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Trauma > Head trauma > Flashcards

Head trauma Flashcards

1
Q

What are the majority of TBIs classified as?

A

Concussion (65%)

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2
Q

How much CSF is in the brain?

A

150mL

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3
Q

What is mean arterial pressure?

A

Pressure driving blood into the brain

  • Systole + Diastole x 2/3
  • Diastole + 1/3 pulse pressure
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4
Q

What is cerebral perfusion pressure?

A

Pressure to push blood in cerebral circulation to maintain O2

  • BP and ICP

** CPP = MAP - ICP

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5
Q

What is normal CPP?

A

70-80mmhg

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6
Q

Dura mater is?

A

inside the skull, tough fibrous layer, Epidural space (potential space)

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7
Q

Pia mater is?

A

closely adhered to the brain

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8
Q

Arachnoid membrane is?

A

layered on top of blood vessels adhered to pia

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9
Q

What cushions the brain?

A

CSF

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10
Q

What CN controls pupillary constriction?

A

III, herniation in the brain causes pupillary dilation

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11
Q

What do decreased levels of CO2 cause in the blood vessels?

A

Vasoconstriction

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12
Q

How does hyperventilating help with ICP?

A

Causes less CO2 which leads to vasoconstriction which then can assist with reducing ICP

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13
Q

What are primary brain injuries?

A

Direct trauma

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14
Q

What are secondary brain injuries?

A

Ongoing process from primary injury

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15
Q

What is mass effect?

A

Elevated ICP which can lead to herniation

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16
Q

What are the 2 biggest predictors to poor outcome in head trauma?

A
  • Increased ICP (>20)

* Hypotension (<90 systolic)

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17
Q

Does the brain need sugar?

A

Yes, without glucose, neurons will become damaged

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18
Q

What should systolic be maintained at ?

A

Above 90

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19
Q

What is Cushing’s triad?

Caused by hypoxic brain leading to vasoconstriction

** ICP

A

Increased BP
Bradycardia
Abnormal Resp (Cheyne-Stokes)

20
Q

What is the single most important observation for TBI?

A

Mental status

21
Q

Basilar fracture signs?

A

suspect if CSF drainage or delayed (several hours) findings of periorbital ecchymosis or battle signs are seen

22
Q

Where does Epidural Hematoma present?

A

Between skull and dura mater

23
Q

Hx of epidural hematoma?

A
  • Low velocity blow to temporal bone
24
Q

Hallmarks of epidural hematoma?

A
  • Lucid intervals of consciousness
  • Dilated pupils
  • sluggish non reactive pupil
25
Q

Subdural hematomas location?

A

Between dura and arachnoid membrane

26
Q

History of subdural hematomas?

A

More severe brain injury

  • MVC
  • Fall
27
Q

Where does SAH occur

A

arachnoid membrane

28
Q

What is the most common cause of SAH?

A

Post traumatic

29
Q

Symptoms of SAH?

A
  • Severe HA
  • N/V
  • Dizzy
  • Meningeal signs
  • Seizures
30
Q

Does SAH cause Mass effect?

A

No

Mass Effect = Increased ICP leading to herniation

31
Q

What head trauma causes mass effect?

A

Subdural hemorrhage

32
Q

All penetrating brain injuries result in?

A

Open fracture

33
Q

When is controlled hyperventilation used for TBI?

A

Signs of herniation:

  • Dilate pupil
  • Posturing
  • No motor response
34
Q

IV fluids for TBI?

A

Hypertonic solution (D10W)

35
Q

Red flags for TBI?

A

(a) Deteriorating level of consciousness
(b) Double vision
(c) Increased restlessness, combative, or agitated behavior
(d) Repeated vomiting
(e) Seizures
(f) Weakness or tingling in arms or legs
(g) Severe or worsening headache
(h) Unsteady on feet
(i) One pupil larger or smaller than the other
(j) Changes in hearing, taste or vision
(k) Repeated episodes of blacking out or passing out

36
Q

How long is the rest period for TBI?

37
Q

What exam is conducted for TBI?

A

MACE 2 exam

>25 is normal

38
Q

Pain management for brain injury?

A

Tylenol 48hrs

** Avoid immediate use of NSAIDS and narcotics (increases bleeding)

39
Q

If asymptomatic at rest, what exam is conducted?

A

Exertional Testing

* 65-85% target heart rate for 2 minutes

40
Q

When to return to duty?

A
  • Asymptomatic and first concussion in 12 months

* Asymptomatic but second concussion, stage 2 light activity for 5 days with NSI screening daily

41
Q

What are stage 2 activities?

A

a) You may wear a uniform and boots
b) May perform these activities no longer than 30 minutes – walk, stretch, ride a stationary bike at slow pace with low resistance, no light housework, use the computer, play simple games, such as cards.

42
Q

If symptom free following 5 days of Stage 2 activity then may progress?

A

Stage 3, 4, and 5

43
Q

Stage 3?

A

no longer than 60 minutes

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

44
Q

Stage 4?

A

90 minutes

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

45
Q

Stage 5

A

Just don’t drink

46
Q

Dispo for TBI?

Trauma (18 decks)

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