Brainscape's Knowledge GenomeTM

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


See full index

Emed/Surg > Head Trauma > Flashcards

Head Trauma Flashcards

1
Q

Ventricles are _____________ filled spaces

A

CSF it is absorbed over the surface of the brain.

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

Normal ICP __________
Critical ICP ____________

A

normal <10
critical > 20

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

The monroe Kellie doctrine states that the total volume of intracranial contents must remain _____________.
If equal venous blood and CSF out =
once the limit is reached, ICP rapidly

A

constant.
OK
INCREASES

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

For airway, what is the worst outcome possible?
You want to avoid bagging in patients who are in _______________ pt gastric dilation can induce vomiting and they can aspirate

A

hypocarbia because can lead to cerebral vasospasm.
active breathing

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

Breathing:
Hypercapnia- increased…
Hypocapnia- decreased…
For ALL head trauma you want to give
CXR

A

morbidity/mortality
cerebral blood flow and decreased cerebral oxygen sat
continuous SPO2%

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

Circulation:
hypotension = increased M/M
How do you treat shock? what do you want to avoid in the treatment?
WATCH FOR CUSHINGS RESPONSE (bodies response to ICP)

A

LR, NS or blood avoid HYPOTONIC saline because it could increase the ICP AND HYPERGLYCEMIA- which is detrimental to ICH.

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

T/F does ICH cause hypotension?

A

FALSE

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

What med is part of the secondary survey? What lab do you want to run because of it?

A

ANTICOAGS, COAGS

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

A mild TBI has a GCS score of __________.
What is the presentation of these patients?

A

14>
asymptomatic with mild amnesia
+/- BRIEF loss of consciousness, usually <30 min
Global HA
N/V

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

The Canadian Head CT Rule is 100% sensitive. It is used in ages _____________ with ______________ head injury.

Obtain CT scan if:
1.
2.
3.
4.
5.
6.

A

16-64
mild

  1. GCS <15 at 2 hours post injury
  2. suspected open/depressed/basilar skull fx
  3. > 2 episodes of vomiting
  4. age > 65
  5. amnesia > 30 min
  6. mechanism
    -ped struck
    -ejection
    -fall from 3+ feet or 5+ stairs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Moderate TBI is a GCS score of ____________.

A

9-13

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

Severe TBI is a GCS score of _____________. You want to ensure to prevent a secondary TBI!!

A

<8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the management of a scalp hematoma/laceration?

A

wash out and close promptly
-keep hair out of wound
-close up to 12 hours post injury
-sutures/staples out in 7-10 days

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

An epidural hematoma (more of a lens shape) is a collection between the ____________ and the skull. Arterial bleeding is present from the _______________ arteries. The pupils will be _________________

A

dura
middle meningeal
fixed/dilated

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

What are the s/s of an epidural hematoma

A

initial, brief, LOC-lucid interval(appears alert and conscious) - rapid neuro deterioration

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

How is an epidrual hematoma managed?

A

emergent neuro sx
control BP/HR
reverse coagulopathy
consider intubation
likely will need OR emergently

17
Q

A subdural hematoma is MORE COMMON. A shearing force on _______________ bridging veins between the ____________ and ______________. It is a ______________ hematoma. There are 3 types:
1.
2.
3.

This is more seen in ___________ and _____________ because they have more space in their brains.

A

venous
dura
arachnoid
concave
1. Acute
2. Chronic
3. Acute/Chronic

elderly, alcoholics

18
Q

What are the s/s of a subdural hematoma?

A

MANY ARE ASYMPTOMATIC- NONFOCALLL!!!!!

HA, diziness, N/V, ataxia, lethargy, wax/wane level of consciousness, focal weakness/paresthesia, coma

19
Q

How does an acute subdural present on imaging? How is it managed?

A

it will show up as bright white. darker blood= chronic.
You want to correct coagulopathy
control HR/BP/O2
Admit to ICU
neurosurgical eval
frequent neuro check
+/- surgical drainage

20
Q

Acute on chronic subdural hematoma occurs after ___________________. The patient experiences increased symptoms. How is it managed?

A

a more recent trauma.

admit to neurosurg
correct coags
control BP
may need evacuation/drainage

21
Q

How is chronic subdural hematoma managed?

A

it is more gray on imaging
admit for observation
if symptomatic- may need drainage
PT/OT

22
Q

When calling neurosurgery for a patient with a hematoma, what do you want to ensure you fill them in on?

A

time of injury
anticoags?
VS- ESP BP
Neuro exam: GCS, any focal deficits?

23
Q

Severe TBI initial management:

For a SEVERE TBI, ensure _______________.
GCS ____________
Prevent ___________
Immobilize the C spine AT ALL TIMES!!!!!!
Neuro checks every __________

A

IMMEDIATE RAPID SEQUENCE INTUBATION
<8
hypoxia
hour

24
Q

Severe TBI initial management:

In a TBI, you want to ensure blood pressure control.

A
  1. AVOID HYPOTENSION
    -decreased cerebral perfusion pressure
    -IV crystalloids, consider blood products
    **SBP goal is 140-160 or 120-140
    **    *MAP >65 (80-90 if SCI)
  2. HTN
    10% reduction of BP
    IV bolus vs Gtt
    Labetolol or hydralazine
  3. Caution with maintenance IVF
    Use NS generally
    NO HYPOTONIC/GLUCOSE CONTANING!!!!!!!
25
Q

Severe TBI initial management:

You want to elevate the HOB _______________
Consider _____________ or 3% normal saline.
PaCo2 _________________
-avoid hyperventilation
Seizure tx/prophylaxis:
1.
2.
3.

A

30-45 degrees
mannitol
30-35 mmHg
1. keppra
2. phenytoin
3. treat seizures with benzos

26
Q

What is the surgical management of severe TBI?

A
  1. intracranial pressure monitor “bolt”
  2. Burr Hole
  3. craniotomy
  4. craniectomy
27
Q

Cerebral contusions(bruising type pattern that will worsen before it gets better) commonly affects the ____________ and ____________ lobes. May have surrounding edema and +/- ____________. The patient will have neurologic dysfunction such as
1.
2.
3.

____________ usually appear when large

contusion >

A

frontal, temporal
SAH

  1. confusion
  2. obtundation
  3. coma

focal deficits
hematoma

28
Q

How is a contusion managed?

A

admit for observation
neurosurg
correct coagulopathy
serial CTs
May go onto require ICP monitor
seizure prophylaxis

29
Q

Traumatic subarachnoid (TSAH) may increase ICP it blocks out __________________________. If its isolated, you want to consider ________________ cause

A

3-4th ventricle
aneurysmal

30
Q

What is the management of traumatic subarachnoid?

A

admit for observation
neuro c/s
serial CT
seizure prophylaxis
if asymptomatic- may D/C home with stable repeat CT and normal exam
AMS/Focal exam- ICP monitor

31
Q

Diffuse axonal injury (DAI) mechanism is _______________. The person has INSTANT __________________. It is a frequent cause of ________________.
Degree of injury > ______________
80% of them is _________________
The patient may have relatively normal head CT but severely diminished GCS. You want to confirm with _____________________

A

shearing forces (high speed MVA)
LOC
post traumatic coma
imaging
nonhemorrhagic
MRI

32
Q

A concussion is trauma induced alteration in mental status which may or may not include a ________________. Many symptoms present such as _______________ and _______________.
retrograde or anterograde. There are no objective CT findings and no timeline for recovery.

You want to avoid _______________

A

LOC
confusion and amnesia
NARCOTICS

33
Q

What are the symptoms of post concussive syndrome?

A

prolonged HA
dizziness
memory impairment

34
Q

When do you admit a patient that had a concussion?

A
  1. persistent amnesia
  2. persistent AMS
  3. inotxication
  4. safe place to be observed
  5. any CT abnormality
35
Q

In peds with head trauma, you want to follow the _____________ rule for low risk head trauma. IF ANY ARE PRESENT (5)
if none are present then D/C

A

PECARN
1. mental status GCS <14
2. LOC > 5 seconds
3. severe mechanism of injury
4. fall >3 feet <2 years old ORRRRRRR > 5ft > 2 years old
5. Physical exam findings consistent with a skull fracture

36
Q

What would be the reason for a kid that had a head trauma to return to the ED?

A

AMS
persistent N/V
numbness/tingling/weakness
severe HA
visual changes

37
Q

What are the two most common areas of basilar fractures?
It can be linear/nondisplaced vs depressed. there is concern for disruption of the ______________ or ______________.

A
  1. petrous portion of temporal bone
  2. occipital condyle

middle meningeal artery, dural sinus

38
Q

What are the s/s of a basilar skull fracture?
What will the CT scan show?
What antibiotic do you want to consider if open?
Closed, nondisplaced fractures > extended observation especially without underlying ICH
Open/displaced > admit

A

hemotympanum
CSF otorrhea/rhinorrhea
racoon eyes
battle sign

CT- pneumocephalus

IV Ancef

Emed/Surg (13 decks)

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