face, head, neck, eye trauma

Question 1

SACLP DAP anatomy of the skull

Answer 1

Skin (epidermis/dermis
connective tissue (dense)
Aponeurosis
Loose connective tissue
Periostium (skull)
Dura mater (nondistensible)
Arachnoid villa
Pia Mater (contiguous with brain surface)

Question 2

Le fort fractures I, II, II

• exam
• management

Answer 2

Le Fort I- across the maxillae
Le Fort II- across the zygomatic, nasal ethmoid bone, orbit
Le Fort III- across the frontal bone, nasal ethmoid facial detachment

exam: grab upper teeth and shake
manage: airway, nothing in nose, delayed operating room

Question 3

Glasgow Coma Scale

Answer 3

Eye opening
4 spontaneous
3 to verbal command
2 to pain
1 no response

verbal response
5 oriented and converse
4 disoriented and converse
3 inappropriate words
2 incomprehensible sounds
1 no response

motor response
6 obeys verbal commands
5 localizes pain
4 withdraws from pain (flexion)
3 abnormal flexion in response to pain (decorticate)
2 extension in response to pain (decerebrate)
1 no response

Question 4

S&S of traumatic brain injury

-GCS indication of mild, mod, severe

Answer 4

-N/V
-irregular breathing patterns
-clear CSF or blood leaking from ears or nose
-unequal pupil size
-Altered mental status
GCS 15-13 mild, 12-9 mod, 8-3 svere
-paralysis or disability on one side of body
-seizures
-high blood pressure with slow pulse

Question 5

monro-kellie hypothesis and effects of cranial insult injury on the body

Answer 5

hypothesis: blood, brain, CSF
effects:
-cranial insult
-tissue edema
-compression of arteries
-decrease O2 with death of brain cells
-increase ICP with compression of brain stem and resp center
-increase ICP due to increase blood volume
-increase ICP
-decrease cerebral blood flow
-edema around necrotic tissue
-CO2 accumulates, vasodilation

Question 6

Focal, diffuse, primary vs. secondary in TBI

types of TBI

Answer 6

focal

• cerebral contusion
• epidural hematoma
• subdural hematoma
• intracerebral hemorrhage

diffuse

• concusion
• diffuse axonal injury

primary vs. secondary
-hypoxic-ischemic

Question 7

cerebral contusion

Answer 7

-capillary bleeding
-blunt head trauma
-coup vs. contrecoup
SS:
-confusion
-neuro changes personality, vision, speech

Question 8

epidural hematoma

Answer 8

• middle meningeal artery (blood btw dura and skull, btw sutures)
• loss of consciousness (LOC) followed by lucid interval
• hemiparesis (weakness) on opposite side of injury

Question 9

subdural hematoma

Answer 9

• shearing of bridgin veins btw brain and dura not btw sutures
• elderly pts
• slower progression to LOC
• hemiparesis on opposite side of injury

Question 10

intracerebral hematoma

Answer 10

• blood collects in brain
• may also enter ventricles
• signs/symptoms highly dependent on size and location

Question 11

concussion

Answer 11

• brief change in mental status
• CT scan normal
• may/not have LOC
• loss of concentration, disorientation
• retrograde & antegrade amnesia
• visual and sensory disturbances
• mood or personality changes

Question 12

diffuse axonal injury

Answer 12

• CT scan normal
• may see loss of grey-white junction
• rotational forces cause microscopic injury
• AMS

Question 13

management of decreased ICP

Answer 13

• head elevated
• control anxiety/pain
• hyperventilate

Question 14

three zones of neck trauma

Answer 14

I- shoulder to cricoid
II- from cricoid to under the chin
III- back of the neck from chin up

Question 15

possible damage of neck trauma

Answer 15

• primary concern is the airway
• consider C-spine (GSW)
• esophageal injury
• carotid artery/jugular vein
• brachial plexus