Head trauma

Question 1

What are the majority of TBIs classified as?

Answer 1

Concussion (65%)

Question 2

How much CSF is in the brain?

Answer 2

150mL

Question 3

What is mean arterial pressure?

Answer 3

Pressure driving blood into the brain

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

Question 4

What is cerebral perfusion pressure?

Answer 4

Pressure to push blood in cerebral circulation to maintain O2

• BP and ICP

** CPP = MAP - ICP

Question 5

What is normal CPP?

Answer 5

70-80mmhg

Question 6

Dura mater is?

Answer 6

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

Question 7

Pia mater is?

Answer 7

closely adhered to the brain

Question 8

Arachnoid membrane is?

Answer 8

layered on top of blood vessels adhered to pia

Question 9

What cushions the brain?

Answer 9

CSF

Question 10

What CN controls pupillary constriction?

Answer 10

III, herniation in the brain causes pupillary dilation

Question 11

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

Answer 11

Vasoconstriction

Question 12

How does hyperventilating help with ICP?

Answer 12

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

Question 13

What are primary brain injuries?

Answer 13

Direct trauma

Question 14

What are secondary brain injuries?

Answer 14

Ongoing process from primary injury

Question 15

What is mass effect?

Answer 15

Elevated ICP which can lead to herniation

Question 16

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

Answer 16

• Increased ICP (>20)

* Hypotension (<90 systolic)

Question 17

Does the brain need sugar?

Answer 17

Yes, without glucose, neurons will become damaged

Question 18

What should systolic be maintained at ?

Answer 18

Above 90

Question 19

What is Cushing’s triad?

Caused by hypoxic brain leading to vasoconstriction

** ICP

Answer 19

Increased BP
Bradycardia
Abnormal Resp (Cheyne-Stokes)

Question 20

What is the single most important observation for TBI?

Answer 20

Mental status

Question 21

Basilar fracture signs?

Answer 21

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

Question 22

Where does Epidural Hematoma present?

Answer 22

Between skull and dura mater

Question 23

Hx of epidural hematoma?

Answer 23

• Low velocity blow to temporal bone

Question 24

Hallmarks of epidural hematoma?

Answer 24

• Lucid intervals of consciousness
• Dilated pupils
• sluggish non reactive pupil

Question 25

Subdural hematomas location?

Answer 25

Between dura and arachnoid membrane

Question 26

History of subdural hematomas?

Answer 26

More severe brain injury * MVC * Fall

Question 27

Where does SAH occur

Answer 27

arachnoid membrane

Question 28

What is the most common cause of SAH?

Answer 28

Post traumatic

Question 29

Symptoms of SAH?

Answer 29

* Severe HA * N/V * Dizzy * Meningeal signs * Seizures

Question 30

Does SAH cause Mass effect?

Answer 30

No Mass Effect = Increased ICP leading to herniation

Question 31

What head trauma causes mass effect?

Answer 31

Subdural hemorrhage

Question 32

All penetrating brain injuries result in?

Answer 32

Open fracture

Question 33

When is controlled hyperventilation used for TBI?

Answer 33

Signs of herniation: * Dilate pupil * Posturing * No motor response

Question 34

IV fluids for TBI?

Answer 34

Hypertonic solution (D10W)

Question 35

Red flags for TBI?

Answer 35

(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

Question 36

How long is the rest period for TBI?

Answer 36

24 hours

Question 37

What exam is conducted for TBI?

Answer 37

MACE 2 exam | >25 is normal

Question 38

Pain management for brain injury?

Answer 38

Tylenol 48hrs ** Avoid immediate use of NSAIDS and narcotics (increases bleeding)

Question 39

If asymptomatic at rest, what exam is conducted?

Answer 39

Exertional Testing | * 65-85% target heart rate for 2 minutes

Question 40

When to return to duty?

Answer 40

* Asymptomatic and first concussion in 12 months | * Asymptomatic but second concussion, stage 2 light activity for 5 days with NSI screening daily

Question 41

What are stage 2 activities?

Answer 41

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.

Question 42

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

Answer 42

Stage 3, 4, and 5

Question 43

Stage 3?

Answer 43

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

Question 44

Stage 4?

Answer 44

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

Question 45

Stage 5

Answer 45

Just don't drink

Question 46

Dispo for TBI?

Answer 46

MEDADVICE