Head trauma

Question 1

TBI classifications?

Answer 1

Mild TBI - GCS 14-15
Mod TBI - GCS 9-13
Sev TBI - GCS 3-8

Question 2

Mild TBI AKA as?

Answer 2

Concussion

Question 3

Most severe TBI deaths occur when?

Answer 3

w/in 48hrs

Question 4

Cerebral blood flow is dependent on?

Answer 4

Autoregulation
CPP - Cerebral perfusion pressure
MAP - Mean arterial pressure
ICP - Intracranial pressure
V-Con from systemic factors (HTN, Alkalosis, etc)

Question 5

W/ a TBI what is often impaired concerning cerebral blood flow homeostasis?

Answer 5

Autoregulation

Question 6

Lower limit of autoregulation is?

Answer 6

<60mmHg CPP

Question 7

Traumatic HOTN can lead to what in low flow regions of the brain?

Answer 7

Ischemia

Question 8

TBI often require what?

Answer 8

Aggresive fluid resusicitation to PVT HOTN

Question 9

What should Mean arterial pressure be maintained at concerning a TBI?

Answer 9

> =80 mmHg

Question 10

Low BP + ^ICP will result in?

Answer 10

Low CPP and brain injury

Question 11

Primary brain injuries include?

Answer 11

Contusions
Hematomas
DIffuse axonal injury
Direct cellular damage
Loss of BBB
Disrupted Neurochemical homeostasis
Loss of electrochemical fx

Question 12

Contusions are?

Answer 12

Bruises to the brain paraenchyma

Question 13

Hematomas types are?

Answer 13

Subdural
Epidural
Intraparenchymal
Intraventricular
Subarachnoid

Question 14

Secondary brain injuries?

Answer 14

Serious of (sub)cellular events

• Neurotoxic cascade of massive neurotransmitter release
• Ion shifts > activate cytoplasmis/nuclear enzymes > cell Apoptosis
• Extensive neuronal loss occurring for longer than a yr

Question 15

Secondary insults are?

Answer 15

Conditions accelerating neurotoxic damage

-HOTN, Hypoxemia, Hyperglycemia

Question 16

Brain edema is a result of what two processes?

Answer 16

LRG ionic shifts > Cellular swelling

Damage/Breakdown of BBB > Extracellular edema

Question 17

Brain edema evolves into?

Answer 17

Increased ICP >
Direct compression tissue damage >
Vascular compression >
Ischemia, herniation, brain death

Question 18

4 major brain herniation syndromes?

Answer 18

Uncal transtentorial
Central transtentorial
Cerebellotonsillar
Upward (transtentorial) posterior fossa

Question 19

MC brain herniation is?

Answer 19

Uncal herniation

Question 20

Uncal herniation patho

Answer 20

Expanding lesion in temporal lobe/lat middle fossa >
Uncus of temporal lobe displaces inferiorly >
Passes through medial edge of tentorium >
Compresses CN III = ipsilateral fixed/dilated pupil >
Further herniation compresses pyramidal tract >
Contralateral motor paralysis

Question 21

Central transtentorial herniation patho?

Answer 21

Midline lesions of frontal/occipital lobes or vertex

Question 22

S/S of Central transtentorial herniation

Answer 22

Initial/prominent
-Bilateral pinpoint pupils and Babinskis signs
-Increased Muscle tone
Then
-Fixed midpoint pupils
-Prolonged hyperventilation
-Decorticate posturing

Question 23

Cerebellotonsillar herniation patho?

Answer 23

Cerebellat tonsils herniate through foramen magnum

Question 24

Cerebellotonsillar S/S?

Answer 24

Pinpoint
Flaccid Paralysis
Sudden death

Question 25

Upward (transtentorial) posterior fossa - NOTES

Answer 25

``` Due to posterior fossa lesion S/S - Conjugate downward gaze - Absence of verticle eye movement - Pinpoint pupils ```

Question 26

What part of GCS independently correlates outcome as well as the entire score itself?

Answer 26

Motor score

Question 27

GCS limitations

Answer 27

Measures behavior not pathology Similar scores can still mean drastically different Dz Affected but Drugs/ETOH or occular injuries

Question 28

Head trauma PE

Answer 28

``` Follow ATLS - w/ life saving interventions as needed Protect C-spine throughour GCS > classify injury Pupillary response Assess motor Fx ```

Question 29

Prior to ER intubation what is required?

Answer 29

Preintubation GCS

Question 30

Unresponsive single fixed/dilated pt may indicate?

Answer 30

Intracranial hematoma w/ uncal herniation

Question 31

Bilateral fixed/dilated pupils suggest?

Answer 31

Increased ICP w/ poor brain perfusion Bilateral uncal herniation Drug effects like atropine Severe hypoxia

Question 32

Bilateral pinpoint pupils suggest either?

Answer 32

Opiate exposure | Central pontine lesion

Question 33

Altered motor fx may indicate?

Answer 33

Brain, Spinal cord, peripheral nerve injury

Question 34

Decorticate posturing is?

Answer 34

upper extremity flexion and lower extremity extension indicates injury above midbrain

Question 35

Decerebrate posturing is?

Answer 35

arm extension and internal rotation with wrist finger flexion and internal rotation extension of the lower extremities Indicates more caudal injury

Question 36

completely unresponsive patients req eval of?

Answer 36

respiratory pattern and eye movements > provides brainstem function info

Question 37

Brain herniation imaging SOC is?

Answer 37

Head CT - best for eval of blood and guides ER management

Question 38

Uncooperative/combative pts needing CT should be?

Answer 38

Sedated/intubated

Question 39

If a head CT is ordered for eval include?

Answer 39

Cervical CT at the same time

Question 40

What intervation may induce cerebral v-con?

Answer 40

Intubation w/ hyperventilation > negative outcomes

Question 41

During TXT Keep Pco2 at?

Answer 41

35-45mmHg

Question 42

Most important prehospital interventions?

Answer 42

AW and BP management

Question 43

Primary goals of TXT

Answer 43

Maintain CPP and Oxygenation w/ IVF voume and vent PVT secondary injuries - correct Glu/temp/Anemia Recognize/TXT increased ICP Arrange neurosurgery PRN TXT other life threats

Question 44

150% increased risk of mortality when?

Answer 44

SBP <90 and Hypoxemia <60 PaO2