Head Trauma

Question 1

Four groups of people at higher risk for intracranial injury after trauma are:

Answer 1

Less than 2 years old (also at more risk for non-accidental trauma)
Elderly (particularly SDH)
Chronic alcoholics
Patients on anticoagulants

Question 2

T/F A concussion does not require a LOC for diagnosis.

Answer 2

True

Question 3

What is associated with transient neurological changes such as transient anemia, confusion, disorientation or visual changes without any gross cerebral abnormalities or deficits on exam and a trauma?

Answer 3

Concussion

Question 4

What are associated with raccoon eyes, hematympanum, battle sign bruising behind ears, and/or clear drainage from nose or ear canal?

Answer 4

Basilar skull fracture

Question 5

What should be obtained if a basilar skull fracture is suspected?

Answer 5

CT and CTA of head

Question 6

Lens shaped lesion that does not extend beyond the cranial sutures

Answer 6

Epidural bleed

Question 7

An epidural bleed is usually associated with what artery?

Answer 7

Middle meningeal artery

Question 8

What diagnosis is characterized by a lucid interval after which patients rapidly decompensated with signs of increased ICP with pupillary dilation and unconsciousness?

Answer 8

Epidural bleed

Question 9

Crescent shaped collection of blood in subdural space

Answer 9

Subdural hematoma

Question 10

What vessels are typically associated with a subdural hematoma?

Answer 10

Bridging veins

Question 11

What day limit constitutes an acute subdural hematoma?

Answer 11

14 or less

Question 12

What injury occurs as a result of abrupt deceleration forces?

Answer 12

Axonal shear injury

Question 13

What is the gold standard of imaging for an axonal shear injury?

Answer 13

MRI

Question 14

What are the four main herniation syndromes?

Answer 14

Uncal herniation
Central herniation
Cingulate herniation
Posterior fossa /cerebellar tonsil herniation

Question 15

Herniation characterized by ipsilateral 3rd nerve palsy, ptosis, and a positive Babinski reflex

Answer 15

Uncal herniation

Question 16

Herniation characterized by pinpoint pupils and hemiparesis

Answer 16

Central herniation

Question 17

Medial portion of temporal hemisphere shifts below tentorium

Answer 17

Uncal herniation

Question 18

Both hemisphere push through tentorium

Answer 18

Cental herniation

Question 19

Cingulate gyrus is forced underneath the fall compression of ventricles and impairs blood flow

Answer 19

Cingulate herniation

Question 20

Herniation characterized by coma and brain stem dysfunction and rapid death; fixed, pinpoint pupils

Answer 20

Posterior fossa/cerebellar tonsil herniation

Question 21

What foramen does posterior fossa/cerebellar tonsil herniation occur in?

Answer 21

Foramen magnum

Question 22

What is the immediate treatment for all herniation syndromes?

Answer 22

Mannitol 1mg/kg over 15 min

Question 23

How does mannitol help with herniation?

Answer 23

Acts as a diuretic to directly decrease volume and ICP

Question 24

What should be maintained while treating a head trauma patient?

Answer 24

Cerebral perfusion pressure

Question 25

What should be avoided while treating a head trauma patient (the 5 Hs)?

Answer 25

``` Hypotension Hypoxia Hypoglycemia Hypercarbia Hyperthermia ```

Question 26

What prophylaxis is important for conditions of increased ICP?

Answer 26

Seizure prophylaxis

Question 27

What MAPs should be avoided during treatment of head trauma?

Answer 27

Less than 50mmHg and greater than 110mmHg

Question 28

Inappropriate _________ will cause the loss of autoregulation, decreased cerebral perfusion pressure, and working injury.

Answer 28

MAP

Question 29

What is an optional treatment to keep CPP above 50mmHg?

Answer 29

Hyperventilation

Question 30

What is the minimum CO2 level that should be reached with hyperventilation before respiratory alkalosis occurs?

Answer 30

35mmHg

Question 31

What is the maximum score of GCS?

Answer 31

15

Question 32

What are the maximum number of points for eye on GCS?

Answer 32

4

Question 33

What are the maximum number of points for verbal on GCS?

Answer 33

5

Question 34

What are the maximum number of points for motor on GCS?

Answer 34

6

Question 35

What assessment rule is an exclusion rule meaning that if the patient does not have the features, they are at low risk for intracranial event and do not require a head CT?

Answer 35

Canada rule

Question 36

What are the PECARN criteria that indicate a child over 2 years old does NOT require a head CT?

Answer 36

None of the below: AMS, severe mechanism, clinical signs of basilar skull fracture, any LOC, history of vomiting, history of severe headache

Question 37

What are the PECARN criteria that indicate a child over 2 years old DOES require a CT?

Answer 37

AMS, severe mechanism, clinical signs of basilar skull fracture

Question 38

What are the PECARN criteria that a child less than 2 years old does NOT require a CT?

Answer 38

Normal MS, frontal scalp hematoma, no palpable skull injury, low risk mechanism, acting normal per parents, LOC <5 seconds

Question 39

What are the PECARN exclusion criteria for a child less than 2 years old?

Answer 39

GCS <15, palpable skull fracture, AMS, dangerous mechanism

Question 40

What are the inclusion criteria for the Canada rule?

Answer 40

GCS 13-15, age >16, no coagulopathy or anticoagulation, no obvious open skull fracture

Question 41

What are the three signs of Cushing's reflex?

Answer 41

Bradycardia, hypertension, decreased respiration rate