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CATA 262 > Head and brain injuries > Flashcards

Head and brain injuries Flashcards

1
Q

What is a meninge?

A

Membranous covering of the brain & spinal cord

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2
Q

What are the 3 meninges?

A

1) Dura mater
2) Arachnoid mater
3) Pia mater

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3
Q

What are the meninges a common site of?

A
  • infection (meningitis)
  • intracranial bleeds
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4
Q

Describe the dura mater.

A
  • In: trigeminal n.
  • outermost layer
  • directly under skull
  • thick, tough, inextensible
  • highly vascularized (middle meningeal a.)
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5
Q

Describe the arachnoid mater.

A
  • middle
  • under dura mater
  • connective tissue
  • AVASCULAR
  • no innervation
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6
Q

Describe the Pia mater.

A
  • Very thing
  • covers brain
  • Highly vascularized
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7
Q

Where is the CSF contained?

A

Sub-arachnoid space (btwn arachnoid and pia mater)

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8
Q

What does CSF do?

A

Acts to cushion brain
(watery sac to support brain and absorb impact and shock)

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9
Q

What are some head/brain pathologies?

A
  • Scalp laceration
  • Skull fracture
  • Brain contusion
  • Intra-cranial bleed
  • concussion
  • second-impact syndrome
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10
Q

Scalp lacerations overview

A
  • looks worse than it is
  • significant blood loss
  • possible sutures necessary
  • possible hypovolemic shock
  • Blunt trauma
  • infection
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11
Q

Scalp laceration Tx

A
  • Gloves/PPE
  • Direct pressure
  • Non-adherent sterile gauze
  • compression dressing
  • referral for sutures (prn)
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12
Q

Skull fractures MOI and 3 types

A

MOI: direct blow
Types:
1- Hairline/Linear
2- Depressed
3- Basal (basilar skull)

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13
Q

Skull linear fracture description and occurrence

A
  • most common (>50% of cases)
  • thin line
  • simple fracture
  • non-fatal
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14
Q

S/S and LOC of Linear skull fracture

A

No S/S
no loss of consciousness

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15
Q

What is a depressed skull fracture?

A
  • bone gets crushed
  • part of bone gets displaced in direction of brain
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16
Q

Describe a basilar skull fracture

A
  • rarest form (extreme force)
  • disruption of bones in middle ear (deafness or CSF from nose/ears)
  • could be life-threatening (pushes on brainstem)
  • temporary or permanent disability
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17
Q

What is drainage from the ear called?

A

CSF otorrhea

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18
Q

What is the anatomical cause of CSF leak? What does it look like?

A
  • Hole of tear in dura mater
  • Clear watery drainage
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19
Q

What is drainage from the nose called?

A

CSF rhinorrhea

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20
Q

What are the causes of CSF leaks?

A
  • head injury
  • inc. pressure in brain
  • poorly functioning shunt
  • malformations of inner ear
21
Q

Tx and examination for Skull fracture

A
  • Gentle palpation
  • Battle’s sign: Mastoid process (behind ear)
  • Raccoon eyes: ecchymosis
  • CSF (eyes, ears, nose, salty/metallic taste)
22
Q

S/S skull fracture

A
  • Bleeding (skull, eyes, ears, nose)
  • CSF
  • Swelling +tenderness
  • Bruising eyes/ears
  • Changes in size of pupil
  • severe headache
  • nausea + comiting
  • deformity
  • incoherent speech + visual impairment
  • difficult balance/coordination
  • neck stiffness
  • irritable
  • photophobia and phonophobia
  • hypotension
  • drowsiness
  • impaired smell, taste, hearing
  • Loss of consciousness
  • convulsions
23
Q

What’s another way to say cerebral contusion

A

Contusio cerebri

24
Q

Describe a cerebral contusion

A
  • Fairly common
  • More severe than a concussion
  • Structural damage to brain
  • Bleeding + swelling
  • Increased pressure on brain (ICP)
25
Q

What are the different lengths of effects of a cerebral contusion (3)

A

1- Short lasting
2- Long lasting
3- Permanent

26
Q

What is the frontal lobe for?

A
  • movement
  • impulses
  • spoken language
  • personality
27
Q

What is the Temporal lobe for?

A
  • written words
  • hearing
  • memory
28
Q

In which lobes to cerebral contusions mostly occur?

A

Frontal and temporal lobes

29
Q

What should you look for in the eyes after a cerebral contusion?

A

Petechial hemorrhage

30
Q

What is intracranial bleeding (hematomas)

A

Inc. pressure on brain in a confined space

31
Q

What are the 3 types of intracranial hematomas?

A

1- Epidural hematoma
2- Subdural hematoma
3- Intracerebral hematoma

32
Q

Describe an epidural hematoma.

A
  • Life threatening epidural bleeding
  • Fast developing
  • btwn dura mater and periosteum
  • secondary complication of Traumatic brain injury (TBI)
33
Q

What is the typical MOI of a an epidural hematoma

A
  • Laceration to middle meningeal a.
  • With skull fracture
  • high velocity blow to temple
34
Q

Epidural hematoma is a complication to look out for after a

A

concussion

35
Q

S/S of an epidural hematoma are similar to a

A

concussion

36
Q

What is the LOC for epidural hematoma?

A

Lucid period and then rapid decline in LOC as bleeding causes pressure in brain and brainstem
“talk and die”

37
Q

Describe subdural hematoma

A
  • most common that requires surgery
  • outside brain
  • btwn dura mater and arachnoid
  • usually change in LOC
  • Slow developing (within 24hrs)
38
Q

Describe an intracerebral hematoma (contusion to the brain)

A

Arterial bleed: fast developing
Venous bleed: slow developing
- Bleeding within brain tissue (intraparenchymal hemorrage)

39
Q

What is the MOI of an intracerebral hematoma?

A
  • skull fracture, other hematoma
  • high BP, bleeding disorders, thinning blood meds
40
Q

What is intracranial pressure (ICP)

A

Pressure exerted by the brain tissue, intracranial blood, and CSF

41
Q

What is the normal ICP

A

0-15mmHg

42
Q

What are the S/S of ICP

A
  • Dec. LOC
  • Inc. pressure feeling on skull
  • inc. BP (systolic)
  • Dec. HR (via vagus n. and PNS)
  • motor dysfunctions
  • impaired reflexes
  • pupillary abnormalities (PERRLA)
  • irregular respirations (Cheyne-Stokes)
43
Q

What is Chyne-stokes ventilation pattern

A

Slow shall breaths, then deeper more rapid, then return to slow
- periods of apnea

44
Q

The symptoms for ICP are the opposite of the symptoms for

A

shock

45
Q

What are the pupillary signs of early increasing ICP

A
  • sluggish to light response
  • unilateral
  • ipsilateral (same side) to lesion
  • papilledema or bulging of optic discs
  • blurred vision
46
Q

What follows and inc. in ICP

A
  • cerebral perfusion pressure dec.
  • leads to cerebral ischemia and hypoxia
47
Q

What are the abnormal postures in late signs of increasing ICP

A

Decorticate posturing: abnormal flexion
Decerebrate posturing: abnormal extension

48
Q

How do you decrease pressure on the brain?

A

Burr hole

CATA 262 (10 decks)

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