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Emed 4 > Head trauma > Flashcards

Head trauma Flashcards

1
Q

TBI classifications?

A

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

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2
Q

Mild TBI AKA as?

A

Concussion

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3
Q

Most severe TBI deaths occur when?

A

w/in 48hrs

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4
Q

Cerebral blood flow is dependent on?

A 
Autoregulation
CPP - Cerebral perfusion pressure
MAP - Mean arterial pressure
ICP - Intracranial pressure
V-Con from systemic factors (HTN, Alkalosis, etc)
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5
Q

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

A

Autoregulation

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6
Q

Lower limit of autoregulation is?

A

<60mmHg CPP

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7
Q

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

A

Ischemia

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8
Q

TBI often require what?

A

Aggresive fluid resusicitation to PVT HOTN

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9
Q

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

A

> =80 mmHg

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10
Q

Low BP + ^ICP will result in?

A

Low CPP and brain injury

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11
Q

Primary brain injuries include?

A 
Contusions
Hematomas
DIffuse axonal injury
Direct cellular damage
Loss of BBB
Disrupted Neurochemical homeostasis
Loss of electrochemical fx
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12
Q

Contusions are?

A

Bruises to the brain paraenchyma

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13
Q

Hematomas types are?

A 
Subdural
Epidural
Intraparenchymal
Intraventricular
Subarachnoid
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14
Q

Secondary brain injuries?

A

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
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15
Q

Secondary insults are?

A

Conditions accelerating neurotoxic damage

-HOTN, Hypoxemia, Hyperglycemia

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16
Q

Brain edema is a result of what two processes?

A

LRG ionic shifts > Cellular swelling

Damage/Breakdown of BBB > Extracellular edema

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17
Q

Brain edema evolves into?

A

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

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18
Q

4 major brain herniation syndromes?

A

Uncal transtentorial
Central transtentorial
Cerebellotonsillar
Upward (transtentorial) posterior fossa

19
Q

MC brain herniation is?

A

Uncal herniation

20
Q

Uncal herniation patho

A

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

21
Q

Central transtentorial herniation patho?

A

Midline lesions of frontal/occipital lobes or vertex

22
Q

S/S of Central transtentorial herniation

A 
Initial/prominent
-Bilateral pinpoint pupils and Babinskis signs
-Increased Muscle tone
Then
-Fixed midpoint pupils
-Prolonged hyperventilation
-Decorticate posturing
23
Q

Cerebellotonsillar herniation patho?

A

Cerebellat tonsils herniate through foramen magnum

24
Q

Cerebellotonsillar S/S?

A

Pinpoint
Flaccid Paralysis
Sudden death

25
Q

Upward (transtentorial) posterior fossa - NOTES

A 
Due to posterior fossa lesion
S/S
- Conjugate downward gaze
- Absence of verticle eye movement
- Pinpoint pupils
26
Q

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

A

Motor score

27
Q

GCS limitations

A

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

28
Q

Head trauma PE

A 
Follow ATLS - w/ life saving interventions as needed
Protect C-spine throughour
GCS > classify injury
Pupillary response
Assess motor Fx
29
Q

Prior to ER intubation what is required?

A

Preintubation GCS

30
Q

Unresponsive single fixed/dilated pt may indicate?

A

Intracranial hematoma w/ uncal herniation

31
Q

Bilateral fixed/dilated pupils suggest?

A

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

32
Q

Bilateral pinpoint pupils suggest either?

A

Opiate exposure

Central pontine lesion

33
Q

Altered motor fx may indicate?

A

Brain, Spinal cord, peripheral nerve injury

34
Q

Decorticate posturing is?

A

upper extremity flexion and lower extremity extension

indicates injury above midbrain

35
Q

Decerebrate posturing is?

A

arm extension and internal rotation with wrist
finger flexion and internal rotation
extension of the lower extremities

Indicates more caudal injury

36
Q

completely unresponsive patients req eval of?

A

respiratory pattern and eye movements > provides brainstem function info

37
Q

Brain herniation imaging SOC is?

A

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

38
Q

Uncooperative/combative pts needing CT should be?

A

Sedated/intubated

39
Q

If a head CT is ordered for eval include?

A

Cervical CT at the same time

40
Q

What intervation may induce cerebral v-con?

A

Intubation w/ hyperventilation > negative outcomes

41
Q

During TXT Keep Pco2 at?

A

35-45mmHg

42
Q

Most important prehospital interventions?

A

AW and BP management

43
Q

Primary goals of TXT

A

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

44
Q

150% increased risk of mortality when?

A

SBP <90 and Hypoxemia <60 PaO2

Emed 4 (10 decks)

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