Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Med Final > Head & Neck injury > Flashcards

Head & Neck injury Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

pupil eval- pinpoint bilaterally

A

opiates

pontine lesion

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

pupil eval- right is nml, left is dilated

A

left hematoma-herniation or ocular globe trauma

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

pupil eval- dilated bilaterally

A

increased ICP w/ poor cerebral perfusion
drug effect
bilateral herniation
severe hypoxia

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

The Glasgow Coma Scale general info

A

standardized eval of neurological status
reproducible- can be performed by multiple examiners at different levels of care
predictive of morbidity/mortality

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

GCS eye opening

A

4: spontaneous eye opening
3: eye opening in response to speech- any speech/shout
2: eye opening in response to pain
1: no eye opening

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

GCS best verbal response

A

5: oriented- pt knows who & where they are, why, & yr, season, & month
4: confused conversation- pt responds in conversational manner, w/ some disorientation & confusion
3: inappropriate speech- random or exclamatory speech, w/ no conversation exchange
2: incomprehensible speech- no words uttered, only moaning
1: no verbal response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

GCS best motor response

A

6: carrying out request (‘obeying command’)- pt does simple things you ask
5: localizing response to pain
4: withdrawal to pain-pulls limb away from painful stimulus
3: flexor response to pain-pressure on nail bed causes abnormal flexion of limbs (decorticate posture)
2: extensor posturing to pain- stimulus causes limb extension (decerebrate posture)
1: no response to pain

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

decorticate posture

A

flexor response to pain-pressure on nail bed causes abnormal flexion of limbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

decerebrate posture

A

extensor posturing to pain- stimulus causes limb extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

GCS interpretation

A

13-15: mild head injury
9-12: moderate head injury
3-8: severe head injury

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

A.V.P.U.

A

Alert, or responsive to
Verbal stimuli, or to
Painful stimuli, or
Unresponsive

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

Trauma eval. secondary survey & AMPLE hx

A 
Allergies
Meds (esp. anticoags/antiplatelets)
PMH
Last meal (esp. if surgery is indicated)
Events (what happened just before)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

bradycardia + HTN + irreg. respirations=

A

Cushing’s Triad

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

increased ICP may lead to

A

herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

pupillary response to light in herniation

A

mydriasis ipsilateral to site of 3rd nerve injury

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

motor deficits usually_____________to sight of injury

A

contralateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

look for HEENT signs

A

battler sign
racoon eyes
hematotympanum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what imaging study for head injury

A

CT w/o contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

immediate actions to be taken in head injury

A

IV
Labs: CBC, electrolytes, d-stick, coags, tox screen, ETOH level
monitor, HR, O2 sat, BP

HOB up 30 degrees & manitol 1g/kg IV
non contrast head CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

oxygenate, ventilate, intubate if indicated by

A

GCS<8
hypoxia
hypoventilation
need to sedate for trip to the scanner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

tx presumptively for increased ICP if…

A 
GCS<8
fixed & dilated pupil(s)
decorticate/ decerebrate posturing
bradycardia
HTN
respiratory depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

epidural hematoma

A

bleeding between the inside of the skull & the outer covering of the brain
usually an arterial bleed
doesn’t cross sutures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

epidural hematoma uncommon in

A

infants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

3rd nerve palsy is a sign of

A

cerebral herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

somnolence often occurs how many hours after an accident that causes an epidural hematoma

A

24-96 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

disruption of dural sinuses is a major cause of epidural hematoma in

A

kids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

most common cause of bleed in epidural hematoma is

A

laceration of dural vessels from skull fracture (91%), usually the middle meningeal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

often there is a transient_________then a lucent interval

A

LOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

course of an epidural hematoma

A

hematoma expands
increased ICP, decreased CBF
herniation, ipsilateral CN-3 dysfunction & contralateral paralysis or posturing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

subdural hematoma

A

more common than epidural hematoma
seen in infants & elderly d/t large subarachnoid space w/ freedom to move
caused by damage to subdural veins “bridging veins”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

acute subdural hematoma

A 
manifests hrs after injury
hyperdense (<1 wk)
isodense (1-3 wks)
hypodense (3-4 wks)
underlying brain injury (50%)
worse long term prognosis than epidural hematoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

course of a subdural hematoma

A

may be acute, like epidural hematoma
may have delayed course, days-wks
increased ICP, edema, herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

EtOH increases__________________by increasing the permeability of the blood brain barrier

A

cerebral edema in a subdural hematoma

34
Q

chronic subdural hematoma

A

following minor injury
rarely parenchymal injury
convex configuration

35
Q

interhemispheric subdural hematoma

A

usually posterior

most common acute finding in child abuse (whiplash injury)

36
Q

sub-arachnoid hemorrhage

A

bleeding from small vessels at site of coup/ contrecoup injury
bleeding under arachnoid, spreads in CSF
vasoactive substances in blood contribute to ischemia & ALOC
often occurs directly below external injury
direct rupture of intrinsic cerebral vessels

37
Q

halo’s sign

A

clear drainage that separates from bloddy drainage

suggests presence of CSF

38
Q

basal skull fracture caused by

A

deceleration injury or occipital trauma
seldom fatal (except for race car drivers)
4% of serious head injuries

39
Q

basal skull fracture may involve

A

orbits or sphenoid bone

fracture near foramen magnum

40
Q

basal skull fracture is a separation of suture between what

A

temporal & occipital bones

41
Q

S&S of basal skull fracture

A 
damage to CN III, VII
CSF otorrhea, CSF rhinorrhea (danger of meningitis)
battle's signs
racoon eyes
hematotympanum
42
Q

tx of the seriously head injured pt

A

seizure prevention: IV phenytoin
prevent fever
ctrl bleeding, transfuse to HCT>30
Abx for penetrating injury or basal skull fx
early neurosurgical sonsultation: ventriculostomy, craniotomy

43
Q

tx hypotension in head injury pt

A

resucitate to MAP >90
SBP 120-140 w/ NS
pressors PRN N.B.
isolated head injury unlikely to be HoTN on initial presentation, so look for other injuries!!!

44
Q

control excessive HTN in head injury pts with what

A

Labetolol to reduce BP 20-30%

45
Q

other tx for head injured pt

A

tx hypoxia
intubate & ventilate (increased CO2 dilates vessels & lowers cpp
sedate if needed (NOT katamine)

46
Q

treating increased ICP in head injury

A

target <20, cpp 70-80
raise HOB to 30 degrees
IV mannitol boluses once euvolemic (serum osmolality 280-300)
hyperventilate PCO2 to 26-30- consider only if other measures ineffective
steroids not proven to have benefit in head trauma

47
Q

head injury disposition of GCS 15 w/ resolved sx’s

A

dispo to home w/ vigilant family members & return precautions

48
Q

head injury disposition w/ GCS of 14-15 (“mild injuries”)

A 
admit for observation
neuro exams q 1-4 hrs
IV fluids
analgesia
anti-emetics
repeat head CT if worsening pain, vomiting or adverse change in LOC
49
Q

head injury disposition GCS of 9-13 (“moderate” injuries)

A

admit to ICU
neuro exam q 1-2 hrs
NPO
repeat head CT 6 hrs after admission or promptly if pt worsens
if pt is immobile, DVT prevention may be warranted

50
Q

head injury disposition GCS of 8 or less (“severe” injuries)

A 
admit to ICU w/ hourly neuro exams
NPO
intracranial pressure monitor
analgesia & sedation
tight ctrl of BP & intracranial pressure
seizure prophylaxis
DVT prevention
****expanding hematoma/signs of imminent herniation- to OR for craniotomy
51
Q

eval of mild/moderate head injured pt

A

Hx: MOI, LOC-how long? observed by?, amnesia, pain
PE: neuro & mental status, repeat PRN, HEENT
consider non contrast head CT

52
Q

high risk indications for CT scan

A

GCS 65 yo (some studies suggest >60)
basal skull fx signs: hemotympanum, periorbital bruising (raccoon eyes), mastoid process ecchymosis (battle’s sign), CSF leakage from ear/nose

53
Q

moderate risk indications for head CT

A 
pre-trauma amnesia lasting longer than 30 min
high risk mechanism of injury
pedestrian in MVA
passenger ejected from vehicle
fall from ht >3" or 5 stairs
54
Q

additional head CT indications

A 
drug/ alcohol intoxication
physical findings of trauma above clavicle
seizure
coagulopathy
focal neuro deficit
55
Q

indications for head CT in awake, alert peds pts

A 
CT of head indicated for ALL high risk pts
age < 3 months
skull fxs, < 24 hrs old (intracranial injury in 15-30%)
scalp hematoma predicts skull fx
basal skull signs, scalp depression
depressed mental status
focal neuro deficit
bulging fontanelle
irritability after head injury
56
Q

grade 1 concussion

A

transient confusion w/o amnesia
no LOC
mental status abnormalities resolve w/in 15 min
most common

57
Q

grade 2 concussion

A

transient confusion/amnesia lasting >15 min
no LOC
pt may have retrograde amnesia of events preceding the injury

58
Q

grade 3 concussion

A

LOC

mental status change &/or amnesia is not included in the definition

59
Q

Postconcussion syndrome

A

PE: nystagmus, CN abnormalities, asymmetric m. reflexes, abnormal plantar reflexes, asymmetric hearing loss, electroencephalographic abnormalities. Exertion & stress can aggravate the sx’s

60
Q

tx for postconcussion syndrome

A

analgesia & outpatient neuro/ primary care. No modality of tx clearly shown to alter course

61
Q

postconcussion syndrome sx’s

A

onset 1 day to wks after injury
HA, dizziness, irritability, insomnia, anxiety, impaired attention, impaired memory, sound sensitivity, vertigo, tinnitus, decreased hearing, blurred vision, diplopia, photophobia, reduced taste & smell, depression, change in personality, fatigue, sleep disturbances, reduced libido, decreased appetite, decreased attention, increased info processing time

62
Q

tx of minor head injury

A

d/c for home observation
diminished LOC is predictive of more serious injury
waking pt Q2 hrs not proven, poor compliance
analgesics

63
Q

second impact syndrome

A

an acute, usually fatal swelling of the brain that occurs when a 2nd impact concussion occurs before the sx’s of a previous concussion have fully cleared. Sx’s can include paralysis, mental disabilities & epilepsy. Death occurs in >50% of cases. Controversial

64
Q

return to play protocol day 1

A

light aerobic exercise (walking, swimming, stationary cycling) keeping exercise heart rate <70% of max predicted heart rate. No resistance training

65
Q

return to play protocol day 2

A

sport-specific exercise, any activities that incorporate sport-specific skills. No head impact activities

66
Q

return to play protocol day 3

A

non-contact training drills

67
Q

return to play protocol day 4

A

full contact practice, participate in nml practice activities

68
Q

return to play protocol day 5

A

return to competition

*If any concussion sx’s return during any of the above activities, the athlete should return to the previous level, after resting 24 hrs

69
Q

evaluating neck injured pt

A
  • ABCDE
  • look for neuro impairment before examining neck
  • maintain inline stabilization of neck
  • protect C-spine until done evaluating
70
Q

Risk factors for more severe neck injuries

A

MVC, higher speeds, air bag deployment, intrusion into vehicle/ car totaled
sports: diving, horseback riding, football, gymanstics, skiing, hang gliding
age > 65, arthritis, osteoporosis

71
Q

neck injury- xray vs no xray

A

if yes to the following questions= no xray
1. no posterior midline C-spine tenderness
2. no evidence of intoxication
3. a normal level of alertness
4. no focal neuro deficit
5. no painful distracting injuries
if no to any=xray

72
Q

examples of dangerous mechanisms in neck injuries

A 
fall from >/= 3 ft. or 5 stairs
an axial load to the head
MVA (>100 km/hr, rollover, ejection)
motorized recreational vehicle accident
bicycle collision
73
Q

SCIWORA Syndrome

A

Spinal Cord Injury w/o Radiologic Abnormality

74
Q

SCIWORA

A

occurs most often in peds pop
~2/3 of cervical injuries < 8yo
-elasticity in peds cervical spine is reason

75
Q

causes of SCIWORA

A

-transverse atlantal ligament injury
-fx thru cartilaginous end plates
-unrecognized interspinous ligamentous injury
-for above 2 injuries, take flexion & extension
views
-adult w/ acute traumatic disc prolapse
-cervical spondylosis

76
Q

problems in cervical spondylosis

A

C-spine tramua occurs w/ hyperextension injury to spine w/ vertebral canal whose diameter is already compromised by spondylosis
excessive ant. buckling of ligamentum flavum into canal already compromised by post. vertebral body osteophyts- probably the cause of central cord syndrome

77
Q

what is central cord syndrome (another card is coming up for this)

A
  • motor loss in arms > than in legs, variable sensory loss

- typically pts are managed nonsurgically w/ orthosis & their neuro status is carefully monitored

78
Q

ED tx of cervical injury

A

protect from further injury
IV steroids
traction for unstable fx’s
treat shock

79
Q

central cord syndrome

A

forced hyperextension injury
flaccid paralysis of upper extremities
variable sensory loss
may extend to lower extremities

80
Q

anterior cord syndrome

A

forced hyperflexion, disk herniation or fx
loss of distal motor function & pinprick, pain & temperature sense
vibration, pressure, light touch sensation preserved

81
Q

Brown-sequard syndrome

A

penetrating trauma
complet ipsilateral motor paralysis & loss of vibration, pressure, & all proprioception
contralateral loss of pinprick, pain, & temp sensations

Emergency Med Final (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions