Head Trauma

Question 1

what is the only opening in the skull

Answer 1

foramen magnum(floating surrounded by csf)

Question 2

What is the anatomy of the head

Answer 2

1)scalp 2)skull 3)dura mater 4)archanoid 5)subarchanoid space 6) pia mater 7)brain

Question 3

What do the ventricles produce and how much

Answer 3

CSF and 1 ml every 3 mins

Question 4

what is coup contracoup

Answer 4

“4 collision concept” car strikes tree, head strikes the windshield, brain strikes inside skull, brain rebounds and hits inside of occipital skull

Question 5

when does the max swelling in the brain occur

Answer 5

72 hours

Question 6

what does DECEREBRATE mean

Answer 6

Abnormal Extension outwards

Question 7

What does DECORTICATE mean

Answer 7

Abnormal Flexion inwards

Question 8

when should we CT scan

Answer 8

GCS <13, Suspect basal skull fracture, head of c-spine injury suspected

Question 9

what are signs of basal skull fracture

Answer 9

Racoon eyes and battle sign(bruising behind the ear)

Question 10

what is a cerebral contusion

Answer 10

brusing/swelling of brain tissue, swelling can be rapid and severe, may present as CVA

Question 11

what is a diffuse axonal injury

Answer 11

most common with severe blunt trauma, diffuse injury, generalized edema, subarchanoid bleeding, seizure activity, coma/vommiting, may develop into herniation syndrome

Question 12

what is Anoxic brain injury

Answer 12

injury related to o2, poor outcome

Question 13

where can an intracranial hemorrhage occur

Answer 13

1)skull and dura 2) dura and arcahnoid 3) directly into the brain tissue

Question 14

What is an epidural hematoma?

Answer 14

bleeding within the epidural space between the bone and dura mater

Question 15

what is the bleeding often caused by?

Answer 15

by a tear in the middle meniginal artery that runs along inside the skull in temporal/parietal region

Question 16

what is a subdural hematoma?

Answer 16

bleeding between dura mater and archanoid mater(subdural space)

Question 17

what is the bleeding

Answer 17

usually venous

Question 18

what is this common in

Answer 18

alcoholics

Question 19

what is a subarchanoid hemorrhage

Answer 19

subarachnoid space between arachnoid mater and pia mater, usually a result of aneurismal rupture or bleeding rom arteriovenous malformation

Question 20

common in what kind of people

Answer 20

cocaine abusers/ bleeding disorders

Question 21

what is intracerebral hemorrhage

Answer 21

bleeding within the brain tissue;cerebrum/white matter;may result from blunt/penetrating trauma

Question 22

What is the Tx?

Answer 22

supportive therapy and possible surgical intervention

Question 23

what is herniation syndrome”coning”

Answer 23

caused by increase in pressure in cranial vault

Question 24

what are symptoms of it?

Answer 24

increase in ICP, dilation of pupils, coma, cushings reflex

Question 25

what is cushings triad?

Answer 25

hypertension, bradycardia, irregular respirations

Question 26

what happens in herniation syndrome?

Answer 26

bruising/swelling towards the spinal cord and trying to push brain down on brainstem compressing it.

Question 27

what does the brainstem control

Answer 27

breathing, HR and temp

Question 28

what is the TX

Answer 28

The only time HYPERVENTILATION is indicated, want co2 in the 25-30 or 30-35 range

Question 29

other txs are?

Answer 29

mannitol, ICP drain, phenobarbital(last resort) will cause an induced coma

Question 30

what is ICP

Answer 30

insertion of a catherter into the lateral ventricle , used for measurement and drainage of CSF

Question 31

what is the usual number for CSF

Answer 31

<15 mmhg

Question 32

what is the formula for CPP?

Answer 32

CPP=MAP-ICP

Question 33

What happens if ICP goes up

Answer 33

then BP must go up as well to maintain CPP

Question 34

when should we ICP?

Answer 34

when GCS is <8 after resuscitation, when CT scan is abnormal(hematoma, contusion, edema)

Question 35

When do we ICP if CT normal

Answer 35

age >40, systolic bp <90, decerebrate or decoritcate

Question 36

what is the normal CPP in adults

Answer 36

70-90mmhg, minimum should be >50mmhg for adequate perfusion

Question 37

what Bp is preffered to keep CPP

Answer 37

hypertension

Question 38

if there is an decrease in CO2 in the brain what occurs

Answer 38

vasoconstriction

Question 39

what will happen if paco2 is low causing vasoconstriction

Answer 39

will decrease ICP

Question 40

where do we want to keep co2 levels

Answer 40

30-35 range

Question 41

where do we wanna keep peep and aw press

Answer 41

low side for both

Question 42

do we want to sx these patients

Answer 42

not usually, will usually sedate before sxing