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ATLS > Head trauma > Flashcards

Head trauma Flashcards

1
Q

Primary goal for treated suspected traumatic brain injury

A

Prevent secondary brain injury

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2
Q

Cushing response to raised ICP

A

High BP
Bradycardia
Irregular resps

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3
Q

Monro-Kellie doctrine

A
  • the total volume of the intracranial contents must remain constant -

as mass affects the intracranial closed space, there must be a change in some aspect of the intracranial contents

  • new mass introduced eg tumour or haemorrhage, there will be a shift. CSF and blood equilibrate first, then brain, leading to impending herniation
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4
Q

Uncal herniation

A

Ipsilateral pupillary dilation with contralateral hermiparesis

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5
Q

Uncus and its significance in herniation

A

Medial part of temporal lobe
- herniates through tentorial nortch
- compression of midbrain and contralateral hemiparesis

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6
Q

Normal ICP

A

10 mm Hg

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7
Q

Cerebral perfusion pressure (CPP) =

A

Mean arterial pressure - intracranial pressure

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8
Q

Traumatic brain injury effect of BP on brain

A

MAP too low - ischaemia and infarction

MAP too high - brain swelling

CPP = MAP - ICP

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9
Q

Physical exam findings suggesting cranial or intracranial injury

A

Facial fractures of midface with instability of maxilla/orbital complex

Auditory canal haemorrhage - temporal bone fracture

Retroauricular ecchymosis (battle’s sign) - basal skull fracture

Asymmetric, non reactive pupil - lateralising intracranial haemorrhage, or 3rd nerve injury

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10
Q

Clinical signs of basilar fracture

A

Raccoon eyes
Battle’s sign
Rhinorrhea
Otorrhea
Facial paralysis
Hearing loss

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11
Q

Diffuse intracranial lesions (3 examples)

A

Concussion

Severe injury

Diffuse axonal injury

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12
Q

Concusion

A

Transient, nonfocal neuro disturbance

Often loss of consciousness

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13
Q

Severe diffuse intracranial injury results from

A

Results from hypoxic, ischaemic insult to brain from prolonged shock or apnoea

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14
Q

Diffuse axonal injury

A

Shearing injury
Seen in high velocity impact or deceleration injuries
Often poor outcome

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15
Q

Epidural haematoma

A

Uncommon
Often temporal or temporoparietal regions
Often middle meningeal

Classic presentation: lucid interval
Appear lenticular or biconvex on CT

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16
Q

Subdural haematoma

A

More common than epidural
Typically from shearing of blood vessels of cerebral cortex
Damage is severe due to underlying brain injury

CT: appear to cover cerebral surface

17
Q

Cerebral contusion

A

Fairly common
Mostly frontal and temporal lobes

Can evolve to form intracerebral haematomas or coalescent contusions

Repeat CT scan these in case of progressive change

18
Q

CT head findings that would indicate injury severe enough to warrant intervention

A
  • midline shift
  • loss of definition of basal cisterns
  • severe skull fractures with intrusion into brain matter
19
Q

Elderly patient characteristics to consider in (head) trauma

A

Antiplatelets
Beta blocker
Anticoag

comorbidities: CAD, stent, rate control for arrhythmias

20
Q

Signs for suspected mild brain injury

A

Witnessed LOC
Definite amnesia
Witnessed disorientation in a patient with GCS 13-15

21
Q

Head CT if suspected mild brain trauma and one of the following:

A

High risk for neurosurgical intervention
Moderate risk for brain injury on CT

22
Q

High risk for neurosurgical intervention

A

GCS <15 at 2 hours post injury
Suspected open or depressed skull fracture
Basilar skull fracture sign
Vomiting more than twice
>65 yo
Anticoagulation

23
Q

Moderate risk for brain injury on CT

A

LOC <5 mins
Amnesia before impact >30 mins
Dangerous mechanism (eg height more than 3 feet)

24
Q

Mild brain injury management

A

If abnormal CT or persistent sx, admit and consult neurosurgery

If asymptomatic, awake/alert: observe for several hours, re examine and safely discharge

25
Q

Management of moderate brain injury (GCS 9-12)

A

Brief hx and stabilise pt
Then neuro assessment
CT head –> again in 24 hrs
Contact neurosurgeon
Admit for observation

26
Q

Management of severe brain injury (GCS 3-8)

A

ABCDE
Secondary survey
Admit to neurosurgery centre
Therapeutic agents
- mannitol
- hypertonic saline

27
Q

Priorities for initial evaluation and triage of patients with severe brain injury (5)

A
  1. ABCDE
  2. Neuro exam once BP normalised
  3. Target hypotension - if SBP <100, work out why eg FAST
  4. If SBP >100 after resus and there is intracranial mass, CT head now takes priority over trauma scans
  5. In borderline cases, try to get CT head before laparotomy if possible

The above is true for >110 for patients 15 to 49, or 70+

28
Q

In brain injury, aim partial pressure of CO2 at approximately

A

35 mmHg

29
Q

True or false: intracranial haemorrhage cannot cause haemorrhagic shock

A

True

30
Q

Seizures in traumatic brain injuries should be treated with

A

Benzodiazepines

31
Q

Repeat CT head should be done with 24 hours of head injury in:

A
  • patients with subfrontal/temporal intraparenchymal contusions
  • those on anticoagulation
  • pts older than 65
  • intracranial haemorrhage with a volume of >10ml
32
Q

Clinical signs of basilar skull fracture

A

Raccoon eyes
Battle’s sign
Rhinorrhea
Otorrhea
Facial paralysis
Hearing loss

33
Q

Heparin and LMWH reversal

A

Protamine sulfate

34
Q

Contraindication to mannitol

A

Systemic hypotension

35
Q

Agent for elevated intracranial pressure, esp when hypotensive

A

Hypertonic saline

36
Q

Control acute seizures post traumatic brain injury with

A

Phenytoin

37
Q

Diagnostic criteria for brain death (5)

A

GCS 3
Non reactive pupils
Absent brainstem reflexes
No spontaneous ventilatory effort
Absence of confounding factors such as alcohol, drug intoxication or hypothermia

ATLS (14 decks)

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