Head and Spinal Trauma

Question 1

Protective layers of the brain

Answer 1

Dura mater
Arachnoid mater
Pia mater

Question 2

Cerebral perfusion pressure

Answer 2

determined by: MAP - ICP

when ICP increases, CPP decreases

Question 3

MAP

Answer 3

= DP + 1/3PP

Question 4

Pulse pressure

Answer 4

SBP-DBP

Question 5

Cushing’s reflex

Answer 5

widening pulse pressure
bradycardia
hypertension

Question 6

Cushing’s Triad

Answer 6

widening pulse pressure
bradycardia
irregular resp pattern

Question 7

Skull fracture

Answer 7

ecchymosis, CSF leak, depressed skull, open vault

Question 8

Diffuse Axonal Injury

Answer 8

shearing and rotational forces result in major structural and functional disturbances

mild: coma 6-12 hrs
mod: over 24 hrs
severe: brainstem injury, prolonged unconsciousness

Question 9

Concussion

Answer 9

subtle pulling, tugging or shearing of brain cells without causing obvious structural damage
effects: brief alteration of consciousness, LOC followed by periods of drowsiness, restlessness, and confusion, amnesia

Question 10

Signs and Symptoms of Concussion

Answer 10

headache, vomiting, combativeness, transient visual disturbances, defect in equilibrium and coordination

Question 11

Contusion

Answer 11

force applied to one sidde of head causing the brain to slam into the side of the skull and rupture blood vessels in pia mater, then rebound on other side of the skull

Question 12

Signs and Symptoms of Contusion

Answer 12

seizures, hemiparesis, aphasia, personality changes, LOC

Question 13

Compression

Answer 13

haemorrhage or oedema within the brain leads to structures being compressed or pressurized

Question 14

Secondary Head injuries

Answer 14

bruised brain leads to dilation of blood vessels, cerebral oedema - increase ICP, reduced CPP, O2 and glucose, increased arterial pressure and BP

Question 15

Causes of secondary head injuries

Answer 15

hypoxia
hypotension
hypoglycaemia
hyercapnia

Question 16

Epidural/Extradural haemorrhage

Answer 16

haemorrhage in space between cranium and dura

caused by: low velocity blows to head, deceleration injuries

Question 17

Presentation of pts with epidural haemorrhage

Answer 17

50% will have transient LOC, EDH enlarges and ICP increases, pt will develop a headache, contra-lateral hemiparesis, lethargy, reduced consciousness

Question 18

Subdural Haemorrhage

Answer 18

collection of blood between dura and surface of brain bleeding from torn bridging veins
classified based on time between injury and symptom presentation

Question 19

Subarachnoid Haemorrhage

Answer 19

intracranial bleeding into CSF resulting in bloody SCF and meningeal irriation
caused by: trauma, aneurysm, arteriovenous malformation

Question 20

Symptoms of subsrachnoid haemorrhage

Answer 20

sudden and severe headache, dull and throbbing, dizziness, neck stiffness, unequal pupils, vomiting, seizures, LOC

Question 21

Intracerebral Haematoma

Answer 21

collection of blood greater than 5ml somewhere in the brain
commonly frontal and temporal lobes
results from: multiple lacerations produced by penetrating head trauma, high velocity deceleration injury

Question 22

Pre-Hospital Management

Answer 22

aim to control airway, stabilise cardiovascular system, interupt ongoing cerebral injury, protection from further harm, transport 
History: 
5 - greater than 5 mins LOC
H - skull fracture
E - emesis more than once 
D - neuro deficit
S - seizure

Question 23

Spinal Cord Tumours

Answer 23

Benign or malignant

Presentation: acute onset, compressive syndrome, irritative syndrome, inflammation

Question 24

Vertebral injury results from:

Answer 24

hyperflexion, hyper extension, flexion rotation, vertebral compression, lateral flexion, distraction

Question 25

Transverse Spinal Cord Damage

Answer 25

no info passed, total paralysis, total anaesthesia and analgesia

Question 26

Acute Central Cervical Cord Syndrome

Answer 26

central part of spinal cord damaged while external remains intact Caused by hyperextension Motor and sensory function reduced in upper limbs

Question 27

Brown Sequard Syndrome

Answer 27

Penetrating injury to one side of the spine | Ipsilateral paralysis

Question 28

Anterior Spinal Artery Syndrome

Answer 28

Artery supplies 2/3 of spinal cord | Reduced cord perfusion inferior to lesion

Question 29

Posterior Column Syndrome

Answer 29

All motor and sensory functions preserved except proprioception - touch and temp

Question 30

Spinal Cord Concussion

Answer 30

Temporary cessation of spinal cord function | Recovery in 48 hours

Question 31

Causes of Secondary Spinal Injury

Answer 31

Inappropriate manual handling, acute response to injury

Question 32

Mechanisms of injury

Answer 32

major trauma, multiple injuries, high speed injuries, falls, sporting injuries, head injuries

Question 33

Signs and Symptoms of spinal injury

Answer 33

Neurological - spinal shock Non Neurological - Cardiovascular: systemic vasodilation, reduced PVR, neurogenic shock, bradycardia, priapism Resp system: poor cough response, poor smooth muscle tone, diaphragm paralysis, paradoxical breathing GI system: paralytic ileus, acute bladder distension Urinary system Thermoregulation: poikilothermic - can't vasoconstrict or shicer/sweat

Question 34

Neurogenic shock

Answer 34

Impairment of descending sympathetic pathways in spinal cord: reduced symp tone, widespread vasodilation, reduced PVR, parasympathetic dominance, compensatory vasoconstriction and tachycardia are not initiated leads to decompensation

Question 35

Neurogenic Shock pts should appear:

Answer 35

flaccid distal to suspected lesion, no compensatory tachycardia or pallor, sweating or vasoconstriction

Question 36

Causes of Neurogenic Shock

Answer 36

``` high spinal injury mid thoracic T5-* and above Insulin reactions Depressive drugs and anaesthetics Poisons Severe emotional stress and pain ```

Question 37

Pre Hospital Management of Spinal Injury

Answer 37

``` G- geriatric over 55 I - injury of distraction N - neuro deficit Q - questions history S - spinal tenderness U - unconscious B - bone disease D - drug/alcohol intoxication ```