Head and Spinal Trauma Flashcards by Sarah Ricciuti

Protective layers of the brain

Dura mater
Arachnoid mater
Pia mater

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Cerebral perfusion pressure

determined by: MAP - ICP

when ICP increases, CPP decreases

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MAP

= DP + 1/3PP

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Pulse pressure

SBP-DBP

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Cushing’s reflex

widening pulse pressure
bradycardia
hypertension

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Cushing’s Triad

widening pulse pressure
bradycardia
irregular resp pattern

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Skull fracture

ecchymosis, CSF leak, depressed skull, open vault

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Diffuse Axonal Injury

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

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Concussion

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

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Signs and Symptoms of Concussion

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

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Contusion

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

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Signs and Symptoms of Contusion

seizures, hemiparesis, aphasia, personality changes, LOC

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Compression

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

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Secondary Head injuries

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

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Causes of secondary head injuries

hypoxia
hypotension
hypoglycaemia
hyercapnia

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Epidural/Extradural haemorrhage

haemorrhage in space between cranium and dura

caused by: low velocity blows to head, deceleration injuries

Presentation of pts with epidural haemorrhage

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

Subdural Haemorrhage

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

Subarachnoid Haemorrhage

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

Symptoms of subsrachnoid haemorrhage

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

Intracerebral Haematoma

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

Pre-Hospital Management

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

Spinal Cord Tumours

Benign or malignant

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

Vertebral injury results from:

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

Transverse Spinal Cord Damage

no info passed, total paralysis, total anaesthesia and analgesia

Acute Central Cervical Cord Syndrome

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

Brown Sequard Syndrome

Penetrating injury to one side of the spine | Ipsilateral paralysis

Anterior Spinal Artery Syndrome

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

Posterior Column Syndrome

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

Spinal Cord Concussion

Temporary cessation of spinal cord function | Recovery in 48 hours

Causes of Secondary Spinal Injury

Inappropriate manual handling, acute response to injury

Mechanisms of injury

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

Signs and Symptoms of spinal injury

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

Neurogenic shock

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

Neurogenic Shock pts should appear:

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

Causes of Neurogenic Shock

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

Pre Hospital Management of Spinal Injury

``` 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 ```