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Trauma > Head Injuries and Hypothermia > Flashcards

Head Injuries and Hypothermia Flashcards

1
Q

1.7 million TBIs occur annually in the U.S.

__% are classified as concussion

A

Over half, 65%

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2
Q

Contributes significantly to the death of approximately half of all trauma victims

A

TBI

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3
Q

Leading causes of TBI

A

MVC

Falls in the elderly

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4
Q

Scalp contains the following layers

A

Skin

Connective tissue

Galea aponeurotica (thick fibrous layer that provides structural support)

Periosteum

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5
Q

Skull

Small openings for blood vessels and nerves to pass

A

Foramina

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6
Q

Brain stem and spinal cord passes through

A

Foramen magnum

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7
Q

Provides protection to the brain

A

Skull/cranium

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8
Q

Layers that cover the brain

A

Meninges

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9
Q

Meninges

Inside the skull, tough fibrous layer, epidural space

A

Dura mater

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10
Q

Meninges

Closely adhered to the brain

A

Pia mater

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11
Q

Layered on top of blood vessels adhered to pia

A

Arachnoid membranes

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12
Q

Surrounds the brain, produced in the ventricular system and functions to cushion the brain

A

CSF (150ml)

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13
Q

Exert a pressure within the brain, which is referred to as intracranial pressure (ICP)

A

Brain tissue, blood, and CSF

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14
Q

Portion of dura mater between cerebrum and cerebellum

A

Tentorium cerebelli

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15
Q

Cranial nerves originate from the:

A

Brain Stem

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16
Q

Controls pupillary constriction. Crosses surface of tentorium. Hemorrhage or edema that leads to herniation of the brain will compress the nerve. Leading to pupillary dilation.

A

CN III (oculomotor)

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17
Q

Mean arterial pressure (MAP) =

A

(systole + diastole x2/3) or diastole + 1/3 pulse pressure

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18
Q

Used to characterize pressure driving blood into the brain

Cerebral perfusion pressure (CPP)

Amount of pressure it takes to push blood through cerebral circulation to maintain oxygen, glucose delivery

A

Mean arterial pressure (MAP)

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19
Q

CPP =

A

MAP - ICP

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20
Q

Normal CPP =

A

70-80 mmHg

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21
Q

CPP

Decreased levels of CO2 lead to:

A

Vasoconstriction

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22
Q

CPP

Elevated levels of CO2 =

A

Dilation

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23
Q

Used to lower ICP

Decreases PaCO2 which in turn affects the acid base balance resulting in vasoconstriction

A

Hyperventilation

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24
Q

Direct trauma to the brain

A

Primary brain injury

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25
Q

Refers to ongoing injury processes set in motion from primary injury

A

Secondary brain injury

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26
Q

2-5% of TBI patients have _________ injury which can affect

patient’s ability to properly ventilate

A

C-spine

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27
Q

The hypoxic brain leads to vasoconstriction and subsequent stimulation of the sympathetic nervous system in an effort to raise BP

Therefore parasympathetic nervous system causes slowing of the heart rate in response

A

Cushing’s reflex

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28
Q

Elevated systolic BP, bradycardia, abnormal respirations (cheyne-stokes)

A

Cushing’s triad

29
Q

Primary assessment includes:

A

Airway
Breathing
Circulation
Disability

30
Q

Suspected if CSF drainage or delayed (several hours) findings of periorbital ecchymosis or battle signs are seen

A

Basilar skull fracture

31
Q
  • Briefly knock you out (loss of consciousness), OR
  • May affect your ability to remember information before, during, or after the event (post traumatic amnesia), OR
  • Makes you feel dazed, like you had your bell rung (alteration of consciousness)
A

Concussion

32
Q

Also known as a mild traumatic brain injury

A

Concussion

33
Q

Bleeding between skull and Dura Mater

1-2% of TBI patients

Usually low velocity blow to temporal bone

Pathognomonic history is patient has head trauma with a brief LOC, regains consciousness (lucid interval), then experiences rapid decline in consciousness

A

Epidural hematoma

34
Q

Account for 30% of severe brain injuries

  • Generally results from venous bleed
  • Bridging veins are torn during blow to the head
  • Blood collects between Dura and Arachnoid membrane
A

Subdural hematoma

35
Q

Bleeding that occurs between arachnoid membrane

Commonly associated with ruptured cerebral aneurysm and onset of worst headache of life.

  • Severe HA
  • Nausea & vomiting
  • Dizziness
  • May have meningeal signs
  • Seizure
A

Subarachnoid hemorrhage (SAH)

36
Q

All suspected TBI should receive:

A

O2, maintain SpO2 >95%

37
Q

After mild TBI/concussion there is a ____-hour minimal recovery period

38
Q

Steps following suspected Concussion or mild TBI

A

MACE exam

Look for red flags

24-hour mandatory rest period

Manage symptoms to facilitate rest and sleep
-Acetaminophen every 6 hours, for 48 hours, after 48 hours, may use
Naproxen as needed

Reevaluate after 24 hours
-Neurobehavioral Symptom Inventory (NSI) screening

39
Q

If symptom free during exertional testing and this is their first concussion in the past 12 months then:

A

Return to duty

40
Q

If symptom free during exertional testing and this is their second concussion in the past 12 months then:

A

Stay at stage 2 light routine activity for the next 5 days

Perform NSI screening questionnaire daily

41
Q

May perform these activities no longer than 30 minutes – walk, stretch, ride a stationary bike at slow pace with low resistance, no light housework, use the computer, play simple games, such as cards.

A

Stage 2 light routine activity

42
Q

May perform the following activities for no longer than 60 minutes: lift and carry objects less than 20 lbs, take a brisk walk, ride in care and look around, use an elliptical machine or stair climber, perform light military tasks such as cleaning equipment

May perform these activities no longer than 30 minutes: shop for one item at the store, talk to someone as you walk, gently increase your exposure to light and noise, perform a maintenance check on a vehicle

A

Stage 3 light occupation-oriented activity

43
Q

You may perform the following activities for no longer than 90minutes: take a brisk walk, do light resistance training, participate in non-contact sports, perform moderate job-related tasks, climb, crawl, or jog

You may perform these activities for no longer than 40 minutes: play video games, foosball, putting and ping-pong, play strategy games such as chess or Sudoku, shop for groceries, perform target practice, drive in a simulator

A

Stage 4 Moderate activity

44
Q

Resume normal routine and exercise, participate in normal military, training and social activities, use night vision goggles, take part in simulations, or be exposed to bright light, start driving again, do heavy job-related tasks, such as digging, communicate by signals during patrol duty or use radio communication

A

Stage 5 Intensive activity

45
Q

If 3 or more documented concussions and/or TBI in the past 12 months then:

A

Stage 1 rest and refer to Neurology for a comprehensive work-up with imaging and assessment.

46
Q

Tool that assists providers in the assessment and diagnosis of a concussion

Most effective when used as close in timing to the time of the incident

A

Military Acute Concussion Evaluation Exam 2 (MACE2 exam)

47
Q

MACE2 exam

__ Steps

__ minutes to complete

A

17 steps

15 minutes

48
Q

Defined as a core temperature below 95ºF.

A

Hypothermia

49
Q

Body temp: 90-95

A

Mild hypothermia

50
Q

Moderate hypothermia

51
Q

Severe hypothermia

52
Q

Normal mental status with shivering

Functioning normally

Able to care for self

Estimated core temperature 35 to 37°C (95 to 98.6°F)

A

Cold stressed

53
Q

Alert, but mental status may be altered

Shivering present

Not functioning normally

Not able to care for self

Estimated core temperature 32 to 35°C (90 to 95°F)

A

Mild hypothermia

54
Q

Decreased level of consciousness

Conscious or unconscious, with or without shivering

Estimated core temperature 28 to 32°C (82 to 90°F)

A

Moderate hypothermia

55
Q

Unconscious

Not shivering

Estimated core temperature <28°C (<82°C)

A

Severe/Profound hypothermia

56
Q

Reflects the balance between heat production and heat loss.

A

Body temperature

57
Q

Vaporization of water through both insensible losses and sweat

A

Evaporation

58
Q

Emission of infrared electromagnetic energy

59
Q

Direct transfer of heat to an adjacent, cooler object

A

Conduction

60
Q

Direct transfer of heat to convective currents of air or water

A

Convection

61
Q

Demonstrates tachypnea, tachycardia, initial hyperventilation, ataxia, dysarthria, impaired judgment, shivering, and so-called “cold diuresis”

A

Mild hypothermia

62
Q

CNS depression, drop in heart rate and cardiac output, hypoventilation, and hyporeflexia

At lower ends of temp, loss of shivering, dysrhythmias (A fib), and dilated pupils below 29ºC

A

Moderate hypothermia

63
Q

Pulmonary edema, oliguria, hypotension, bradycardia, ventricular dysrhythmias. (V fib/tach/asystole)

Loss of oculocephalic reflexes

A

Severe hypothermia

64
Q

Hypothermic patients are extremely sensitive movement and prone to which arrhythmia?

65
Q

Lab studies for hypothermic patients

A

Fingerstick glucose

Electrocardiogram (ECG): Osborne Waves

66
Q

Mild hypothermia is treated with:

A

Passive external rewarming

67
Q

Moderate and refractory mild hypothermia are treated with:

A

Active External rewarming

68
Q

Severe (and some cases of refractory moderate) hypothermia is treated with:

A

Active internal rewarming and possibly extracorporeal rewarming

69
Q

Prevent the head injured patient from going into:

This will lead to hypo-perfusion for the brain.

A

Hypotension

Trauma (12 decks)

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