head injury Flashcards

1
Q

what is a primary brain injury

A

occurs at the moment of impact

target prevention, not treatable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is secondary brain injury

A

effects of trauma on the brain that occur later, e.g. lack of cerebral perfusion, blood glucose, CO2, temp
secondary processes which occur at the cells and molecular level to exacerbate neurological damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what processes can cause secondary brain injury

A
glutamate release
free radical generation 
calcium mediated damage
inflammatory response
mitochondrial dysfunction 
early gene activation
oedema 
opening of BBB
increased interstitial fluid pressure
neuronal death cascades
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

describe a graph of intracranial volume against intracranial pressure

A

as intercranial pressure rises pressure slowly increases too until the critical volume where pressure rises exponentially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how do you manage head injury

A

assessment of pt

investigations -CT head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

who should be sent to hospital

A
extremes of age
amnesia
LoC
high energy injury 
vomiting 
seizure
bleeding/clotting disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

describe the eye component of GCS

A

1 eyes do not open
2 open to pain
3 open to speech
4 open spontaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the verbal component of GCS

A
1 no response
2 incomprehensible sounds
3 innapropriate words
4 confused
5 oriented
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the motor component of GCS

A
1 no response
2 extension to pain
3 abnormal flexion to pain 
4 normal flexion to pain 
5 localizes pain 
6 obeys command
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what GCS constitutes a mild head injury

A

13-15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what GCS constitutes a moderate head injury

A

9-12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what GCS constitutes a severe head injury

A

8 or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

when should you request a ct head

A

GCS is less than 13 on initial assessment

gcs is less than 15 2 hours after injury

suspected open or depressed skull

basal skull fracture

vomiting

amnesia for events more than 30 mins before impact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are red flags`

A
LoC
painful headache
vomiting 
visual disturbance
clear fluid from ear or nose
bleeding from ears
deafness
difficulty understanding 
loss of balance
weakness
difficulty walking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how do you treat convulsions in head injury

A

phenytoin

treat pyrexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what PaCO2 is ideal

17
Q

what is CPP

A

cerebral perfusion pressure

18
Q

what is MAP

A

mean arterial pressure

diastolic pressure + 1/3 pulse pressure

19
Q

what is ICP

A

intra cranial pressure

20
Q

how do you calculate CPP

21
Q

what is cerebral autoregulation

A

maintains constant blood flow to brain between various MAP

this may be compromised in trauma/ ischaemia

22
Q

what parameters should be maintained after head injury

A

CPP above 60-70mmHg

systolic should be above 90mmHg

ICP less than 20 mmHg

23
Q

what should you do if the patient is hypotensive

A

not due to head injury

could be chest trauma
pelvic fracture

stop bleeding and give fluids

24
Q

what features suggest a risk of intracranial mass

A

high impact injury
retrograde amnesia
coagulopathy
seizure

gcs <12
signs of skull fracture

25
what does periorbital bruising suggest
anterior cranial fossa fracure
26
what does Battle's sign suggest (bruising behind the ear
petrous temporal bone fracture
27
what is an extradural haematoma associated with
skull fracture middle meningeal artery or venous bleeding good outcome if treated
28
subdural haematoma
complicates 25% of head injuries rupture of veins travelling from the brain to the saggital sinus worse prognosis
29
subarachnoid haemorrhage
ruptured aneurysm or head injury
30
intracerebral head injury
contre coup injury | impact on side of skull
31
what should you say when you contact the neurosurgeons
* Mechanism of injury * Age of patient * Respiratory and cardiovascular status * GCS score & pupil response * Alcohol/drugs * Associated injuries * Results of CT scan
32
what are the signs of herniation
``` dilated or unreactive pupils extensory posturing (decerebrate injury) ``` decrease in gcs of 2 or more
33
what does mannitol do
decreases blood viscosity osmotic duretic decrease icp
34
what is the importance of glucose
tight control improves outcome hypoglycaemia is dangerous enteral nutritional support