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6903 > head trauma > Flashcards

head trauma Flashcards

1
Q

what is the primary injury in head trauma?

A

what occurs at the scene, damage is irreversible, may be focal or diffuse, and treat the consequences

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2
Q

What are the secondary injuries in head trauma?

A

occur any time after primary event; potentially prevetable, inflammation, reperfusion, superoxide production, necrosis, apoptosis

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3
Q

Greatest negative affect in head injuries?

A

decreased oxygen

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4
Q

30% of patients are hypoxic on admission for head injuries d/t what 2 causes?

A

central resp depression, chest injuries

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5
Q

What 2 things do you consider first in head injuries?

A

hypoxia and shock

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6
Q

What should you do first in a head injury pt before sedation and paralytics?

A

baseline neuro exam

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7
Q

Signs of compression of oculomotor nerve?

A

dilation and sluggish response

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8
Q

Indication of uncal herniation?

A

maximally dilated and blown pupil

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9
Q

6 positive findings on CT scan?

A

midline shift, distortion of ventricle and cisterns, effacement of sulci in uninjured hemisphere, presence of hematoma in any location of cranial vault, fractures, intracranial air

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10
Q

Severe head injury requires immediate?

A

intubation using c spine stabilization and techniques that avoid increasing ICP

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11
Q

Most frequent type of head injury?

A

scalp laceration

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12
Q

Extensive scalp lacerations can result in?

A

significant blood loss and air embolism

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13
Q

Head injury that results from a violent shock or jarring?

A

concussion

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14
Q

5 sx associated w concussion?

A

transient amnesia, vertigo, nausea, weak pulse, slow respiration

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15
Q

3 types of skull fractures?

A

open, depressed, basilar

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16
Q

Open fractures include those….?

A

with deep scalp lacerations and fractures extending in to the sinuses

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17
Q

What does an open skull fracture require w/in 24 hours?

A

debridement

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18
Q

Linear fractures that occur on the floor of the cranial vault are?

A

basilar skull fractures

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19
Q

This type of skull fracture requires more force to cause than other fractures?

A

basilar

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20
Q

4 signs of basilar skull fracture?

A

blood in sinuses, CSF leak from nose/ears, racoons eyes (periorbital ecchymosis), battle’s sign (retroaricular ecchymosis or bruising over the mastoid process)

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21
Q

Highest mortality rate and most common of all cranial lesions?

A

subdural hematoma

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22
Q

Where is subdural hematoma located?

A

between brain and dura

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23
Q

Subdural hematoma usually caused by?

A

accel decel

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24
Q

Shape of subdural hematoma?

A

crescent

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25
Q

Treatment of subdural hematoma?

A

immediate surgical decompression

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26
Q

What shape and where is an epidural hematoma?

A

biconvex and located between dura and skull

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27
Q

Usual cause of epidural hematoma?

A

torn middle meningeal injury

28
Q

5 sx of epidural hematoma?

A

HA, vomiting, seizure, HTN, difficulty breathing

29
Q

What is characteristic of epidural hematomas?

A

have brief LOC followed by periods of lucidness. often walk and die though

30
Q

Treatment for small epidural hematoma w no pressure on brain?

A

observation

31
Q

Deterioration of neuro status is sx of this?

A

cerebral hematoma

32
Q

Cerebral hematoma presence on CT often delayed for how long?

A

24-48 hours

33
Q

3 determinants of cerebral hematoma pt outcome?

A

cerebral hypoxia, GCS, hematoma volume

34
Q

Caused by sudden decel or rotational forces that most often occur at gray white matter junction?

A

diffuse axonal injury

35
Q

Best diagnostic tests for diffuse axonal injury?

A

MRI

36
Q

DAI causes downstream deafferentation and disconnection in the brain stem which leads to?

A

coma

37
Q

Sx of DAI?

A

immediate loss of conscious, most have no period of lucidity

38
Q

Most frequent cause of persistent vegetative state following trauma?

A

DAI

39
Q

CPP is?

A

difference between MAP and ICP or CPV, whichever is highest

40
Q

normal upper limit of ICP?

A

10-15

41
Q

ICP monitoring is recommended in?

A

all pts with GCS

42
Q

6 sx of increased ICP?

A

HA, vomiting, papilledema, drowsiness, LOC, behavioral changes

43
Q

Cushing’s reflex?

A

HTN, bradycardia, irregular respirations

44
Q

Cushing’s reflex is probably due to?

A

medullary ischemia

45
Q

Methods to decrease ICP via CSF?

A

mannitol, drain, hypertonic solution

46
Q

Methods to decrease ICP via brain?

A

mannitol, hypertonic sltn, lasix, decompressive craniectomy, resection of contusion or other mass lesion, blood volume

47
Q

Methods for controlling ICP via blood volume?

A

mannitol, hyperventilation, hypothermia, head elevation, neutral neck position, deep prop or barb sedation/paralysis, control of seizures

48
Q

Brain receives what % of CO?

A

15

49
Q

CBF remains constant d/t adjustment of?

A

cerebral vascular resistance

50
Q

3 things that abolish autoregulation?

A

trauma, certain anesthetics, hypoxia

51
Q

is CO2 a dilator or constrictor?

A

dilator

52
Q

Doubling PaCO2 does what to blood flow?

A

doubles

53
Q

Why is BP exceeding that of autoregulation bad?

A

can cause disruption of BBB and lead to cerebral edema

54
Q

4 components of resuscitation of head trauma pts?

A

hyperventilation, secure the airway, diuretics, intravascular volume expansion

55
Q

etomidate dose for head trauma?

A

0.2-0.3 mg/kg

56
Q

lido dose for head trauma

A

1.5 mg/kg

57
Q

What gas do you avoid in head trauma pts?

A

nitrous

58
Q

Goal for CPP and MAP in head trauma pts?

A

60-70; 70-80

59
Q

how does hypervent reduce ICP?

A

vasoconstriction reducing blood flow

60
Q

Brain is rich in what coagulant?

A

tissue thromboplastin

61
Q

FFP indicated when INR exceeds what level?

A

1.4

62
Q

When should platelets be given to a head trauma pt?

A

plts

63
Q

Preferred fluid in head traumas?

A

hypertonic or isotonic crystalloid

64
Q

Neurosurgical patients should be hyperventilated until?

A

dura is open

65
Q

What do you want the MAP to be in a neurosurgical pt?

A

at least 80

66
Q

Why should you avoid nitrous in head pts?

A

increases CMRO2, ICP, and CBF

6903 (12 decks)

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