Head trauma

Question 1

what is a linear skull fracture?

Answer 1

the most common type, resembles a line. There is no gross deformity in a linear fracture and it can be diagnosed only through a radiograph.

Question 2

what is depressed skull fracture?

Answer 2

bone ends are pushed inward toward the brain.

Question 3

what is a closed skull fracture?

Answer 3

the skull is fractured but there isn’t an open wound to the overlying scalp.

Question 4

what is a open skull fracture?

Answer 4

a fracture of the skull with an associated open wound to the scalp.

Question 5

With a depressed skull fracture, what do you typically do?

Answer 5

Typically, the depression is palpated in the area of the fracture.

Question 6

When does a depressed skull fracture pose harm?

Answer 6

if the bone ends damage the brain tissue.

Question 7

An open wound to the scalp allows for what?

Answer 7

the possibility that bacteria and other contaminants will enter the skull and infect the brain.

Question 8

What will happen If the dura mater is damaged?

Answer 8

cerebrospinal fluid can leak from the open wound.

Question 9

What is a basilar skull fracture?

Answer 9

a fracture to the floor or bottom of the cranium. This fracture often begins as a linear temporal fracture that extends downward and continues into the base of the skull.

Question 10

S/S for basilar skull fracture

Answer 10

cerebrospinal fluid from the ears, nose, or mouth, ecchymosis (bruise-type discoloration) around the eyes (raccoon eyes) and behind the ears (battle signs) often occurs with a basilar skull fracture; however, it often takes several hours for the bruising to appear.

Question 11

What are primary brain injuries?

Answer 11

direct (from penetrating trauma) Indirect (from a blow to the skull)

Question 12

What are secondary brain injuries?

Answer 12

secondary (for example, from a lack of oxygen, buildup of carbon dioxide, or change in blood pressure).

Continued brain damage resulting after the initial injury is called secondary brain injury.

Question 13

what can cause primary brain injury?

Answer 13

direct impact, acceleration/deceleration, or penetrating wound

Question 14

What may result from primary brain injury?

Answer 14

contusion, laceration, or bleeding in the brain

Question 15

What does a secondary brain injury increase?

Answer 15

Increases % chances of mortality

Ex: Single event of Hypoxemia associated with 150% increase in mortality rate

Question 16

what conditions worsen secondary Brain Injuries?

Answer 16

Hypoxemia,

Hypercarbia,

Hypo/Hyperglycemia,

hypotension

Question 17

What to establish with secondary Brain injury?

Answer 17

Patent Airway
Adequate ventilation and oxygenation
Systolic higher than 90
Normal body core temp
Normal blood glucose level

Question 18

why is brain herniation so dangerous?

Answer 18

Compression of the brain causes it to dysfunction. Pushing the brain downward and out of the foramen magnum or through the tentorium compresses the brainstem, destroying vital functions including the heartbeat, respirations, and blood pressure

Question 19

Major symptoms of brain herniation

Answer 19

• Dilated or sluggish pupil on one side from compression of the third cranial nerve
• Weakness or paralysis
• Severe alteration in consciousness
• Posturing (decorticate, also called flexion; decerebrate, also called extension)—also known as nonpurposeful movement
• Abnormal ventilation pattern
• Cushing reflex (increased systolic blood pressure
  and decreased heart rate)

Question 20

patho of brain herniation?

Answer 20

With a rise in ICP, the brain is eventually compressed and pushed out of its normal position, downward toward and through the foramen magnum, which is the large opening in the base of the skull or other openings in the tentorium.

Question 21

Why is an open head injury more severe?

Answer 21

Diffuse axonal injury. DAI is the tearing of the brains connective tissue fibers. This could result in delayed reactions

Question 22

What is a concussion?

Answer 22

a mild diffuse axonal injury which involves stretching, tearing, and shearing of the brain tissue

Question 23

What is coup/contracoup injury?

Answer 23

acceleration/deceleration injury

Question 24

patho of an coup/contrecoup injury?

Answer 24

the head comes to a sudden stop but the brain continues to move back and forth
inside the skull, resulting in bruising (possibly severe)
to the brain.

Question 25

S/S of contusion?

Answer 25

* Decreasing mental status or unresponsiveness * Paralysis * Unequal pupils * Vomiting * Alteration of vital signs * Profound personality changes

Question 26

What is a general about concussion patient's mental status?

Answer 26

Generally, a concussion presents with an altered mental status that progressively improves. If the mental status does not improve, if it improves and then worsens, or if it deteriorates from when you arrived on the scene, suspect a type of head injury other than concussion.

Question 27

What is a contusion?

Answer 27

bruising and swelling of the brain tissue

Question 28

S/S of a concussion?

Answer 28

* Momentary confusion * Confusion that lasts for several minutes * Inability to recall the incident and, sometimes, the period just before it (retrograde amnesia) and after it (anterograde amnesia) * Repeated questioning about what happened * Mild to moderate irritability or resistance to treatment * Combativeness * Inability to answer questions or obey commands appropriately * Nausea and vomiting * Restlessness

Question 29

Key characteristics of concussion?

Answer 29

its effects appear immediately or soon after impact, and then they gradually disappear. An injury that causes symptoms that develop several minutes after an incident or symptoms that do not subside over time is not a concussion, but a more serious injury.

Question 30

patho/where does a subdural hematoma occur?

Answer 30

a collection of blood between dura mater and arachnoid layer of the meninges, typically due to traumatic injuries.

Question 31

type of bleeding in a subdural hematoma?

Answer 31

Bleeding is venous, resulting from torn bridging veins

Question 32

the types of subdural hematoma

Answer 32

Acute = immediate (w/in 72 hours) or Occult/chronic = continual bleeding (weeks or months post injury)

Question 33

Who is at risk the most with subdural hematoma?

Answer 33

There’s an increased risk with hemophiliacs even with minimal injuries and with people who’re taking anticoagulant drugs

Question 34

S/S of subdural hematoma?

Answer 34

headache, confusion, changes in consciousness, & facial neurological deficits Condition is confirmed via CT or MRI imaging

Question 35

where does the hematoma occur in a epidural hematoma and type of bleeding?

Answer 35

In an epidural hematoma, arterial or venous bleeding pools between the skull and the dura (protective covering of the brain)

Question 36

in a epidural hematoma, why is it almost always associated w/skull fractures?

Answer 36

associated w/skull fractures - focuses around temporal region due to proximity of meningeal arteries

Question 37

describe the bleeding in a epidural hematoma?

Answer 37

Bleeding is rapid, profuse, and severe, increasing intracranial pressure

Question 38

S/S of epidural hematoma?

Answer 38

decreasing mental status (the common presentation) * Loss of responsiveness followed by return of responsiveness (lucid interval) and then rapidly deteriorating responsiveness (a presentation that occurs in only 20 percent of cases) * Severe headache * Fixed and dilated pupil * Seizures * Vomiting * Apnea or abnormal breathing pattern * Systolic hypertension and bradycardia (Cushing reflex) * Posturing (withdrawal or flexion)

Question 39

treating epidural hematoma?

Answer 39

immediate surgical attention such as a craniotomy (prevents brain damage and death)

Question 40

Glasgow Coma Scale

Answer 40

Eye Opening Spontaneous 4 To verbal command 3 To pain 2 No response 1 Verbal Response Oriented and converses 5 Disoriented and converses 4 Inappropriate words 3 Incomprehensible sounds 2 No response 1 Motor Response Obeys verbal commands 6 Localizes pain 5 Withdraws from pain (flexion) 4 Abnormal flexion in response to pain (decorticate rigidity) 3 Extension in response to pain (decerebrate rigidity) 2 No response 1

Question 41

GCS rating severity

Answer 41

GCS Score Head Injury Severity 14–15 Mild 9–13 Moderate 3–8 Severe

Question 42

BP

Answer 42

if the systolic blood pressure is high or rising, suspect pressure inside the skull; if it is low or dropping, suspect blood loss from other sources that has led to shock.

Question 43

HR

Answer 43

f the heart rate is fast or increasing, suspect hemorrhage elsewhere in the body or early onset of hypoxia. If it is slow or decreasing, suspect pressure inside the skull or severe hypoxia.

Question 44

Respiration

Answer 44

The patient might display several different respiratory patterns if the brain is compressed from increased intracranial pressure resulting from swelling and/or bleeding inside the skull. The respirations might be extremely fast and shallow, completely irregular, or absent (apnea). A sign of severe head injury, increasing intracranial pressure, and possible herniation is the Cushing reflex, in which the systolic blood pressure increases and the heart rate decreases. The respiratory pattern might also change and become irregular.

Question 45

Cushing reflex

Answer 45

the systolic blood pressure increases and the heart rate decreases. (opp of shock)

Question 46

Questions to ask during history?

Answer 46

* When did the incident occur? * What is the patient’s chief complaint? Did he feel pain, tingling, numbness, or paralysis? Where? How have symptoms changed since the accident? * How did the accident occur? Does he remember the accident? * Did he lose consciousness at any time? This information is critically important in assessing a brain injury. How long was the period of unresponsiveness? When did it occur in relation to the injury? Did the patient suddenly lose consciousness and then gradually reawaken, or did he pass out immediately, suddenly wake up, and then gradually lose consciousness again? * Was the patient moved after the incident? * Is there any history of a previous injury to the head? If so, when did it occur? Was the patient knocked unconscious? Sometimes an injury to the head days or weeks after an incident in which a patient was knocked unconscious can reinjure the brain.