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My Stuff > Head Trauma > Flashcards

Head Trauma Flashcards

1
Q

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

A

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

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2
Q

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

A

True

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3
Q

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?

A

Concussion

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4
Q

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

A

Basilar skull fracture

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5
Q

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

A

CT and CTA of head

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6
Q

Lens shaped lesion that does not extend beyond the cranial sutures

A

Epidural bleed

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7
Q

An epidural bleed is usually associated with what artery?

A

Middle meningeal artery

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8
Q

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

A

Epidural bleed

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9
Q

Crescent shaped collection of blood in subdural space

A

Subdural hematoma

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10
Q

What vessels are typically associated with a subdural hematoma?

A

Bridging veins

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11
Q

What day limit constitutes an acute subdural hematoma?

A

14 or less

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12
Q

What injury occurs as a result of abrupt deceleration forces?

A

Axonal shear injury

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13
Q

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

A

MRI

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14
Q

What are the four main herniation syndromes?

A

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

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15
Q

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

A

Uncal herniation

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16
Q

Herniation characterized by pinpoint pupils and hemiparesis

A

Central herniation

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17
Q

Medial portion of temporal hemisphere shifts below tentorium

A

Uncal herniation

18
Q

Both hemisphere push through tentorium

A

Cental herniation

19
Q

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

A

Cingulate herniation

20
Q

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

A

Posterior fossa/cerebellar tonsil herniation

21
Q

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

A

Foramen magnum

22
Q

What is the immediate treatment for all herniation syndromes?

A

Mannitol 1mg/kg over 15 min

23
Q

How does mannitol help with herniation?

A

Acts as a diuretic to directly decrease volume and ICP

24
Q

What should be maintained while treating a head trauma patient?

A

Cerebral perfusion pressure

25
Q

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

A 
Hypotension
Hypoxia
Hypoglycemia
Hypercarbia
Hyperthermia
26
Q

What prophylaxis is important for conditions of increased ICP?

A

Seizure prophylaxis

27
Q

What MAPs should be avoided during treatment of head trauma?

A

Less than 50mmHg and greater than 110mmHg

28
Q

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

A

MAP

29
Q

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

A

Hyperventilation

30
Q

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

A

35mmHg

31
Q

What is the maximum score of GCS?

A

15

32
Q

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

A

4

33
Q

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

A

5

34
Q

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

A

6

35
Q

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?

A

Canada rule

36
Q

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

A

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

37
Q

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

A

AMS, severe mechanism, clinical signs of basilar skull fracture

38
Q

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

A

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

39
Q

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

A

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

40
Q

What are the inclusion criteria for the Canada rule?

A

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

41
Q

What are the three signs of Cushing’s reflex?

A

Bradycardia, hypertension, decreased respiration rate

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