Head and Spinal Trauma Flashcards
Protective layers of the brain
Dura mater
Arachnoid mater
Pia mater
Cerebral perfusion pressure
determined by: MAP - ICP
when ICP increases, CPP decreases
MAP
= DP + 1/3PP
Pulse pressure
SBP-DBP
Cushing’s reflex
widening pulse pressure
bradycardia
hypertension
Cushing’s Triad
widening pulse pressure
bradycardia
irregular resp pattern
Skull fracture
ecchymosis, CSF leak, depressed skull, open vault
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
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
Signs and Symptoms of Concussion
headache, vomiting, combativeness, transient visual disturbances, defect in equilibrium and coordination
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
Signs and Symptoms of Contusion
seizures, hemiparesis, aphasia, personality changes, LOC
Compression
haemorrhage or oedema within the brain leads to structures being compressed or pressurized
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
Causes of secondary head injuries
hypoxia
hypotension
hypoglycaemia
hyercapnia
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
