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Surgery > Head Trauma > Flashcards

Head Trauma Flashcards

1
Q

MC cause of mortality following trauma is

A

Head trauma

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2
Q

Scalp laceration management in emergency cases

A

Apply pressure

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3
Q

Scalp laceration definitive management

A

Suture; silk or nylons
Cutting or reverse cutting needle

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4
Q

how does loose areolar tissue can cause cavernous sinus thrombosis ?

A

They contain emissary veins, which carry, retrograde infection

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5
Q

Where is the dangerous area of face?

A

Lower part of the nose and upper lip. Any local infection in this area can spread retrograde to cause cavernous sinus thrombosis. 

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6
Q

In Anterior cranial fossa fracture there is fracture of

A

Cribriform plate

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7
Q

Raccoon eyes / periorbital ecchymosis are associated with

A

Subaponeurotic bleeding(anterior cranial fossa)

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8
Q

Black eyes are associated with

A

Subconjunctival hemorrhage

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9
Q

What is target /halo sign

A

To differentiates CSF rhinorrhea from epistaxes. There will be a central circle of blood and outer circle of CSF. 

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10
Q

Which biochemical marker is seen in CSF?

A

β2 transferrin

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11
Q

What is paradoxical rhinorrhea?

A

CSF accumulates in the middle year and travels down through eustachian tube and comes out through nasal cavity 
Seen in middle cranial fossa fracture

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12
Q

Middle cranial fossa fracture included

A

Fracture of petrous Part of temporal lobe

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13
Q

Posterior cranial fossa fracture included

A

Fracture of occipital bone

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14
Q

CF of posterior cranial fossa fracture

A

Visual problem
Occipital contusion
6th nerve injury(longest intracranial nerve)
Vernet syndrome

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15
Q

What is vernet syndrome

A

Jugular foramen syndrome
(Injury to 9 th to 11th CN)

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16
Q

What are the indications to involve a neurosurgeon?

A

• GCS <= 8.
• Fall in GCS after admission.
• Unexplained confusion > 4 hours.
• Loss of consciousness.
• Seizures.
• > I episode of vomiting.
•ENT bleed.
• Focal neurological signs.
• Penetrating CNS injury.

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17
Q

Indications to carry out NCCT in head injury

A

• GCS < 13.
• If GCS fails to reach 15 within a hours of admission.
• Loss of consciousness.
• seizures.
• > I episode of vomiting.
• ENT bleed
• Focal neurological signs.
• Penetrating CNS injury.

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18
Q

What to suspect if there is hypovolemic shock is present ?

A

Blood on floor ;;
Blood in the thorax , abdomen , pelvis , long bone fracture

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19
Q

Colorado claudication for traumatic concussion

A

Concussion seen during contact sport .
Type 1: confusion ,
Type 2 : Amnesia ,
Type 3 : Loss of consciousness

20
Q

Management of concussion.

A

Rest , Take a break from contact sports

21
Q

What is Post concussion syndrome

A

Repeated concussions can cause personality/behavioral changes later on (Chronic traumatic encephalopathy)

22
Q

Most severe type of brain injury is

A

Diffuse axonal injury (shearing force between grey and white matter)

23
Q

HPE of diffuse axonal injury

A

Clubbed axons / retraction balls

24
Q

What is the most common type of traumatic brain bleed

A

Contusion: Intraparenchymal hemorrhage

25
Q

What is the most common site of Intraparenchymal hemorrhage

A

Temporal region > frontal region

26
Q

Lucid interval is seen in

A

EDH ( not pathognomic)

27
Q

IN EDH what is seen On NCCT

A

Biconvex / lens shaped appearance/ lentiform

28
Q

Most common site where EDH occurs

A

Pterion

29
Q

Indications for craniotomy in EDH

A

• > 30 cc clot size.
• > 5 mm midline shift
• > 1.5 cm thickness

30
Q

When craniotomy is not available Burr hole / craniotomy is done at

A

On the side of the dilated pupil ( if there is no localizing sign best choice would be to do a butt hole in the dominant hemisphere, most commonly the left temporal region)

31
Q

What is false localizing sign (Kernohan’s notch phenomenon )

A
  • Left sided EDH -> Left dilated pupil
  • Temporal/uncal herniation on left side
  • Presses on the corticospinal tract of the right side (Kernohan’s notch)
  • Left hemiparesis
32
Q

Impacted vessels in EDH

A

MMA

33
Q

Impacted vessels in SDH

A

Cortical bridging veins

34
Q

What would you see on NCCT of patient presented with SDH

A

Concavo-convex / crescentic hemorrhage

35
Q

What are the indications of craniotomy in SDH

A

• > I cm thickness.
• > 5 mm midline shift.
Any two out of these three
• > 2 points GCS fall.
• ICP > 20 mmHg.
• Fixed dilated pupil.
Extent of brain injury is more in SDH > EDH.

36
Q

What is monro-kellie doctrine

A

States that the skull is a fixed space with components like brain, CSF, venous blood and arterial blood. The skull has tremendous capacity to compensate for an increasing mass or bleed ( by pushing
out CSF or reducing venous volume), but once the point of decompensation is met, there can be rapid increase in ICP and hemiation.

37
Q

CPP =

A

MAP-ICP
CPP >=60 mmHg

38
Q

Crushing reflex is described as

A

Bradycardia
Hypertension
Altered respiration

39
Q

Cushing’s ulcer

A

Stress ulcer in head injury

40
Q

Steroids used in

A

Vasogenic cerebral edema

41
Q

Goal of treatment in head injury

A

Pulse oximetry > 95%.
ICP : 20-25 mmg.
CPP 2 60 mmHg.
Glucose : 80- 180 mg/d.
SBP >=100 mmHg.

42
Q

Criteria of brain death

A

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

43
Q

Glasgow outcome score

A

Prognostic score following head injury

  1. Death.
  2. Persistent vegetative state.
  3. severe disability.
  4. moderate disability.
  5. Good recovery.
44
Q

Which is the first reflects that you will expect to repair reappear after a spinal shock

A

Bulbocavernosus reflex

45
Q

Causes of secondary brain injury

A

• Hypoxia
• Hypotension
• Raised ICP >20 mmHg
• Low cerebral perfusion pressure
• Hypercapnea
• Hyperthermia
• Seizures
• Metabolic disturbance (hyperglycemia)

Surgery (30 decks)

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