Head Injuries

Question 1

What are most preventable prehospital deaths due to?

Answer 1

Hemoragic shock or tension physiology.

Question 2

What is the key point to managing a head injury?

Answer 2

Maintain oxygen and nutrients to the brain.

Question 3

What is the skull?

Answer 3

An inflexible cavity with no free space.

Question 4

What is in the skull.

Answer 4

Brain matter.
Arteries and arterial blood.
Veins and venous blood.
CSF

Question 5

What is interracial pressure?

Answer 5

An intrinsic pressure within the cranial cavity that is quite low 10mmHg but can be measured with Lumbar puncture.

Question 6

What is Cerebral Prefusion Pressure?

Answer 6

The difference between ICP and BP that allows blood to enter the cranial cavity.

Question 7

What does a large part of neurocritical care consist of?

Answer 7

Maintenance of cerebral profusion pressure through either increasing arterial pressure into the brain or decreasing the pressure in the cranium by removing the clot or CSF, reducing brain swelling or removing the skull.

Question 8

What can you do for the initial trauma with a brain injury?

Answer 8

Not a lot.

Question 9

What problems will make a head injury worse.

Answer 9

Hypoxia
Hypercarbia
Hypoperfusion
Hypo/hyperglycaemia

Question 10

What MOIs can lead to head injury?

Answer 10

Penetrating-
Bullets
Fragmentation

Blunt-
Falls
Direct Trauma
RTC
Blast

Question 11

What might you see that will lead you to suspect a head injury?

Answer 11

Racoon eyes
Rhinorrhoea- csf and blood from nose
Otorrhea-from ear
Mastoid process bruising- behind the ears

Question 12

What do you record for head injury level of consciousness?

Answer 12

AVPU
GCS
PEARL
Size

Question 13

Waht is the AVPU scale

Answer 13

Alert
Voice
Pain
Disability

Question 14

What is the 3 categories for gcs

Answer 14

Eye response
Verbal
Motor

Question 15

What is worse flexion or extension to pain?

Answer 15

Extension.

Question 16

What GCS and bellow is considered a severe head injury?

Answer 16

8

Question 17

What is the highest and lowest gcs?

Answer 17

15 and 3

Question 18

What happens with Cushings Reflex?

Answer 18

Pulse goes down.
BP goes up.
GCS goes down
Resp usually go down

Question 19

What do patients experiencing Cushings Reflex need?

Answer 19

Urgent critical care, a brain scan and potentially surgical intervention.

Question 20

How are head injuries treated and managed?

Answer 20

Airway- clear and maintain
Breathing- give O2 aiming for 94-98% SP02
BVM if low resp rate to blow off CO2
Consider 30 degree tilt to drain venous blood from cranium. (Not for spinal injury)
Circulation- Maintain normal tension SBP 110
Disbility- Correct hypoglycemia

Question 21

What can we do in a non-permissive environment?

Answer 21

Cat heam

Question 22

What can we do in a permissive environment?

Answer 22

C- acat heam
A- Check, Clear, Maintain C spine if needed
B- RISE'N'FALL
C- Maintain BP
E- Keep warm

Question 23

What extra can we do in a permissive environment?

Answer 23

GCS
Movement for pressure sores
Stretcher movement
HITMAN

Question 24

What should you not do if you consider ICP?

Answer 24

Use a collar.