Head trauma Flashcards
what is a linear skull fracture?
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.
what is depressed skull fracture?
bone ends are pushed inward toward the brain.
what is a closed skull fracture?
the skull is fractured but there isn’t an open wound to the overlying scalp.
what is a open skull fracture?
a fracture of the skull with an associated open wound to the scalp.
With a depressed skull fracture, what do you typically do?
Typically, the depression is palpated in the area of the fracture.
When does a depressed skull fracture pose harm?
if the bone ends damage the brain tissue.
An open wound to the scalp allows for what?
the possibility that bacteria and other contaminants will enter the skull and infect the brain.
What will happen If the dura mater is damaged?
cerebrospinal fluid can leak from the open wound.
What is a basilar skull fracture?
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.
S/S for basilar skull fracture
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.
What are primary brain injuries?
direct (from penetrating trauma) Indirect (from a blow to the skull)
What are secondary brain injuries?
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.
what can cause primary brain injury?
direct impact, acceleration/deceleration, or penetrating wound
What may result from primary brain injury?
contusion, laceration, or bleeding in the brain
What does a secondary brain injury increase?
Increases % chances of mortality
Ex: Single event of Hypoxemia associated with 150% increase in mortality rate
what conditions worsen secondary Brain Injuries?
Hypoxemia,
Hypercarbia,
Hypo/Hyperglycemia,
hypotension
What to establish with secondary Brain injury?
Patent Airway
Adequate ventilation and oxygenation
Systolic higher than 90
Normal body core temp
Normal blood glucose level
why is brain herniation so dangerous?
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
Major symptoms of brain herniation
- 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)
patho of brain herniation?
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.
Why is an open head injury more severe?
Diffuse axonal injury. DAI is the tearing of the brains connective tissue fibers. This could result in delayed reactions
What is a concussion?
a mild diffuse axonal injury which involves stretching, tearing, and shearing of the brain tissue
What is coup/contracoup injury?
acceleration/deceleration injury
patho of an coup/contrecoup injury?
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.
S/S of contusion?
- Decreasing mental status or unresponsiveness
- Paralysis
- Unequal pupils
- Vomiting
- Alteration of vital signs
- Profound personality changes
What is a general about concussion patient’s mental status?
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.
What is a contusion?
bruising and swelling of the brain tissue
S/S of a concussion?
- 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
Key characteristics of concussion?
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.
patho/where does a subdural hematoma occur?
a collection of blood between dura mater and arachnoid layer of the meninges, typically due to traumatic injuries.
type of bleeding in a subdural hematoma?
Bleeding is venous, resulting from torn bridging veins
the types of subdural hematoma
Acute = immediate (w/in 72 hours) or
Occult/chronic = continual bleeding (weeks or months post injury)
Who is at risk the most with subdural hematoma?
There’s an increased risk with hemophiliacs even with minimal injuries and with people who’re taking anticoagulant drugs
S/S of subdural hematoma?
headache, confusion, changes in consciousness, & facial neurological deficits Condition is confirmed via CT or MRI imaging
where does the hematoma occur in a epidural hematoma and type of bleeding?
In an epidural hematoma, arterial or venous bleeding pools between the skull and the dura (protective covering of the brain)
in a epidural hematoma, why is it almost always associated w/skull fractures?
associated w/skull fractures - focuses around temporal region due to proximity of meningeal arteries
describe the bleeding in a epidural hematoma?
Bleeding is rapid, profuse, and severe, increasing intracranial pressure
S/S of epidural hematoma?
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)
treating epidural hematoma?
immediate surgical attention such as a craniotomy (prevents brain damage and death)
Glasgow Coma Scale
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
GCS rating severity
GCS Score Head Injury Severity
14–15 Mild
9–13 Moderate
3–8 Severe
BP
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.
HR
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.
Respiration
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.
Cushing reflex
the systolic blood pressure
increases and the heart rate decreases. (opp of shock)
Questions to ask during history?
- 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.
