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Clinical Science > Head and Spinal Trauma > Flashcards

Head and Spinal Trauma Flashcards

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1
Q

Protective layers of the brain

A

Dura mater
Arachnoid mater
Pia mater

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2
Q

Cerebral perfusion pressure

A

determined by: MAP - ICP

when ICP increases, CPP decreases

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3
Q

MAP

A

= DP + 1/3PP

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4
Q

Pulse pressure

A

SBP-DBP

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5
Q

Cushing’s reflex

A

widening pulse pressure
bradycardia
hypertension

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6
Q

Cushing’s Triad

A

widening pulse pressure
bradycardia
irregular resp pattern

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7
Q

Skull fracture

A

ecchymosis, CSF leak, depressed skull, open vault

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8
Q

Diffuse Axonal Injury

A

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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9
Q

Concussion

A

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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10
Q

Signs and Symptoms of Concussion

A

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

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11
Q

Contusion

A

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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12
Q

Signs and Symptoms of Contusion

A

seizures, hemiparesis, aphasia, personality changes, LOC

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13
Q

Compression

A

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

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14
Q

Secondary Head injuries

A

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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15
Q

Causes of secondary head injuries

A

hypoxia
hypotension
hypoglycaemia
hyercapnia

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16
Q

Epidural/Extradural haemorrhage

A

haemorrhage in space between cranium and dura

caused by: low velocity blows to head, deceleration injuries

17
Q

Presentation of pts with epidural haemorrhage

A

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

18
Q

Subdural Haemorrhage

A

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

19
Q

Subarachnoid Haemorrhage

A

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

20
Q

Symptoms of subsrachnoid haemorrhage

A

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

21
Q

Intracerebral Haematoma

A

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

22
Q

Pre-Hospital Management

A 
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
23
Q

Spinal Cord Tumours

A

Benign or malignant

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

24
Q

Vertebral injury results from:

A

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

25
Q

Transverse Spinal Cord Damage

A

no info passed, total paralysis, total anaesthesia and analgesia

26
Q

Acute Central Cervical Cord Syndrome

A

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

27
Q

Brown Sequard Syndrome

A

Penetrating injury to one side of the spine

Ipsilateral paralysis

28
Q

Anterior Spinal Artery Syndrome

A

Artery supplies 2/3 of spinal cord

Reduced cord perfusion inferior to lesion

29
Q

Posterior Column Syndrome

A

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

30
Q

Spinal Cord Concussion

A

Temporary cessation of spinal cord function

Recovery in 48 hours

31
Q

Causes of Secondary Spinal Injury

A

Inappropriate manual handling, acute response to injury

32
Q

Mechanisms of injury

A

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

33
Q

Signs and Symptoms of spinal injury

A

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

34
Q

Neurogenic shock

A

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

35
Q

Neurogenic Shock pts should appear:

A

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

36
Q

Causes of Neurogenic Shock

A 
high spinal injury mid thoracic T5-* and above 
Insulin reactions
Depressive drugs and anaesthetics
Poisons
Severe emotional stress and pain
37
Q

Pre Hospital Management of Spinal Injury

A 
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

Clinical Science (13 decks)

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