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EM 1 > HEAD INJURIES > Flashcards

HEAD INJURIES Flashcards

1
Q

impairment of brain function as a result of mechanical force w/ diminished/altered consciousness

A

TBI

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2
Q

trauma induced alteration of mental status which may or may not involve consciousness; functional disturbance sx, normal imaging

A

concussion

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3
Q

GCS of mild TBI (majority of head injuries)

A

14-15

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4
Q

GCS of mod. TBI

A

9-13

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5
Q

signs of severe TBI

A
  • Fixed or dilated pupils, decorticate (flexion) or decerebrate (extension) posturing, bradycardia, HTN respiratory depression
  • periorbital ecchymosis (racoon eyes), battle signs, hemotympanum, CSF otorrhea, CSF rhinorrhea
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6
Q

what GCS do you intubate? what 3 meds can you give for induction?

A
  • < 8 or uncooperative/combative
  • Etomidate, propofol for induction & succinylcholine/rocuronium
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7
Q

why do you do aggressive fluid resusicitation?

A

to prevent hypotension and secondary injury

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8
Q

Single fixed and dilated pupil in unresponsive pt indicates what?

A

uncal herniation (will be same side lesion)

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9
Q

3 things that Bilateral fixed and dilated pupils suggest

A
  • increased ICP w/ poor perfusion
  • bilateral uncal herniation
  • drug or severe hypoxia
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10
Q

2 things bilateral pinpoint suggests

A
  • opiate use
  • pontine lesion
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11
Q

eye opening for GCS scale

A
  • 1= none
  • 2= pain; 3= voice
  • 4= spontaneous
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12
Q

verbal response for GCS

A
  • 1= none
  • 2= no words, only sounds
  • 3= words but not coherent
  • 4= disoriented conversation
  • 5= normal conversation
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13
Q

motor response for GCS

A
  • 1= none
  • 2= deceberate
  • 3= decorticate posture
  • 4= withdraws to pain
  • 5= localized to pain
  • 6= normal
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14
Q

“cor”- body clenched; arms, head oriented towards core is what posture? indicates damage to what 3 structures?

A
  • decorticate posture
  • thalamus, midbrain, cerebral hemispheres
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15
Q

decerebrate posture indicates what?

A
  • brainstem injury –worse
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16
Q

bleeding into the brain tissue; usually component of cerebral contusion disrupting intraparenchymal capillaries; hyperdense area in brain tissue on CT with surrounding hypodense area (edema)

A

intracerebral hemorrhage

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17
Q

2x likely to die, remain in persistent vegetative state or experience severe disability; Can be missed on early CT; looks like whispy white lines on CT

A

SAH

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18
Q

bleeding in epidural space (between skull and dura mater) caused by laceration of meningeal arteries; often associated w/ skull fractures

A

epidural hemorrhage

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19
Q

hyperdense lens shaped hematoma on CT scan is what kind of hemorrhage

A

epidural hemorrhage

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20
Q

Classic presentation of LOC then lucid interval w/ subsequent rapid neurologic demise (can lead to herniation w/in hrs)

A

epidural hemorrhage

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21
Q

why do we say that GCS does not necessarily reflect underlying injury

A

its based off level of consciousness and patients w/ same level of consciousness per GCS may have very different pathophys

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22
Q

what is the monroe-kelli hypothesis

A

if theres increase in one compartment of the cranium, ther needs to be compensatory decrease in another otherwise ICP will increase

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23
Q

3 goals of approaching head injuries

A
  • find life threatening injuries
  • find treatable mass lesions like bleeding
  • prevent more injury by preventing things that will increase metabolic demand
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24
Q

3 goals of approaching head injuries

A
  • find life threatening injuries
  • find treatable mass lesions like bleeding
  • prevent more injury by preventing things that will increase metabolic demand
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25
Q

labs that would be helpful in determining what is occuring (5)

A
  • CBC
  • type & cross-match
  • electrolytes
  • coags
  • consider tox screen, ethanol level, ABG
26
Q

completely unresponsive, total coma is what GCS

A

3

27
Q

patient is confused (dementia, intox, concussion?) is what GCS score

A

14

28
Q

patient is talking out of their head (bleed?); whats their GCS score

A

13

29
Q

why should you avoid long acting agents with intubation

A

may mask neurologic changes like seizures

30
Q

which type of hemorrahage is common in mod-severe TBI

A

SAH

31
Q

what hematoma results when this happens

trauma tears cerebral veins bridging the spce between the brain and venous sinuses causing slower venous bleedin ginto subdural space

A

subdural

32
Q

blood surrounds brain forming crescent-shaped hyperdense (acute)areas on CT; isodense if subacute

A

subdural hematoma

33
Q

which hematoma is comon in elderly and alcoholics, trivial trauma; pt may be asymp. or have progressive focal neuro deficits over days/weeks

A

subdural hematoma; need to have high suspicion even for near falls or other minor injuries

34
Q

3 things non-con CT is good for

A

brain
bone
air

35
Q

when do you do surgical drainage of epidural hematoma

A

over 30 ml

36
Q

when do you do surgical drainage for acute subdural hematomas (3)

A

over 10 mm thick or shifts over 4mm of midline
GCS decreases 2+ points since admit
ICP over 20 mmHg

37
Q

when do you do surgical drainage with intracerebral hemorrhage

A

if evidence of mass effect

38
Q

other than hemorrhages and hematomas, what two injuries is surgical drainage indicated

A
  • penetrating injury
  • depressed skull frature if open or if depressed more than cranial thickness
39
Q

if surgical drainage is complete, your focus moves to what?

A

preventing secondary injury & lowering ICP

40
Q

general things to do when preventing secondary injury (5)

A
  • maintain VS
  • frequent neuro checks
  • prevent seizures
  • monitor ICP
  • avoid fever and hypoglycemia
41
Q

goal PaCO2 and O2 saturation when ventilating

A
  • PaCO2: 35-40 mmHg
  • O2 saturation: 95%
42
Q

goal systolic BP when preventing secondary injury

A

> 90 mmHg

43
Q

why do you elevate HOB to 30 degrees when preventing secondary injury

A

increase CSF outflow from skull base

44
Q

what medication can be used to lower ICP and helps to maintain cerebral perfusion; immediate plasma expaing; diuretic effects

A

Mannitol by repetitive boluses

reduces ICP w/in 30 mins and effects last 6-8 hrs

45
Q

when do you initiate ICP monitoring

A

pt w/ evidence of increased ICP or GCS <9

46
Q

normal ICP

A

< 15 mmHG

47
Q

battle sign & racoon eyes is associated with what injury

A

basilar skull fracture

48
Q

aka midaxillary fracture; affect the midface of the skull and collectively involve a partial or complete separation of the midface from the skull.

A

Lefort fractures

49
Q

break of one or more of the bones that surround the eye

A

blow out fracture

50
Q

3 ways to tx scalp lacerations

A
  • direct pressure
  • lido w/ epi
  • clamp or ligate vessel
51
Q

T/F: torn dura causes otorrhea or rhinorrhea

A

true

52
Q

imaging will appear normal for which type of TBI

A

mild (GCS 14-15)

53
Q

LOC, vomiting, HA, focal neuro findings, over 65yo, coagulopathy, basilar skull fx, coagulopathy, etc + any alteration in the mental state at the time of event like seing stars, beind dazed/confused

A

mild TBI

54
Q

3 ways mild TBI can cause significant morbidity

A
  • neuropsych difficulties– memory, attention, executive functioning, depression
  • disrupt relationships & affects ability to resume usual activities
  • repeat concussions can cause longer term structural deficits
55
Q

which imaging is more sensitie in showing small areas of contusion, hemorrhae, axonal injury, or small extra-axial hematoma

A

MRI

56
Q

3 populations to get CT on if TBI (not a comprehensive list)

A
  • 2+ episoes of vomitting
  • 65+ yo
  • amnesia before impact of 30+ mins
57
Q

according to New orleans critera, get CT if GCS of 15 + (5)

A
  • HA
  • vomit
  • over 60
  • drug/alcohol
  • persistent anterograde amnesia
  • visible trauma above clavicle
58
Q

when do you do CT on kids < 2 yo

A

if theres high risk of intracranial injury or suspected skull fx

59
Q

signs of high risk sxs that would warrant CT in < 2 yo

A

focal neuro findings
skull fx
depressed mental status
bulging fontanel
persistent vomit
seizure, prolonged LOC
child abuse
hx of AV malformation or bleeding do

60
Q

what do you do for intermediate risk where CT isnt indicated

A

observe for 4-6hrs after injury w/ planto CT for any worsening condition during that time

61
Q

4 times where you would admit for observation

A
  • GCS < 15
  • abnormal CT
  • seizures
  • abnormal bleeding parameters

EM 1 (5 decks)

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