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TRAUMA > Head Injuries and Hypothermia > Flashcards

Head Injuries and Hypothermia Flashcards

1
Q

What are the leading causes of TBI include what?

A
  1. Motor vehicle collisions
  2. Falls in the elderly
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2
Q

What cranial nerve controls pupil constriction?

A

CN III

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3
Q

What does MAP stand for?

A

Mean Arterial Pressure

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4
Q

What is the equation of Mean Arterial Pressure?

A

Systolic + Diastole x 2/3 or Diastole +1/3 pulse pressure.

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5
Q

What does CPP stand for?

A

Cerebral Perfusion Pressure

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6
Q

What is the equation for Cerebral Perfusion Pressure?

A

MAP-ICP= CCP

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7
Q

What are the normal CCP levels?

A

70-80 mmHg

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8
Q

What is the pathophysiology of primary brain injury?

A

1, Direct Trauma to the brain
2. Contusion, Hemorrhages, Lacerations, or direct mechanical injury
3. Neural tissue does not regenerate well therefore low expectation to recovery.

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9
Q

What is the pathophysiology of Secondary brain injury?

A
  1. Refers to ongoing injury processes set in motion from primary injury.
  2. Primary focus is to limit or stop secondary injury
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10
Q

What are the types of secondary injuries include?

A
  1. Mass effect-elevated ICP
  2. Hypoxia
  3. Hypotension
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11
Q

What are the 2 biggest predictors of poor outcomes in head trauma?

A
  1. Amount of time spent with ICP > 20 mmHg (usually below 15 mmHg).
  2. TIme spent with systolic BP< 90 mmHg. a single episode of hypotension can lead to a worse outcome.
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12
Q

What is the Cushing Triad?

A
  1. Elevated systolic BP
  2. Bradycardia
  3. Abnormal Respirations (Cheyne-stokes)
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13
Q

What is the acronym SAMPLE stand for?

A

Symptoms
Allergies
Medications
Past Medical Hx.
Last oral intake
Event leading up

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14
Q

What is an open globe injury?

A
  1. signs include teardrop pupil, sub-conjunctival hemorrhage, and decrease in vision.
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15
Q

Where is the bleeding location for epidural hematoma?

A

Bleeding BTW skull and Dura Mater

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16
Q

What type of injury is sustained with an Epidural Hematoma?

A

Usually Low-Velocity blow to the temporal bone.

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17
Q

What types of eye-related issues are seen in Epidural Hematoma?

A

Dilated, sluggish non-reactive Pupil

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18
Q

What type of injury is sustained with a subdermal Hematoma?

A
  1. MVC
  2. Falls
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19
Q

Where is the bleeding location for Subdural Hematoma?

A

BTW Dura and Arachnoid membrane

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20
Q

What is known to be the worse headache in life?

A

Subarachnoid Hemorrhage

21
Q

What are the most common symptoms of a member with SAH?

A
  1. Severe HA
  2. Nausea & Vomiting
  3. Dizziness
  4. May have meningeal signs
  5. Seizures
22
Q

What are the red flags for patients with concussion and mild TBI?

A

1.) Deteriorating level of consciousness
2.) Double Vision
3. Increased restless, combative, or agitated behavior
4. repeat vomiting
5. Seizure
6. Weakness or tingling in arms or legs
7. Severe or worsning HA
8. Unsteady on feet
9. One pupil larger or smaller than other
10. Changes in hearing, taste, or vision
11. Repeated episodes of blacking out or passing out

23
Q

How long is the initial mandatory rest period?

A

24 hours

24
Q

During the initial 24-hour mandatory rest what must the member do?

A
  1. Rest with extremely limited cognitive activity
  2. Limit physical activities to those of daily living and extremely light leisure activity
  3. Avoid work, Exercise, video games, reading, or driving
  4. Avoid caffeine and alcohol
25
Q

What medications are authorized to use for members of TBI?

A

Acetaminophen Q 6 HRS, for 48 HRS

26
Q

When reevaluating after 24 hours, evaluate for any of the following symptoms?

A
  1. Confusion
  2. Unsteady on feet.
  3. HA
  4. Phonophobia
  5. Irritability
  6. Vertigo/Dizziness
  7. Photophobia
  8. Sleep Issues
27
Q

What consist of Exertional Testing?

A

Exert to 65-85%
THR=220
Exercise, push-ups, sit-ups, treadmill, etc…
Maintain for two minutes
Assess for symptoms

28
Q

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

A

Return to duty

29
Q

if symptom-free during exertional testing and this is their second concussion in the past 12 months then?

A

Stay at stage two light routine activity for the next 5 days and perform NSI screening questionnaire daily

30
Q

During Stage 2 light routine activity how long can they perform the activities?

A

30 mins

31
Q

If symptoms are free following 5 days of Stage 2 activity then may progress through that stages ?

A

3, 4, and 5 ( Each 24 hours)

32
Q

What is stage 3 and how long can it sustain these activities?

A
  1. Light occupation-oriented activity
  2. 60 minutes
33
Q

What is stage 4 and how long can it sustain these activities?

A
  1. Moderate Activity
  2. 90 minutes
34
Q

What is stage 5 and how long can it sustain these activities?

A
  1. Intensive Activity
  2. Resume normal routine and exercise.
35
Q

If symptoms develop/return during any of the above stages then go back to what stage?

A

Stage 1

36
Q

If 3 or more documented concussions and or TBI in the past 12 months then Stage 1 and refer to where?

A
  1. Neurology for comprehensive work up with imaging and assessment.
37
Q

What is the temperature range for mild hypothermia?

A

1.) 32 to 35 C or 90 to 95F

38
Q

What is the temperature range for Moderate hypothermia?

A

1.) 28 to 32 C or 90 to 82F

39
Q

What is the temperature range for Sever hypothermia?

A

1.) <28 C or <82F

40
Q

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

A

Evaporation

41
Q

What term is the emission of infrared electromagnetic energy

A

Radiation

42
Q

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

A

Conduction

43
Q

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

A

Convection

44
Q

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

A

Arrhythmias (V-Fib)

45
Q

Many standard thermometers only read to a minimum of what temp F?

A

93 F

46
Q

What are the important lab values in a hypothermic patient?

A
  1. Fingerstick Glucose
  2. ECG (Osborne Waves)
47
Q

Passive external rewarming is good for?

A

Mild Hypothermia

48
Q

Active external rewarming is used for?

A

Moderate and refractory mild hypothermia.

49
Q

Active internal rewarming and possibly extracorporeal rewarming are used for?

A

Sever and some moderate refractory hypothermia.

TRAUMA (15 decks)

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