Head trauma Flashcards
___% of MVC-related deaths are due to HI
60%
Kinds of skull fractures
vault fractures
basal skull fractures
Kinds of vault fractures
◆ linear, non-depressed
◆ depressed
◆ linear, non-depressed vault fracture. Frequency and site
– most common
– typically occur over temporal bone, in area of middle meningeal artery (commonest cause of
epidural hematoma)
◆ depressed vault fracture: kinds and asociations
open (associated overlying scalp laceration and torn dura, skull fracture disrupting paranasal
sinuses or middle ear) vs. closed
■ basal skull fractures: common site, deployment, way to Dx,
◆ typically occur through floor of anterior cranial fossa (longitudinal more common than
transverse)
◆ generally a clinical diagnosis (poorly visualized on CT)
■ basal skull fractures: , signs
◆ associated with battle signs or racoon eyes.
CSF rhinorrhea/ otorrhea. Haematotympanum.
Bump
severe facial fractures may pose risk to airway from ______
profuse bleeding
scalp laceration
management
achieve hemostasis, inspect and palpate for skull bone defects ± CT head (rule-out skull fracture)
• neuronal injury kinds
. diffuse
focal injuries
mild TBI =_____
concussion
concussion definition
transient alteration in mental status that may involve loss of consciousness
◆ hallmarks of concussion:
confusion and amnesia, which may occur immediately after the
trauma or minutes later
◆ loss of consciousness (if present in head trauma) must be less than____ min, initial GCS must be between __-__,
and post-traumatic amnesia must be less than ___ h
◆ loss of consciousness (if present in head trauma) must be less than 30 min, initial GCS must be between 13-15,
and post-traumatic amnesia must be less than 24 h
Kinds of diffuse axonal injury
diffuse axonal injury: mild, moderate, severe
mild diffuse axonal injury features
coma 6-24 h, possibly lasting deffcit
moderate diffuse axonal injury features
moderate: coma >24 h, little or no signs of brainstem dysfunction
severe diffuse axonal injury features
severe: coma >24 h, frequent signs of brainstem dysfunction
Kinds of focal injuries on head trauma
■ contusions
■ intracranial hemorrhage (epidural, subdural, intracerebral)
A
On BRAIN INJURY, its severity is determined by … (only titles)
LOC
pupils
Lateralizing signs
on LOC, ◆ if GCS ___ intubate, any change in score of 3 or more = serious injury
◆ GCS ≤8 intubate, any change in score of 3 or more = serious injury
anisocoria is defined by >__mm
1
what labs would you ask in a head trauma
: CBC, electrolytes, INR/PTT, glucose, toxicology screen
Imaging on head trauma
- CT scan head and neck (non-contrast) to exclude intracranial hemorrhage/hematoma
- C-spine imaging
Management of head trauma. • goal in ED:
: reduce secondary injury by avoiding hypoxia, ischemia, decreased CPP, seizure
Management of head trauma, general measures
■ ABCs
■ ensure oxygen delivery to brain through intubation and prevent hypercarbia
■ maintain BP (sBP >90)
■ treat other injuries
Warning Signs of Severe Head Injury
- GCS <8
- Deteriorating GCS
- Unequal pupils
- Lateralizing signs N.B. Altered LOC is a hallmark of brain injury
How you do the seizure treatment/prophylaxis
■ benzodiazepines, phenytoin, phenobarbital
■ steroids are of no proven value
if HI with signs of increased ICP, management:
■ intubate
■ calm (sedate) if risk for high airway pressures or agitation
■ paralyze if agitated
■ hyperventilate (100% O2) to a pCO2 of 30-35 mmHg
■ elevate head of bed to 20º
■ adequate BP to ensure good cerebral perfusion
■ diurese with mannitol 1g/kg infused rapidly (contraindicated in shock/renal failure)
for minor HI not requiring admission, provide ____h HI protocol to competent caregiver, follow-up with
neurology as even seemingly minor HI may cause lasting deffcits
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