Emergency war surgery ch 22 Flashcards
What are the three open scalp injuries?
Puncture
Laceration
Avulsion
Crainiocerebral injuries are classified according to their type and extent of injury to what three areas?
Scalp
Skull
Brain
What is a closed scalp injury?
Contusion
What are the three open skull injuries?
Depressed fracture
Comminuted fracture
Linear fracture
What is an open brain injury?
A penetrating injury
What are two closed brain injuries?
-Diffuse parenchymal injury
-focal interceanial hematomas
Extradural
Subdural
Intracerebral
What are the three types of focal intracranial hematomas?
Extradural
Subdural
Intracerebral
The brain can be protected from secondary injury by prompt recognition of such systemic events as what 5?
Hypoxia Hypotension Hypercarbia Hyponatremia Other forms of electrolyte imbalances
The cause of death after head injuries can be decided into what two phases?
Acute
Subacute
In the acute phase of brain injuries massive sympathetic and parasympathetic discharge give rise to what three events?
- Cardiac arrhythmias
- Low cardiac out put
- Respiratory difficulties due to ventilation/perfusion mismatches
Death in the subacute phase of a brain injury is usually due to what?
The enlargement of an intracranial mass in the form of a hematoma or parenchymal swelling
Consciousness can be described by what 4 states?
Awake/ aware
Lethargic
Stuporous
Comatose
The neurological condition may be expressed quantitatively with the use of what?
Glasgow Coma Scale
The GCS is determined in which numerical scores quantitate the best level of what three things response to standardized verbal and tactile stimuli?
Motor
Verbal
Eye opening
How is a coma defined using the GCS?
Absence of verbal response
Absence of eye opening
Motor response can vary from none to localized
A summary GCS of __ or less, 6 hours after injury in a patient with adequate BP and ventilation indicates severe brain injury.
7 or less
Progressive dilation of a pupil indicates what?
Expanding intracranial mass and transtentorial herniation
85% of the time occurs on side of the dilated pupil
When determining the GCS score how many points are given for a patient that obeys all motor commands?
6
When determining the GCS score how many points are given for a patient that localized pain?
5
When determining the GCS score how many points are given for a patient that withdraws from pain?
4
When determining the GCS score how many points are given for a patient with abnormal flexion?
3
When determining the GCS score how many points are given for a patient with extension?
2
When determining the GCS score how many points are given for a patient that has no motor response?
0
When determining the GCS score how many points are given for a patient who’s eyes open to verbal command?
3
When determining the GCS score how many points are given for a patient who’s eyes open spontaneously?
4
When determining the GCS score how many points are given for a patient who’s eyes open to pain?
2
When determining the GCS score how many points are given for a patient who’s eyes don’t open to response?
1
When determining the GCS score how many points are given for a patient who is oriented, conversing?
5
When determining the GCS score how many points are given for a patient who is disoriented, conversing?
4
When determining the GCS score how many points are given for a patient who are speaking inappropriate words?
3
When determining the GCS score how many points are given for a patient who are speaking incomprehensible sounds?
2
When determining the GCS score how many points are given for a patient who are speaking no response?
1
If menningitis is suspected after a trauma use what gauge needle to remove how many cc s of spinal fluid?
20-22 gauge
3-5cc s
Subtle change In what can be the first or even the only sign of impending intracranial disaster?
Change in neurological condition or state of consciousness
