Head injury* Flashcards
Primary brain injury
Secondary brain injury
From time of injury
Due to consequences of injury (partly preventable)
CPP = what
MAP - ICP
what CPP should be aimed for after a head injury
so Map should be what and ICP what
what is the normal ICP
> 60
80 and keeping ICP<20
9-11 (12-15cmH2O)
Types of head injury
open - penetrating (missile)
closed - acceleration/deceleration/rotation (non-missile)
Skull vault fracture types
linear
depressed
compound
types of skull base fracture
anterior cranial fossa - racoon or panda eyes
middle cranial fossa - battle sign over mastoid area
Focal signs
laterlising motor signs
pupillary responses to light (CNIII nerve palsy)
Assessment of head injury
Glasgow Coma scale
Definition of coma
do not open eyes
do not obey command
do not speak
GCS of 8 or less
what kills px with head injury
hypoxia
hypotension
raised ICP
body weight brain cardiac output carried oxygen carried glucose irreversible neuronal damage in how long of circulatory arrest
2% 15% 20% 12% 5 mins
CT scan when
skull fracture
not orientated
focal neurological signs
taking anti coags
List the types of traumatic intracranial bleeding
extradural haematoma subdural haematoma traumatic subarachnoid haemorrhage intracerbral contusion intracerebral haematoma intraventricular haemorrhage
what intensive care management
sedation - reduces metabolic rate and blood flow and ICP
ventilation - adequate oxygenation, normocapnia
BP - CPP >60 aim
normoglycemia
euthermia
what are the following for CSF drainage Mannitol hypertonic saline hyperventilation
reduces ICP
improves micro perfusion
better than mannitol
temp effect (2-4 hours)
