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CLASS 22010 TRAUMA > HEAD INJURIES AND HYPOTHERMIA > Flashcards

HEAD INJURIES AND HYPOTHERMIA Flashcards

1
Q

What contributes significantly to the death of approximately half of all trauma victims?

A

TBI

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2
Q

The leading causes of TBI or Endocranial Hemorrhage include what?

A
  1. Motor vehicle collisions

2. Falls in the elderly

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3
Q

What is the outermost layer of the head with many layers that include the following?

  1. Skin
  2. Connective tissue
  3. Galea aponeurotica (tick fibrous layers provide structural support)
  4. Periosteum
A

Scalp

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4
Q

What includes the following?

  1. Foramina (small openings for blood vessels and nerves to pass)
  2. Foramen magnum (brain stem and spinal cord)
  3. Provides protection to the brain
A

Skull

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5
Q

What are the layers that cover the brain?

A

Meninges

  1. Dura mater inside the skull, tough fibrous layer, Epidural space (potential
    space)
  2. Pia mater – closely adhered to the brain
  3. Arachnoid membranes layered on top of blood vessels adhered to pia
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6
Q

The brain is surrounded by about how much CSF which is produced in the ventricular system and functions to cushion the brain?

A

150ml

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7
Q

Brain tissue, blood, and CSF exert a pressure within the brain, which is referred to as what?

A

Intracranial Pressure (ICP)

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8
Q

What is the portion of the dura mater between cerebrum and cerebellum?

A

Tentorium cerebelli

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9
Q

True or False

Cranial nerves originate from the spine

A

False

Cranial nerves originate from the brain stem

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10
Q

What cranial nerve 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

Cranial nerve III (oculomotor)

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11
Q

(Systole + Diastole x 2/3) or Diastole + 1/3 pulse pressure equals what?

A

Mean Arterial Pressure (MAP)

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12
Q

What is used to characterize pressure driving into the brain?

A

MAP

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13
Q

What is the amount of pressure it takes to push blood through cerebral circulation, to maintain oxygen and glucose delivery?

A

Cerebral Perfusion Pressure (CPP)

Relates to blood pressure and ICP

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14
Q

MAP - ICP equals what?

A

Cerebral Perfusion Pressure (CPP)

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15
Q

What is the normal CPP?

A

70-80mmHg

sudden increase or decrease will alter perfusion

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16
Q

Cerebral Vessels respond to changes in CO2, elevated levels leading to ___ and decreased levels causing ___

A
  1. Vasoconstriction

2. Dilation

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17
Q

What is direct trauma to the brain such as contusions, hemorrhages, lacerations or direct mechanical injury?

A

Primary brain injury

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18
Q

What refers to ongoing injury processes set in motion from primary brain injury?

A

Secondary brain injury

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19
Q

These are all what types of brain injury?

  1. Mass effect - elevated ICP (can lead to herniation)
  2. Hypotension
  3. Predictors of poor outcome
    a. amount of time with ICP > 20mmHg
    b. time spent with systolic BP <90mmHG, single episode of hypotension can lead to worse outcome
  4. Hypoxia
  5. Hypo/hyperglycemia
  6. Watch for and treat seizures
A

Secondary brain injuries

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20
Q

___ to ___ % of TBI patients have concomitant C-spine injury which can affect the patient’s ability to properly ventilate

A

2-5%

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21
Q

The following refers to what reflex?

  1. Increased ICP can lead to cardiovascular changes
  2. hypoxic brain leads to vasoconstriction and subsequent stimulation of sympathetic nervous system in an effort to raise BP
  3. therefore parasympathetic nervous causes slowing of the heart rate in response
A

Cushings reflex

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22
Q

What refers to the elevated systolic BP, bradycardia, and abnormal respirations (Cheyne-stokes)?

A

Cushing’s triad

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23
Q

The primary assessment includes what?

A
  1. Airway
  2. Breathing
  3. Circulation
  4. Disability
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24
Q

True or False

Once life threatening injuries have been managed, if time permits or during the transport, perform a secondary assessment

A

True

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25
Q

What should you suspect is there is CSF drainage or delayed (several hours) findings of periorbital ecchymosis or battle signs are seen?

A

Basilar skull fracture

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26
Q

Trauma to the eye and orbit must be considered with facial trauma and you should evaluate for what?

A
  1. Hyphema
  2. Open globe - signs include teardrop pupil, sub conjunctival hemorrhage, decrease in vision

If suspected, do not apply pressure to the eye and place a protective shield over the eye

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27
Q

What is a head injury from a blow, hit, or jolt to the head that may:

  1. Briefly knock you out OR
  2. Affect your ability to remember info before, during, or after the event (post traumatic amnesia) OR
  3. Makes you feel dazed, like you had your bell rung
  4. Also known as a mild TBI
A

Concussion

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28
Q

What is bleeding between the skull and the Dura Mater, occurs in 1-2% of TBI patients, usually from low velocity blows to the temporal bone?

A

Epidural Hematoma

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29
Q

The pathognomonic history of what is a patient that has had head trauma with a brief period of LOC, regains consciousness (lucid interval), then rapidly declines?

A

Epidural Hematoma

30
Q

What accounts for 30% of severe brain injuries from the following?

  1. MVC, falls
  2. Results from venous bleed
  3. Bridging veins torn during blow to head
  4. Blood collects between Dura and Arachnoid membrane
  5. Typically results from the rapid accumulation of blood in the subdural space and rapid onset of mass effect
A

Subdural Hematomas

31
Q

What is bleeding that occurs between the arachnoid membrane and commonly associated with ruptured cerebral aneurysm and onset of the worst headache of their life and post trauma is the most common cause?

A

Subarachnoid Hemorrhage

32
Q

True or False

ALL suspected TBI should receive supplemental O2

A

True

over 95% spo2

33
Q

Blood loss and ____ are important causes of secondary brain injury

A

Hypotension

34
Q

Circulation with Head injuries

Maintain systolic pressure between ____ mmHg and ____mmHg with IV/IO access and crystalloids

A

90-100mmHg

35
Q

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

A

24 hour

36
Q

Concussion and Mild TBI

If any red flags such as what are present then you need to refer to a higher echelon of care and consider urgent evacuation?

A
  1. Deteriorating level of consciousness
  2. Double vision
  3. Increased restlessness, combative, or agitated behavior
  4. Repeated vomiting
  5. Seizures
  6. Weakness or tingling in arms or legs
  7. Severe or worsening headache
  8. Unsteady on feet
  9. One pupil larger or smaller than the other
  10. Changes in hearing, taste or vision
  11. Repeated episodes of blacking out or passing out
37
Q

What are the steps following a suspected concussion or mild TBI?

A
  1. Conduct MACE2
  2. Look for red flags
  3. Initiate mandatory 24 hour rest
  4. In the initial 24 hours manage symptoms to facilitate rest and sleep
  5. Use Tylenol every 6 hours, for 48 hours, after 48 hours, may use naproxen. AVOID Tramadol, Fioricet, and Narcotics
  6. Reevaluate after 24 hours
  7. Conduct Neurobehavioral Symptom Inventory (NSI) Screening
38
Q

If a patient is symptoms free during exertional testing and this is their first concussion in the past 12 months then what should be done?

A

Return to duty

39
Q

If symptom free during exertional testing and this is their second concussion in the past 12 months then stay at stage ___ light routine activity for the next ___ days and then perform NSI screening questionnaire daily

A
  1. Stage 2

2. 5 Days

40
Q

What routine activity is this?

  1. You may wear uniform and boots
  2. May perform these activities no longer than 30 minutes - walk, stretch, ride a stationary bike at a slow pace with low resistance, no light house work, use the computer, play simple games such as cards
  3. DO NOT: drink, play video games, do resistance training or repetitive lifting, do sit ups, push ups, or pull ups, go to crowded areas where you may be bumped into
A

Stage 2 light routine activity

41
Q

True or False

If symptom free following 5 days of Stage 2 activity then may progress through Stages 3, 4, and 5 (each for 24 hours) and if symptom free following this progression, then perform Exertional testing and if symptom free after exertional testing then may return to full duty.

A

True

42
Q

What activity routine is this?

  1. 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
  2. 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
  3. DO NOT: Drink alcohol, drive, play video games, do resistance training
    or repetitive lifting, go to crowded places, participate in combative or
    contact sports
A

Stage 3 light occupation-oriented activity

43
Q

What activity routine is this?

  1. You may wear personal protective equipment
  2. You may perform the following activities for no longer than 90 minutes:
    take a brisk walk, do light resistance training, participate in non-contact
    sports, perform moderate job-related tasks, climb, crawl, or jog
  3. 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
  4. DO NOT: Drink alcohol, participate in combative or contact sports, drive
A

Stage 4 Moderate Activity

44
Q

What activity routine is this ?

  1. 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
  2. DO NOT: drink alcohol, participate in combative or contact sports, go
    outside the wire in a combat zone
A

Stage 5 Intensive activity

45
Q

True or False

Concussion/Mild TBI

If symptoms develop/return during any of the above stages then go back to stage 1 (Rest), provide symptom management, refer to rehabilitation provider for daily monitored progressive return to activity processes

A

True

46
Q

If there are 3 or more documented concussions and/or TBI in the past 12 months then stage 1 rest and refer to ___ for a comprehensive work up with imaging and assessment.

A

Neuro

47
Q

What is a tool that assists providers in the assessment and diagnosis of a concussion and is most effective when used as close in timing to the time of the incident?

A

Military Acute Concussion Evaluation Exam 2 (MACE2 exam)

48
Q

Prior to performing the MACE2 Exam evaluate for any of the following red flags and if present what is the next step ?

  1. Deteriorating LOC
  2. Diplopia
  3. Increasing combativeness or restlessness
  4. Repeated vomiting
  5. Seizures
  6. Weakness or paresthesia’s in extremities
  7. Severe/worsening HA
A

Defer exam, MEDEVAC/MEDADVICE

49
Q

The Mace2 Exam consists of __ steps and takes approximately ___ minutes to complete

A
  1. 17 steps

2. 15 minutes

50
Q

What is defined as a core temperature below 95 degrees F?

A

Hypothermia

51
Q

What is defined as mild hypothermia?

A

90-95F

52
Q

What is defined as moderate hypothermia?

A

82-90 F

53
Q

What is defined as Severe hypothermia?

A

Below 82F

54
Q

What is the following?

  1. Normal mental status with shivering
  2. Functioning normally
  3. Able to care for self
  4. Estimated core temp 35 - 37 C (95 to 98.6F)
A

Cold Stressed (not hypothermic)

55
Q

What is the following?

  1. Alert, but mental status may be altered
  2. Shivering present
  3. Not functioning normally
  4. Not able to care for self
  5. Estimated core temp 32-35 C (90-95 F)
A

Mild Hypothermia

56
Q

What is the following?

  1. Decreased level of consciousness
  2. Conscious or unconsciousness, with or without shivering
  3. Estimated core temp 28 to 32 C (82 to 90F)
A

Moderate Hypothermia

57
Q

What is the following?

  1. Unconscious
  2. Not shivering
  3. Estimated core temp <28C (<82F)
A

Severe/Profound hypothermia

58
Q

What is generated by cellular metabolism ( most prominently in the heart and liver ) and lost by the skin and lungs ?

A

Heat

59
Q

Heat is lost by the skin and lungs via what processes?

A
  1. Evaporation
  2. Radiation
  3. Conduction
  4. Convection
60
Q

What is vaporization of water through both insensible losses and sweat?

A

Evaporation

61
Q

What is the emission of infrared electromagnetic energy?

A

Radiation

62
Q

What is direct transfer of heat to an adjacent, cooler object?

A

Conduction

63
Q

What is the direct transfer of heat to convective currents or air or water?

A

Convection

64
Q

What are the most common mechanisms of accidental hypothermia?

A

Convective heat loss to cold air and conductive heat loss to water

65
Q

What form of hypothermia demonstrates tachypnea, tachycardia, initial hyperventilation, ataxia, dysarthria, impaired judgment, shivering, and so-called “cold diuresis”?

A

Mild

66
Q

What form of hypothermia demonstrates CNS depression, drop in heart rate and cardiac output, hypoventilation, and hyporeflexia and at lower ends of temp, loss of shivering, dysryhtmias (A fib), and dilated pupils
below 29ºC?

A

Moderate

67
Q

What form of hypothermia demonstrates Pulmonary edema, oliguria, hypotension, bradycardia, ventricular dysrhythmias (V fib/tach/asystole) and the loss of oculocephalic reflexes?

A

Severe

68
Q

Hypothermic patients are extremely sensitive to movement and are prone to what?

A

Arrhythmia

69
Q

These are lab studies that should be gathered for what kind of patient?

  1. Fingerstick glucose *
  2. Electrocardiogram (ECG) * (Osborne Waves)
  3. Basic serum electrolytes, including potassium and calcium
  4. BUN and creatinine
  5. Serum hemoglobin, white blood cell, and platelet counts
  6. Serum lactate
  7. Fibrinogen
  8. Creatine kinase (CK)
  9. Arterial blood gas, uncorrected for temperature, in ventilated patients
  10. Chest radiograph (take care to avoid jostling the patient)
A

Hypothermia

70
Q

Mild hypothermia is treated with what?

A

Passive external warming

71
Q

Moderate and refractory mild hypothermia are treated with what?

A

Active External Warming

72
Q

What forms of hypothermia are treated with active internal rewarming and possibly extracorporeal rewarming?

A

Severe and some cases of refractory moderate hypothermia

CLASS 22010 TRAUMA (12 decks)

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