Head Trauma

Question 1

How do you manage uncomplicated head injuries?

Answer 1

AB (avoid hypoxia)

C (avoid hypotension)

Question 2

If a patient has taken a fall and has a skull fracture, what are they at a risk of?

Answer 2

Haematoma

Question 3

What is Diffuse Axonal Injury?

Answer 3

Axon shear (post concussion syndrome)
Trauma causes the axon of the nerve to twist and tear
The result is permanent death of the brain cell

Question 4

What is the Monro-Kellie Doctrine?

Answer 4

The volume of the head/skull/cranial vault
v.intracranial (constant) = v.brain + v.csf + v.blood + v.mass lesion
If one pressure goes up, other must go down to keep constant

Question 5

What is the equation for cerebral perfusion pressure (CPP)?

Answer 5

CPP = MAP - ICP

Question 6

What are the effects of CO2 on cerebral blood flow?

Answer 6

Inc CO2 -> Vessels dilate -> Inc ICP -> Inc cerebral blood flow

Question 7

How should fluids be managed in patients with head trauma injuries?

Answer 7

Should be kept normovolaemic

Question 8

What are the effects of giving mannitol (osmotic diuretic) to patients with head trauma injuries?

Answer 8

Damaged blood brain barrier -> osmotically active particles may leak into cerebral interstitium -> will not reduce brain water content

Question 9

What focal damage might be present in patients with head trauma injuries?

Answer 9

Hemispheric sequelae
Cranial nerve palsies
Anosmia
Vestibulocochlear - vertigo and nystagmus

Question 10

What mental sequelae may result in patient survivors with head trauma injuries?

Answer 10

Personality disorders
Memory disorders
Reduced reasoning power
Apathy, lack of drive
Temper tantrums
Family disruption