Disorders of Trauma Flashcards
What is ICP
fluid at rest as measured in the brain
contents of the skull (3)
brain and vascular tissue
CSF (cerebral spinal fluid)
what is normal ICP amount
0-15 mm Hg
what is normal ICP influenced by
changes in arterial and venous pressure, posture, temp, blood gases (esp. CO2)
where can you measure ICP
ventricles, subdural space, epidural space, and the brain tissue itself
what are the 3 cranial contents
brain
cerebral spinal fluid
blood
what is the Monroe-Kellie hypothesis
any increase in 1 of the cranial contents results in IICP
what is dynamic equilibrium
everything in the brain stays the same
when can the brain expand
in infancy - suture lines aren’t’ sealed yet (hydrocephalus)
skull fractures - herniation through fracture line
where is CSF displaced to in ICP?
the spinal cord
Compensatory mechanisms of CSF
vasoconstriction - decreases pressure
CSF shunted to spinal cord
brain slows down CSF production - expands
what % of body’s oxygen is used by the brain
20
what % of body’s glucose is used by the brain
25
the brain HAS TO HAVE these 2 things
oxygen and glucose
the blood flow to our brain is maintained by
auto regulation
what does auto regulation do
adjusts cerebral blood vessels to maintain constant blood flow during changes in arterial BP
what do vessels in the brain do when a pt. is hypotensive
dilate - to increase pressure (auto-regulation)
what do vessels in the brain do when a pt. is hypertensive
constrict - to decrease pressure (auto-regulation)
when does auto regulation not work
If MAP 150 mm Hg
what s/s will we see in pt. whose oxy. level drops
**altered LOC (most sensitive indicator)
what is a late sign of ICP
**Cushing’s Triad
what is Cushing’s Triad
widening pulse pressure
Brady w/full and bounding pulse
change in resp.
which vital sign is most indicative of ICP
widening pulse pressure, bradycardia
what other factors in our body affect CBF (cerebral blood flow)
CO2 - it dilates the vessels
high co2 - dilate vessels
low co2 - constriction of vessels (decrease ICP)
oxygen
causes vessels to dilate to get oxygen to the brain
what causes IICP
mass lesions - hematoma, abscess, tumor, hemorrhage
metabolic insult - lead/arsenic intoxication, uremia
2 major problems of ICP
inadequate cerebral perfusion
cerebral herniation
what population(s) have head injuries
children
geriatrics
adolescents (male)
types of head injuries
scalp lacerations - bleed profusely
skull fractures
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)
what is the worst type of skull fracture
compound
how do we test drainage from nose we suspect as CSF
glucose test tape to see if sugar is in it
blood causes false +
the location of the fracture alters the presentation of the manifestations, t or f
true
damage to the frontal lobe you will see changes in
executive function
damage to the occipital lobe you will see changes in
vision
a basilar skull fracture is where
back of the head - hard hit to break bone
CSF leaking from the nose is called
rhinorrhea
typically in a basilar skull fracture you have a tear in the
Dura and leak CSF (through nose, ear)
when CSF leaks from nose or ear it increases risk of
infection
which assessment finding is most indicative of ICP in a pt. admitted with a basilar skull fracture
papilledema
2 ways to classify a brain injury
diffuse or generalized (can’t localize to certain area of brain)
OR
focal or localized (mass lesion)
classifying a brain injury w/GCS
minor (13-15)
moderate (9-12)
severe (3-8)
when does post concussion syndrome occur
2 weeks to 2 months after injury
what is the most important thing in concussions to have a full return to normal
rest - no tv
a contusion can also be referred to as
coup contracoup
do you have to have an impact to sustain coup contracoup
no (shaken baby, seat belt restraint prevents impact)
if you are on this medicine and sustain coup contracoup it is a death sentence
coumadin - difficult to stop brain bleed
contusions are usually closed head injuries, t or f
true
classification for contusions on GCS
8 or lower
what happens to the brain tissue in lacerations
tearing
lacerations typically occur with these type of fractures
depressed/open fractures
can we surgically repair lacerations
no - sutures would create more damage
lg intracerebral lacerations have very poor outcomes, t or f
true
diffuse axonal injury are considered general injuries to the brain, t or f
true - theory is axons are sheared
lg intracerebral lacerations have very poor outcomes, t or f
true
what part of the brain is not working in a vegetative state
frontal lobe (executive fxn, speech, recognition)
majority of pt w/diffuse axonal injury are in a veg state, t or f
true - most don’t recover
what part of the brain is not working in a vegetative state
frontal lobe exectuive fxn
majority of pt w/diffuse axonal injury are in a veg state, t or f
true
what happens in a epidural hematoma
bleeding between dura and inner surface of the skull
**an epidural hematoma is an emergent condition, t or f
true
what will we do for pt w/epidural hematoma
cat scan - prepare for OR
most life threatening head injury
epidural hematoma - bleeding wont stop w/o surgical intervention
what will we do for pt w/epidural hematoma
prepare for surgery
most life threatening head injury
epidural hematoma - bleeding wont stop w/o surgical intervention
s/s of a acute subdural hematoma occur within the first
24-48 hrs LOC
what vessel bleeds in a subdural hematoma
venous bleed - mostly
population with chronic subdural hematomas
elderly - brain shrinks=more space between brain/skull
alcoholics
3 types of subdural hematomas
acute
sub-acute
chronic
population with chronic subdural hematomas
elderly - brain shrinks more space between brain/skull
s/s of chronic hematoma
forgetful
weird feeling in arm
confusion
somnolent (sleepy)
what kind of lesion is an intracerebral hematoma
mass lesion
dx of intracerebral hematoma
CT scan for rapid results
cervical spine x-ray
s/s of intracerebral hematoma
ICP (stroke, trauma, aneurysm)
after CT scan, assess pt for
urine passage - allergic reaction - encourage fluids
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
how many chest x-rays are in a CT scan
about 20 - cancer causing
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
spinal cord ends between which 2 vertebrae
1 and 2
*ascending spinal cord track does what
sensory - carry info to the brain - pain/temp/body position
spinal cord ends between
1 and 2
upper motor neurons never leave the
CNS
lower motor neurons go to the
skeletal muscles
what do lower motor neurons do
goes out to skeletal muscles
s/s of upper motor neurons
spasticity/hyper-reflexia
s/s of lower motor neurons
hyporeflexia/flaccidity
reflexes are wired in the
CNS
reflexes are wired in the
CNS
tough layer around spinal cord
dura
spinal cord is rarely transected, t or f
true
primary spinal cord injury is
what happened
secondary injury of the spinal cord is
what damage after the injury - progressive
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
spinal shock is life threatening, t or f
false - experienced by half of those with acute spinal cord injury
s/s of spinal shock
temp loss of reflexes, sensations
flaccid paralysis below injury
how long does spinal shock last?
days - months (temporary) - may return w/hyper-reflexia (erection,etc)
what happens in neurogenic shock
unopposed parasympathetic stimulation
massive vasodilation
sympathetic impulses don’t counteract it
s/s of neurogenic shock
hypo-tension and bradycardia - can have hypothermia
neurogenic shock can be life-threatening, t or f
true
how would you differentiate neurogenic shock from hypovolemic shock
hypovolemic shock = hypotensive/tachycardia
neurogenic shock = hypotensive/bradycardia
classification of SCI
mechanism of injury - how did it occur
skeletal level of injury -
neurological level of injury
completeness or degree of injury
which classification of SCI is the most unstable injury
flexion-rotation (Christopher reeve)
when a spinal cord injury comes into the ER, Dr will do a rectal exam, why?
muscle tone - sphincter
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)
thoracic or lumbar SCI pt will present with
paraplegic
cervical SCI pt will present with
tetraplegic or quadriplegic
paralysis of all 4 extremities occurs when
cervical cord is involved
most SCI occur in what part of the spine
cervical and lumbar (most flexible part of spine)
SCI degree of involvement (2)
incomplete/partial - some motor sensory going on
complete cord involvement - no motor/sensory below injury
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)
if cauda equina syndrome is left untreated what can happen
perm damage to bowel/bladder
what happens in autonomic dysreflexia (autonomic hyper-reflexia)
uncompensated sympathetic stimulating body
parasympathetic cant respond
autonomic dysreflexia occurs with this type of SCI
SCI T6 or higher
wont occur during spinal shock - recovered
visceral stimulation
s/s of autonomic dysreflexia
excruciating headache
hypertensive
most common precipitating factor of autonomic dysreflexia
distended bladder
second most factor distended rectum (impaction)
second most common precipitating factor of autonomic dysreflexia
distended rectum (impaction)
what should we use when doing rectal exam or placing Foley in autonomic dysreflexia
lidocaine
pt with t6 injury 6 months ago develops facial flushing hypertension
elevate HOB - relieve pressure
assess for distended bladder
give BP med
what change in VS would the nurse note specific in neurogenic shock
bradycardia
BP 80/60, pulse 120, resp rate 30 theses findings are most likely associated with what?
hypovolemic
