Head Trauma Flashcards
Criteria for a “Present Airway”
Patient is conscious and speaking in a normal tone of voice.
Criteria for Needing an Airway
- Expanding Hematoma
- Emphysema in the Neck
- Unconscious
- Breathing Noisily or Gurgly
- Severe Inhalation Injury
Most Common Method of Maintaining Secured Airway
Orotracheal Intubation
How do you intubate orotracheally?
- Direct Vision with Laryngoscope
- Monitor Pulse Oximetry
T/F: If there is a possible cervical spinal injury and needing airway securement, you should deal with the cervical spinal injury to avoid paralysis in the patient.
False, you’ll stabilize the head, but airway clearance is first!
Second Line Intubation Technique
Nasopharyngeal Inutbation
Third Line Intubation Technique
Fiber Optic Bronchoscope
When is third line intubation (Fiber Optic Bronchoscope) mandatory to use?
- Subcutaneous Emphysema (major sign of traumatic dirutpion in the tracheobronchial tree).
In the setting where we need an airway, but cannot intubate, what should we do?
Cricothyroidotomy
What would cause an inability to intubate?
- Laryngospams
- Severe Maxillofacial Injuries
- Impacted Foreign Body
Clinical Signs of Shock
- Low BP
- Fast Feeble Pulse
- Low Urinary Output (under 0.5 mL/kg/h)
- Pale, Cold, Shivering, Sweating, Thirsty, Apprehensive
What can cause shock in trauma case?
- Bleeding (Hypovolemic-hemorrhagic)
- Pericardial Tamponade
- Tension Pneumothorax
Physical Findings of Pericardial Tamponade
- Blunt or Penetrating Chest Trauma
- High CVP
- No Resp. Distress
Physical Findings of Tension Pneumothorax
- Blunt or Penetrating Chest Trauma
- High CVP
- Severe Resp. Distress
- No Breath Sounds, Hyperresonant on one side
- Mediastinum is displaced to opposite side.
Treatment of Hemorrhagic Shock with Big Trauma Center Nearby
First, Surgical removal of source
Then, Volume replacement
Treatment of Hemorrhagic Shock without Big Trauma Center Nearby
First, Volume Replacement (2L LR -> PRBC until Urine Output 0.5-2.0 mL/kg/h)
* Watch for CVP! Do not want above 15 mmHg
Management of Pericardial Tamponade
!Prompt Evacuation of Pericardial Sac, via;
- Pericardiocentesis
- Tube
- Pericadial Window
- Open Thoracotomy
*IV Fluids and Blood also helpful simultaneously.
Management of Tension Pneumothorax
Start with Big Needle or Big IV Catheter into the Pleural Space
- Follow with Chest Tube with Underwater Seal
This type of head trauma requires surgical intervention and repair of the damage. It involves piercing the skin/skull
Penetrating Head Trauma
This type of skull fracture via head trauma does not require intervention if there is a closed wound. However, if there is an open wound, you can just close it and let it heal.
Linear Skull Fractures
This type of skull fracture via head trauma requires surgical intervention.
- Comminuted Fractures
- Depressed Fractures
An unconscious patient comes in with head trauma, what do you do? Why?
CT!!!
- Possible intracranial hematoma
When a patient comes in with head trauma, CT is negative, and they are neurologically intact. When can they be discharged?
After 24 hours observation to make sure a coma doesn’t happen.
Signs of Basilar Skull Fracture
- Racoon Eyes
- Rhinorrhea
- Otorrhea
- Ecchymosis behind ear
Management of Basilar Skull Fracture
- Expectant Management
- Evaluate the Cervical Spine (CT Scan)
AVOID NASOPHARYNGEAL INTUBATION
This type of hematoma occurs with modest trauma to the side of the head and has classic sequence of trauma.
Acute Epidural Hematoma
Sequence of Head Trauma
- Unconsciousness
- Lucid interval
- Gradual lapsing into coma again
- Fixed dilated pupil (Usually on affected side)
- Contralateral hemiparesis with decerebrate posture.
CT Scan Results of Acute Epidural Hematoma
- Biconvex, lens hematoma
Treatment of Acute Epidural Hematoma
Emergency Craniotomy
This type of hematoma appears as a more advanced version of an Acute Epidural Hematoma; appears sicker, more neurologic damage.
Acute Subdural Hematoma
CT Scan Results of Acute Subdural Hematoma
Semilunar, crescent-shaped Hematoma
Management of Acute Subdural Hematoma with midline deviation.
Craniotomy, but poor prognosis
Management of Acute Subdural Hematoma without midline deviation.
Therapy to prevent further damage and increasing ICP.
- ICP Monitoring
- Elevate Head
- Hyperventilate
- Avoid Fluid Overload
- Mannitol or Furosemide (don’t diurese below systemic arterial pressure)
What is it called when the CT Scan shows diffuse blurring of the gray-white matter interface and multiple small punctate hemorrhages.
Diffuse Axonal Injury.
Consistent with severe trauma.
T/F: Without hematoma, there is no role for surgery.
True. Therapy would be to prevent further damage and monitor ICP.
This type of hematoma occurs in the very old or in severe alcoholics. It is caused by a shrunken brain that is rattled around the head by minor trauma, tearing venous sinuses. After several days, mental function deteriorates as the hematoma forms.
Chronic Subdural Hematoma
T/F: If a patient appears to be in hypovolemic shock with acute head trauma and the CT scan reveals a cranial hematoma, then this is the cause of the shock.
False. There is not enough space in the cranium to house enough blood to create shock.
