Head Trauma Flashcards
frontal lobe
goal-oriented motor, cognitive functions, emotions
occipital lobe
visual perception
parietal lobe
touch, pain, limb position, size/shape, perception
temporal lobe
perceive/localize sound, visual form/color, emotions
what is the left and right hemisphere separated by
falx cerebri (part of dura)
component of brainstem
midbrain
pons
medulla
reticular activation system
midbrain and upper pons
state of alertness
dura mater 2 layers
periosteal (attached to inner skull)
meningeal- forms falx cerebri
what is the dura mater
Dense connective tissue tough, thick
**Vascular (dural sinuses)
is the arachnoid mater vascular
no
what is arachnoid mater
Nonvascular connective tissue THIN, FILAMENTOUS
Adjoins but does not adhere to the dura mater forming a potential space (subdural space → subdural hematoma)
pia mater
Very thin, delicate
Adheres to surface of the brain and spinal cord and invaginates along cortical surface.
Space between arachnoid mater and pia mater and what does it contain
subarachnoid space
– contains CSF and veins/arteries
T/F- Patients can bleed out and die from scalp lacs if not managed appropriately
TRUE
what is intracranial pressure (ICP)
The pressure exerted by fluids (like CSF) inside the skull on brain tissue
ranges of ICP in mmHg that are:
normal
above
severe
10 mm Hg = Normal
>20 mm Hg = Abnormal
>40 mm Hg = Severe
in compensated and decompensated states of a brain bleed, what are the two things to be decreased
CSF
venous volume
what type of ICP device can monitor ICP and drain CSF
intraventricular
what does CCP stand for and how do we measure it (equation)
Cerebral Perfusion Pressure
CPP= MAP-ICP
what is CPP
CPP is net pressure gradient that drives oxygen delivery to brain tissue, but NOT actually CEREBRAL BLOOD FLOW
normal range of CCP
60 to 70 mmHG
what does low CCP mean
brain is not being profused properly
5 Hs of secondary brain injury
Hypotension Hypoxia Hypoglycemia Hyperthermia Hypocapnia
what should you do in the primary survey of head trauma
ABCDEs
immobilize the C spine
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
B
Breathing
- avoid hypoxia
- CO2 range = 35-42mmHg
C
Circulation
- hypotension
- Normal Saline is the crystalloid of choice in
- Cushings Reflex: hypertesion, bradycardia, irregular respirations
what should the SBP NEVER be less than
90mmHg
T/F-INTRACRANIAL HEAD BLEEDS DO NOT CAUSE HYPOTENSION
TRUE!
what is cushings reflex
hypertesion, bradycardia, irregular respirations
increased ICP
D
Disability
GCS
Document initial exam before meds
Pupillary Response
Rule out other causes!
3 categories of GCS
eye opening response
best verbal response
best motor response
GCS comatose pt
8 or less
GCS-eye opening response
spontaneously- 4
to speech- 3
to pain- 2
none-1
BCS- best verbal response
oriented to time place and person-5 confused-4 inappropriate words-3 incomprehensible words-2 unresponsive - 1
GCS- best motor repsonse
obeys commands moves to localized pain-5 flexion withdrawal from pain-4 abnormal flexion (decorticate)-3 abnormal extension (decerebrate)-2 no response-1
E
Exposure
completely undress
rewarm for hypothermia
most important part of secondary survey
anticoagulants
components of secondary survey
Head to Toe Physical Exam ONLY AFTER Primary Survey is STABLE
HPI
PMHX
Allergies
Medications
Anticoagulants
Past Surgical Hx
Family Hx
Social Hxmost important labs
coags
radiology: head CT and cervical spine CT are both done withOUT….
CONTRAST
Mild Brain injury GCS
13-15 & a mechanism
aka a concussion
symptoms/sign of mild brain injury
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
for mild TBI, what criteria must be met for outpt observation
GCS 15 NO ANTICOAGULANTS NO Seizure Caregiver at home Head CT negative (if indicated)
when for mild TBI is there an admission
If GCS <15 or + ANTICOAGULANTS or + Seizure or - Caregiver at home or + Head CT
moderate TBI, GCS and s/sxs
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
Severe TBI GCS and s/sxs
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)
epidural hematoma Collection between dura and skull
Collection between dura and skull
80% Skull Fx
*Arterial Bleeding
*Middle meningeal arteries
Lenticular/Biconvex shape
Space Occupying lesion
Herniation likely if untreateds/sxs of epidural hematoma most imp
Initial, brief LOC—lucid interval—rapid neuro deterioration
Fixed dilated pupil on the unilateral side as herniation
subdermal hematoma
- 30% of TBIs
- shearing force of VENOUS bridging veins between DURA and ARACHNOID
- CONCAVE hematoma
- space occupying lesion
most imp to know about s/sxs of subdermal hematoma
Many be relatively asymptomatic-nonfocal!
acute vs chronic subdural hematoma color
Acute subdural = white
Chronic subdural = black
Traumatic Subarachnoid Hemorrhage (TSAH)
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
cerebral contusions
- “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
MC type of skull fx
Linear Skull Fractures
MC location of linear skull fxs
temporoparietal, frontal, occipital
when are linear skull fxs sig imp
They cross the middle meningeal groove in the TEMPORAL BONE or major venous dural sinus
