Head Trauma

Question 1

TBI def

Answer 1

clinically any change in mentation no matter how brief following head trauma

Question 2

GCS Scale Rapid measurements

Answer 2

eyes, verbal, motor

Question 3

decorticate

Answer 3

Decorticate double C so arms by chest
Flexor

tells me: problem with cervical spinal tract or cerebral hemisphere

Question 4

decerebrate

Answer 4

arms are like es
Problem with midbrain or pons
**more severe than decorticate

Question 5

3 key GCS scores

Answer 5

normal is 15
intubate at 8
dead at 3

Question 6

ABCDE D portion

Answer 6

D: deficit neurological ..
pupils
gross movement
and GCS

Question 7

mild TBI is

Answer 7

GCS 13-15

Question 8

moderate TBI is

Answer 8

GCS 9-12

Question 9

severe TBI is

Answer 9

GCS8 or less (intubate)

Question 10

high risk criteria that suggests a CT

Answer 10

GCS less than 15 even after 2 hrs post injury

any suspected skull fx

Basal skull fx signs (raccoon eyes, otorrhea/rhinorrhea, battle sign, hemotypanum)

Vomit more than 2 times

Older than 65 years old

Question 11

PECARN pediatric head CT criteria

Answer 11

if GCS is less than 15 at any point scan!!

skull fx scan!

Question 12

t/f all moderate or severe tbi get scanned?

Answer 12

true

Question 13

t/f ct cannot show concussion

Answer 13

true

Question 14

nonoperative head injury when..

Answer 14

no intracranial mass lesion

treat ICP

Question 15

operative tx

Answer 15

decompressive craniectomy or brain resection less common

Question 16

gender difference epidural hematoma

Answer 16

male to female is 4: 1

Question 17

epidural hematoma blood source

Answer 17

MMA

Question 18

unique feature of epidural hematoma is…

Answer 18

lucid interval

Question 19

2 common sources of bleeding for SDH

Answer 19

cortical laceration or tearing of bridging veins

Question 20

epidural or subdural hematoma more deadly?

Answer 20

SDH.. although with epidural lucid interval still not good

Question 21

cerebral contusion tx

Answer 21

non operative
maintain central perfusion pressure
reduce secondary damage

Question 22

what is normal central perfusion pressure

Answer 22

over 50

CCP = MAP - ICP

Question 23

with a higher ICP what would you expect to happen to CCP value?

Answer 23

it would drop..subtracting a higher number .. bad this means less blood flow to the brain

Question 24

what is cushings reflex or triad?

Answer 24

systolic BP increase
bradycardia
with irregular respirations

sign of elevated ICP

aka cushing phenomenon etc

Question 25

when ICP monitoring indicated?

Answer 25

loss of ability to do a neuro exam - sedation, general anesthesia

Question 26

first tier treatment for intracranial hypertension

Answer 26

positioning, ventricular draining, osmotic diuresis (mannitol), hyperventilation

Question 27

second tier therapy for intracranial HTN

Answer 27

sedation, neuromuscular blockade, hypothermia, barbiturate coma

Question 28

___ are not recommended for intracranial HTN

Answer 28

glucocorticoids