Head Injuries

Question 1

What are the two classification of wounds?

Answer 1

Blunt Force

Sharp Force

Question 2

What are blunt force wounds?

Answer 2

Abrasions
Bruises
Lacerations

Question 3

What are sharp force wounds?

Answer 3

Incised wounds

Stab wounds

Question 4

What are abrasions?

Answer 4

Light abrasion of epidermis
Tend to have no blood loss
No damage of blood vessels

Question 5

What are bruises?

Answer 5

Different colours- release and breakdown of haemoglobin just under skin, degradation of haemoglobin through spectrum of colours

Question 6

What are lacerations?

Answer 6

Edges irregular
Over bony regions
Hard to join together with stitches

Question 7

What are incised wounds?

Answer 7

Longer than they are deeper
See where mechanism of injury has occurred
Deeper at entry wound, shallower as it goes on (tappers off)

Question 8

What are stab wounds?

Answer 8

Deeper than they are wide (narrower)

If knife hits in intercostal spaces (between ribs)- lung puncture

Question 9

What is the skull composed of?

Answer 9

Cranium- neurocranium and viscerocranium (viscero=organs)
Bones of face
N.B. The mandible is considered separaetely

Question 10

What is a pneumatised bone?

Answer 10

A bone that is hollow or contains many air cells, such as the mastoid process of the temporal bone, frontal sphenoidal, ethmoidal

Question 11

What is the weakest point of the skull?

Answer 11

Pterion

Question 12

What is the Pterion?

Answer 12

Point of meeting in frontal, temporal and sphenoid

Question 13

What is the zygomatic bones use?

Answer 13

Crash impact barrier to protect eyes from injury

Question 14

What are the facial features?

Answer 14

Eyes
Nore
Maxilla- upper teeth
Mandible
Teeth

Question 15

What are the 2 types of head injuries?

Answer 15

Primary

Secondary

Question 16

What are primary head injuries?

Answer 16

SCALP
S- Skin
C-Connective tissue
A- Aponeurosis 
L-Loose connective tissue
P- Periosteam

Question 17

What is aponeurosis?

Answer 17

Injury to scalp- takes off three layers off all in one

Question 18

What are secondary head injuries?

Answer 18

Meningitis- menigis inflamed around brain and spinal chord
itis- inflammation
Ischaemia- reduction of blood supply
Increased ICP- intracranial pressure (trauma, bleeding, infections)
Oedema- swelling of brain

Question 19

What types of skull fractures can you get?

Answer 19

Linear
Hinge
Comminutes
Ring 
Distant

Question 20

What are linear fractures?

Answer 20

Straight ish line

Question 21

What are hinge fractures?

Answer 21

Back of skull, one of the skull moves relative to other

Question 22

What are comminutes fracture?

Answer 22

Many different pieces (less common)

Question 23

What are ring fractures?

Answer 23

Ring all the way around the skull (most serious)

Question 24

What are distant fractures?

Answer 24

Impact at one point, skull fractures at different point

Question 25

What are sutures?

Answer 25

Hold bits of skull together, allow for all the different moves to move over each other

Question 26

What are CT scans useful for?

Answer 26

Bony injuries

Question 27

What are MRI scans useful for?

Answer 27

Soft tissue damage

Question 28

What is a basal skull fracture?

Answer 28

Generally occipital or temporal trauma | Only high impact injuries

Question 29

What is the CSF rhinorrhoea?

Answer 29

Cerebrospinal fluid, hole between nose and brain

Question 30

What is Battle's sign?

Answer 30

Mastoid process, bleeding causes bruising

Question 31

What is 'Panda eyes'?

Answer 31

Or ‘racoon eyes’- blackened and bruised areas around eyes, blood leaking out of the brain

Question 32

What are effects of basal skull fracture?

Answer 32

CSF rhinorrhoea Battle's sign Panda/ racoon eyes

Question 33

What is cerebral contusion?

Answer 33

A form of traumatic brain injury, is a bruise of the brain tissue. Like bruises in other tissues, cerebral contusion can be associated with multiple microhemorrhages, small blood vessel leaks into brain tissue. Contusion occurs in 20–30% of severe head injuries.

Question 34

What is stripped from the brain in cerebral contusion?

Answer 34

Pia (lining around the brain)

Question 35

What is the point of contact known as?

Answer 35

'Coup'

Question 36

What is the opposite point of impact?

Answer 36

Contrecoup

Question 37

What is primary contact?

Answer 37

Being hit on the head

Question 38

What is secondary contact?

Answer 38

Whiplash

Question 39

What are the meninges?

Answer 39

Dura mater Arachnoid mater Pia mater

Question 40

What types of intracranial haemorrhages are there?

Answer 40

Extradural haemorrhage Subdural haemorrhage Subarachnoid haemorrhage Diffuse Axonal Injury (DAI)

Question 41

What is extradural haemorrhage?

Answer 41

Above the dura under the surface of the skull >90% associated with hashtag esp. at pterion Usually middle meningeal artery

Question 42

What are the effects of extradural haemorrhage?

Answer 42

Fine Initially have a lucid interval | A while after feel groggy, vomiting, takes time for dura to peel off skull

Question 43

What is subdural haemorrhage?

Answer 43

Above arachnoid but below the dura mater Venous in origin Tearing of superior cerebral vein

Question 44

Who is more likely to suffer from subdural haemorrhaging?

Answer 44

Alcoholics and the elderly more prone to subdural haemorrhage because of cerebral atrophy (peak IQ, greatest number of neurons late teens early 20s) older you get obtain cerebral atrophy, less nerves deteriorating

Question 45

Why are the elderly more likely to suffer from subdural haemorrhaging?

Answer 45

Old age, brain starts ti shrink. As brain starts to shrink, veins shrink

Question 46

Why are alcoholics more likely to suffer from subdural haemorrhaging?

Answer 46

Drink to much alcohol- kills brain and nerves, brain shrinks blood vessels grow

Question 47

What is subarachnoid haemorrhage?

Answer 47

Occurs in natural disease or injury AV (arterial venous) malformation (bad connections between arteries and veins) or rupture of Berry aneurysm (abnormal dilation of artery causing it to burst)

Question 48

What is subarachnoid haemorrhaging associated with?

Answer 48

Trauma e.g. cranial fractures or cerebral lacerations Internal carotid- linked to aorta Carotid syphon- regulates blood pressure

Question 49

What is Diffuse Axonal Injury (DAI)?

Answer 49

Diffuse brain injury without obvious lesion Can’t diagnose until post-mortem Can be unconscious straight away

Question 50

What causes Diffuse Axonal Injury?

Answer 50

Due to shearing rotational forces (grey matter- where neurons are and white matter- where pathways are) separation of grey and white matter, weak point

Question 51

How is DAI diagnosed?

Answer 51

Microscopic diagnosis

Question 52

What is the Glasgow Coma Scale (GCS)?

Answer 52

Conscious Scale

Question 53

How is the GCS marked?

Answer 53

Out of 15 Eye opening (4)- responsive/ unresponsive Verbal response (5)- coherent Motor response (6)- movement Get 1 for no response- dead have 3 out of 15