 different ways
skeletal level- bone - which vertebrae has damage
| neurological level - function- lowest level w/norm sensory and motor (full or partial)
105
thoracic or lumbar SCI pt will present with
paraplegic
106
cervical SCI pt will present with
tetraplegic or quadriplegic
107
paralysis of all 4 extremities occurs when
cervical cord is involved
108
most SCI occur in what part of the spine
cervical and lumbar (most flexible part of spine)
109
SCI degree of involvement (2)
incomplete/partial - some motor sensory going on
| complete cord involvement - no motor/sensory below injury
110
in cauda equina (spinal nerves coming off end of spine) syndrome what 2 questions do you want to ask the pt.
do you have any numbness or tingling
do you have any loss of bowel/bladder
if so pt. needs work-up (imaging)
111
if cauda equina syndrome is left untreated what can happen
perm damage to bowel/bladder
112
what happens in autonomic dysreflexia (autonomic hyper-reflexia)
uncompensated sympathetic stimulating body
| parasympathetic cant respond
113
autonomic dysreflexia occurs with this type of SCI
SCI T6 or higher
wont occur during spinal shock - recovered
visceral stimulation
114
s/s of autonomic dysreflexia
excruciating headache
| hypertensive
115
most common precipitating factor of autonomic dysreflexia
distended bladder
| second most factor distended rectum (impaction)
116
second most common precipitating factor of autonomic dysreflexia
distended rectum (impaction)
117
what should we use when doing rectal exam or placing Foley in autonomic dysreflexia
lidocaine
118
pt with t6 injury 6 months ago develops facial flushing hypertension
elevate HOB - relieve pressure
assess for distended bladder
give BP med
119
what change in VS would the nurse note specific in neurogenic shock
bradycardia
120
BP 80/60, pulse 120, resp rate 30 theses findings are most likely associated with what?
hypovolemic
