Head trauma

Question 1

Management of penetrating head trauma

Answer 1

surgical intervention

Question 2

management of linear skull fractures

Answer 2

closed - left alone. Open - wound closuore. Depressed - treated in the OR

Question 3

Management of head trauma with unconsciouness

Answer 3

CT scan. If negative and neurologically intact, sent home if family wakes them frequently over next 24 hours to prevent coma

Question 4

Fracture of base of skull - signs, assessment, contraindicated procedure

Answer 4

racoon eyes, runny nose, runny ears, ecchymosis behind ear. Assess integrity of cervical spine with CT. Avoid endotracheal intubation

Question 5

Clinical picture and imaging of acute epidural hematoma

Answer 5

Modest trauma to side of head, unconsciouness, lucid interval, gradual lapsing to coma, fixed dilated pupil, contralateral hemiparesis. CT reveals biconvex (lens shape) hematoma

Question 6

Management of acute epidural hematoma

Answer 6

Craniotomy

Question 7

Clinical picture and imaging of acute subdural hematoma

Answer 7

Severe trauma, sicker, severe neurological damage. CT reveals semilunar (crescent) hematoma

Question 8

Management of acute subdural hematoma

Answer 8

Reduce damage from increased ICP: elevate head, hyperventilate, avoid fluid overload (diurese), reduce oxygen demand of brain (sediation or hypothermia)

Question 9

Imaging and management of diffuse axonal injury

Answer 9

CT shows diffuse blurring of gray-white matter interface and hemorrhages. Prevent damage from increased ICP

Question 10

Clinical picture of chronic subdural hematoma

Answer 10

Old or alcoholic patient. Shrunken brain is shaken by minor trauma, treaing venous sinuses -> chronic mental function deterioration and hematoma formation.

Question 11

Management of chronic subdural hematoma

Answer 11

Surgical evacuation

Question 12

Can intracranial bleeding cause hypovolemic shock

Answer 12

No!