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Emergency Medicine > Head Trauma > Flashcards

Head Trauma Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is the definition of head trauma?

A

Injury to scalp, skull, or brain

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2
Q

What is the definition of a traumatic brain injury (TBI)?

A

Injury to brain tissue / vessels with any change in mentation, no matter how brief, following head trauma

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3
Q

What mechanism of action (MOI) is the most common cause of TBI?

A

Falls (28%)

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4
Q

What are the three main components of the Glasgow Coma Scale (GCS)?

A

Eye Opening, Verbal Response, Motor Response

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5
Q

What is the point breakdown for Eye Opening in the GCS?

A 
4 = Spontaneous
3 = To voice
2 = To pain
1 = None
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6
Q

What is the point breakdown for Verbal Response in the GCS?

A 
5 = Normal conversation
4 = Disoriented conversation
3 = Words, but not coherent ("word salad")
2 = No words, only sounds
1 = None
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7
Q

What is the point breakdown for Motor Response in the GCS?

A 
6 = Normal
5 = Localizes to pain
4 = Withdraws to pain
3 = Decorticate posture
2 = Decerebrate posture
1 = None
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8
Q

Describe Decorticate posture

A

Flexor, arms like “Cs”, moves toward the “Cord”

Problems with cervical spinal tract or cerebral hemisphere

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9
Q

Describe Decerebrate posture

A

Extensor, arms like “e”

Problems within midbrain or pons

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10
Q

What is the following patient’s GCS score?
42 y/o M, eyes open after a car accident, slightly confused about events of accident (repetitive questioning), follows commands.

A

14 (loses point for verbal)

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11
Q

What is the following patient’s GCS score?

Will not open eyes to pain, moaning, when stimulated pulls arms to chest and becomes rigid

A

6 (1 for eyes, 2 for verbal, 3 decorticate posture = 6 GCS, pt will likely go to trauma center and be intubated, highly likely cerebral hemisphere/cortical spinal tract injury w/ high mortality)

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12
Q

A mild TBI is defined as a GCS of ____-____. Moderate TBI GCS? Severe TBI GCS? What type is the most common?

A

Mild 13-15 (most common)
Moderate 9-12
Severe 8 or less

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13
Q

What rules or criteria can be followed to determine if a pt requires a CT scan following a mild TBI? (children vs adults)

A

Canadian CT Head Rule

PECARN Pediatric Criteria

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14
Q

According to the Canadian CT Head Rule, what are the high risk findings that would indicate that a CT head is indicated in a pt with a minor head injury? (hint: 5)

A
  1. GCS score < 15 at 2 hours post-injury
  2. Suspected open or depressed skull fx
  3. Any sign of basal skull fx
  4. Vomiting > or = 2 episodes
  5. Age > or = 65 y/o
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15
Q

According to the Canadian CT Head Rule, what are the medium risk findings that would indicate that a CT head is indicated in a pt with a minor head injury? (hint: 2)

A
  1. Amnesia before impact > or = 30 min

2. Dangerous mechanism

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16
Q

What are considered signs of basal skull fx?

A

Hemotympanum, “raccoon eyes”, CSF otorrhea/rhinorrhea, Battle’s sign

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17
Q

What are examples of “dangerous mechanism”?

A

Pedestrian struck by vehicle, occupant ejected, fall from >2x height/3ft/or 5 stairs

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18
Q

What is Battle’s sign?

A

Mastoid ecchymosis

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19
Q

PECARN is the largest study ever done in emergency medicine in children, and there is one rule for kids under ___ y/o and one for kids over ___ y/o

A

2 y/o

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20
Q

T/F All pts with a moderate or severe TBI get a CT scan performed

A

True

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21
Q

T/F All pts with a moderate or severe TBI are admitted for observation (why or why not?)

A

True, high potential for decompensation

22
Q

Diffuse axonal injury (DAI) occurs most frequently during what type of injury mechanism?

A

Deceleration injury

23
Q

What are some examples of impact injuries?

A

Cerebral or brainstem contusions
Cerebral lacerations
Immediate hematomas
Diffuse axonal injury (DAI)

24
Q

What are some examples of secondary injuries?

A

Intracranial hematoma
Edema
Ischemia

25
Q

What type of imaging study is best for visualizing blood and bone?

A

CT Scan

26
Q

Can you visualize a concussion on CT scan?

A

No, there is no good study for dx of a concussion and the dx is usually clinical

27
Q

T/F Surgery is not often required even if there is a significant intracranial mass lesion

A

False, surgery is typically required when there is a significant intracranial mass lesion present

28
Q

Does an epidural hematoma affect more men or more women? At what ratio?

A

Men, 4:1

29
Q

The ____(vessel)____ is responsible for EDH ~85% of the time

A

Middle meningeal artery

30
Q

EDH comprise ~___% of head trauma admissions

A

1%

31
Q

Mortality ranges from ___-___% with optimal management of EDH

A

5-10%

32
Q

What is a lucid interval? With what condition is it associated with?

A

A period of improvement or wellness (~1 hour)
“Talk then die”
Associated with EDH

33
Q

A subdural hematoma (SDH) is more or less common than an EDH?

A

More common by ~2x

34
Q

What are the common sources of bleeding in a SDH?

A

Bridging veins and cortical lacerations

35
Q

What is the mortality of SDH? (%)

A

50-90%

36
Q

Is the clinical course of SDH fast or slow?

A

Slow, with subtle sx, can worsen progressively over weeks

37
Q

What age population is SDH most common in?

A

The elderly

38
Q

What are the “shapes” of EDH and SDH, respectively?

A 
EDH = football
SDH = crescentic
39
Q

Are cerebral contusions often associated with mass effect?

A

No, they often have little mass effect

40
Q

T/F Cerebral contusions are not often operative

A

True

41
Q

What is the focus on in regards to non operative management of cerebral contusions? What is the goal?

A

Focus: Reducing pressure and secondary damage
Goal: Goal is maintain Central Perfusion Pressure (>50 is normal) (CCP)

42
Q

CCP = ___ - ___

A

CCP = MAP - ICP

43
Q

ICP increase = (more/less) flow

A

Less

44
Q

What are the three components of Cushing’s Reflex?

A

Systolic BP increase
Bradycardia
Irregular respirations

45
Q

What is the most important component of nonoperative management in head trauma pts?

A

FREQUENT neuro checks!

in addition to ICP monitoring

46
Q

What are possible indications for ICP monitoring?

A

Loss of neurological examination i.e. due to sedation or general anesthesia

47
Q

Therapy for Intracranial HTN includes Tier 1 and Tier 2 therapies. What are examples of each?

A 
First tier:
Positioning (elevate head of bed)
Ventricular drainage
Osmotic diuresis (to reduce edema)
Hyperventilation
Second tier:
Sedation  have brain less active to use less glucose
Neuromuscular blockade
Hypothermia
Barbiturate coma
48
Q

T/F Glucocorticoids are recommended as part of tx of intracranial HTN

A

False, they are NOT recommended

49
Q

What are the two major types of potential surgical lesions?

A

Epidural and Subdural hematomas

50
Q

In the approach to head injuries, you as a provider should always first perform your exam and assess the patient’s GCS, then determine if their injury is mild / mod / severe (to image or not to image), determine any necessary surgical intervention, and then admit ___ and ___ TBI pts.

A

Moderate and severe

51
Q

A palpable radial pulse indicates a systolic BP of at least ____-____ mmHg, which is “good enough” for a mass casualty triage setting

A

80-90mmHg

Emergency Medicine (20 decks)

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