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Emergency Med > Head Trauma > Flashcards

Head Trauma Flashcards

1
Q

frontal lobe

A

goal-oriented motor, cognitive functions, emotions

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2
Q

occipital lobe

A

visual perception

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3
Q

parietal lobe

A

touch, pain, limb position, size/shape, perception

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4
Q

temporal lobe

A

perceive/localize sound, visual form/color, emotions

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5
Q

what is the left and right hemisphere separated by

A

falx cerebri (part of dura)

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6
Q

component of brainstem

A

midbrain
pons
medulla

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7
Q

reticular activation system

A

midbrain and upper pons

state of alertness

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8
Q

dura mater 2 layers

A

periosteal (attached to inner skull)

meningeal- forms falx cerebri

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9
Q

what is the dura mater

A

Dense connective tissue tough, thick

**Vascular (dural sinuses)

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10
Q

is the arachnoid mater vascular

A

no

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11
Q

what is arachnoid mater

A

Nonvascular connective tissue THIN, FILAMENTOUS

Adjoins but does not adhere to the dura mater forming a potential space (subdural space → subdural hematoma)

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12
Q

pia mater

A

Very thin, delicate

Adheres to surface of the brain and spinal cord and invaginates along cortical surface.

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13
Q

Space between arachnoid mater and pia mater and what does it contain

A

subarachnoid space

– contains CSF and veins/arteries

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14
Q

T/F- Patients can bleed out and die from scalp lacs if not managed appropriately

A

TRUE

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15
Q

what is intracranial pressure (ICP)

A

The pressure exerted by fluids (like CSF) inside the skull on brain tissue

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16
Q

ranges of ICP in mmHg that are:
normal
above
severe

A

10 mm Hg = Normal
>20 mm Hg = Abnormal
>40 mm Hg = Severe

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17
Q

in compensated and decompensated states of a brain bleed, what are the two things to be decreased

A

CSF

venous volume

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18
Q

what type of ICP device can monitor ICP and drain CSF

A

intraventricular

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19
Q

what does CCP stand for and how do we measure it (equation)

A

Cerebral Perfusion Pressure

CPP= MAP-ICP

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20
Q

what is CPP

A

CPP is net pressure gradient that drives oxygen delivery to brain tissue, but NOT actually CEREBRAL BLOOD FLOW

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21
Q

normal range of CCP

A

60 to 70 mmHG

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22
Q

what does low CCP mean

A

brain is not being profused properly

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23
Q

5 Hs of secondary brain injury

A 
Hypotension
Hypoxia
Hypoglycemia
Hyperthermia
Hypocapnia
24
Q

what should you do in the primary survey of head trauma

A

ABCDEs

immobilize the C spine

25
Q

A

A

Airway

“less than 8 intubate” 8 and below LOL (Referring to GCS-glascow coma scale)
Loss of gag/inability to clear secretions

*Get GCS before intubating

26
Q

B

A

Breathing

  • avoid hypoxia
  • CO2 range = 35-42mmHg
27
Q

C

A

Circulation

  • hypotension
  • Normal Saline is the crystalloid of choice in
  • Cushings Reflex: hypertesion, bradycardia, irregular respirations
28
Q

what should the SBP NEVER be less than

A

90mmHg

29
Q

T/F-INTRACRANIAL HEAD BLEEDS DO NOT CAUSE HYPOTENSION

A

TRUE!

30
Q

what is cushings reflex

A

hypertesion, bradycardia, irregular respirations

increased ICP

31
Q

D

A

Disability

GCS
Document initial exam before meds
Pupillary Response
Rule out other causes!

32
Q

3 categories of GCS

A

eye opening response
best verbal response
best motor response

33
Q

GCS comatose pt

A

8 or less

34
Q

GCS-eye opening response

A

spontaneously- 4
to speech- 3
to pain- 2
none-1

35
Q

BCS- best verbal response

A 
oriented to time place and person-5
confused-4
inappropriate words-3
incomprehensible words-2
unresponsive - 1
36
Q

GCS- best motor repsonse

A 
obeys commands
moves to localized pain-5
flexion withdrawal from pain-4
abnormal flexion (decorticate)-3
abnormal extension (decerebrate)-2
no response-1
37
Q

E

A

Exposure

completely undress
rewarm for hypothermia

38
Q

most important part of secondary survey

A

anticoagulants

39
Q

components of secondary survey

A 
Head to Toe Physical Exam ONLY AFTER Primary Survey is STABLE
      HPI
        PMHX
        Allergies
        Medications
            Anticoagulants
       Past Surgical Hx
       Family Hx
       Social Hx
40
Q

most important labs

A

coags

41
Q

radiology: head CT and cervical spine CT are both done withOUT….

A

CONTRAST

42
Q

Mild Brain injury GCS

A

13-15 & a mechanism

aka a concussion

43
Q

symptoms/sign of mild brain injury

A

Symptoms: confusion, amnesia, +/- loss of consciousness, HA, dizziness, vertigo, imbalance, nausea, vomiting, mood and cognitive disturbances, sensitivity to light/noise, sleep disturbances

Signs: stumbling, inability to walk in a straight line, vacant stare, delayed verbal expression, inability to focus attention, disorientation, slurred speech, emotionality, memory deficits

44
Q

for mild TBI, what criteria must be met for outpt observation

A 
GCS 15
NO ANTICOAGULANTS
NO Seizure
Caregiver at home
Head CT negative (if indicated)
45
Q

when for mild TBI is there an admission

A 
If GCS <15
 or + ANTICOAGULANTS
 or + Seizure
 or - Caregiver at home
 or + Head CT
46
Q

moderate TBI, GCS and s/sxs

A

GCS 9-12

Symptoms: may have similar complaints to Mild TBI/Concussion if able to communicate?

Signs: decreased GCS (ex: withdrawing to pain, confused, opens eyes to pain), pupillary reaction/dilation altered

47
Q

Severe TBI GCS and s/sxs

A

GCS 3-8

Symptoms: …they probably won’t be able to tell you complaints

Signs: …decreased GCS (ex: no motor response, incomprehensible sounds, opens eyes to pain), pupillary asymmetry, unilateral or bilateral fixed and dilated pupils bradycardia, irregular respirations, hypertension, posturing)

48
Q

epidural hematoma Collection between dura and skull

A 
Collection between dura and skull
80% Skull Fx
*Arterial Bleeding
        *Middle meningeal arteries
Lenticular/Biconvex shape
Space Occupying lesion
Herniation likely if untreated
49
Q

s/sxs of epidural hematoma most imp

A

Initial, brief LOC—lucid interval—rapid neuro deterioration

Fixed dilated pupil on the unilateral side as herniation

50
Q

subdermal hematoma

A
  • 30% of TBIs
  • shearing force of VENOUS bridging veins between DURA and ARACHNOID
  • CONCAVE hematoma
  • space occupying lesion
51
Q

most imp to know about s/sxs of subdermal hematoma

A

Many be relatively asymptomatic-nonfocal!

52
Q

acute vs chronic subdural hematoma color

A

Acute subdural = white

Chronic subdural = black

53
Q

Traumatic Subarachnoid Hemorrhage (TSAH)

A

Venous bleeding in subarachnoid space (between the arachnoid and pia mater)
Usually associated with other hemorrhage
Non space occupying
May increase ICP—blocks outflow of CSF from 3-4th ventricle
**If isolated SAH– Consider Aneurysmal Cause

Signs and Symptoms: HA, signs and symptoms associated with other types of bleeds as discussed

54
Q

cerebral contusions

A
  • “Bruise of the brain tissue”
  • Occurs primarily in the cortical tissue when the brain collides with bony protuberances on the inside surface of the skull
  • Frontal/Temporal lobes most common
  • Contusions are frequently associated with edema which can cause elevated ICP
55
Q

MC type of skull fx

A

Linear Skull Fractures

56
Q

MC location of linear skull fxs

A

temporoparietal, frontal, occipital

57
Q

when are linear skull fxs sig imp

A

They cross the middle meningeal groove in the TEMPORAL BONE or major venous dural sinus

Emergency Med (9 decks)

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