Head trauma

Question 1

___% of MVC-related deaths are due to HI

Answer 1

60%

Question 2

Kinds of skull fractures

Answer 2

vault fractures

basal skull fractures

Question 3

Kinds of vault fractures

Answer 3

◆ linear, non-depressed

◆ depressed

Question 4

◆ linear, non-depressed vault fracture. Frequency and site

Answer 4

– most common
– typically occur over temporal bone, in area of middle meningeal artery (commonest cause of
epidural hematoma)

Question 5

◆ depressed vault fracture: kinds and asociations

Answer 5

open (associated overlying scalp laceration and torn dura, skull fracture disrupting paranasal
sinuses or middle ear) vs. closed

Question 6

■ basal skull fractures: common site, deployment, way to Dx,

Answer 6

◆ typically occur through floor of anterior cranial fossa (longitudinal more common than
transverse)
◆ generally a clinical diagnosis (poorly visualized on CT)

Question 7

■ basal skull fractures: , signs

Answer 7

◆ associated with battle signs or racoon eyes.
CSF rhinorrhea/ otorrhea. Haematotympanum.
Bump

Question 8

severe facial fractures may pose risk to airway from ______

Answer 8

profuse bleeding

Question 9

scalp laceration

management

Answer 9

achieve hemostasis, inspect and palpate for skull bone defects ± CT head (rule-out skull fracture)

Question 10

• neuronal injury kinds

Answer 10

. diffuse

focal injuries

Question 11

mild TBI =_____

Answer 11

concussion

Question 12

concussion definition

Answer 12

transient alteration in mental status that may involve loss of consciousness

Question 13

◆ hallmarks of concussion:

Answer 13

confusion and amnesia, which may occur immediately after the

trauma or minutes later

Question 14

◆ 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

Answer 14

◆ 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

Question 15

Kinds of diffuse axonal injury

Answer 15

diffuse axonal injury: mild, moderate, severe

Question 16

mild diffuse axonal injury features

Answer 16

coma 6-24 h, possibly lasting deffcit

Question 17

moderate diffuse axonal injury features

Answer 17

moderate: coma >24 h, little or no signs of brainstem dysfunction

Question 18

severe diffuse axonal injury features

Answer 18

severe: coma >24 h, frequent signs of brainstem dysfunction

Question 19

Kinds of focal injuries on head trauma

Answer 19

■ contusions
■ intracranial hemorrhage (epidural, subdural, intracerebral)
A

Question 20

On BRAIN INJURY, its severity is determined by … (only titles)

Answer 20

LOC
pupils
Lateralizing signs

Question 21

on LOC, ◆ if GCS ___ intubate, any change in score of 3 or more = serious injury

Answer 21

◆ GCS ≤8 intubate, any change in score of 3 or more = serious injury

Question 22

anisocoria is defined by >__mm

Answer 22

1

Question 23

what labs would you ask in a head trauma

Answer 23

: CBC, electrolytes, INR/PTT, glucose, toxicology screen

Question 24

Imaging on head trauma

Answer 24

• CT scan head and neck (non-contrast) to exclude intracranial hemorrhage/hematoma
• C-spine imaging

Question 25

Management of head trauma. • goal in ED:

Answer 25

: reduce secondary injury by avoiding hypoxia, ischemia, decreased CPP, seizure

Question 26

Management of head trauma, general measures

Answer 26

■ ABCs
■ ensure oxygen delivery to brain through intubation and prevent hypercarbia
■ maintain BP (sBP >90)
■ treat other injuries

Question 27

Warning Signs of Severe Head Injury

Answer 27

• GCS <8
• Deteriorating GCS
• Unequal pupils
• Lateralizing signs N.B. Altered LOC is a hallmark of brain injury

Question 28

How you do the seizure treatment/prophylaxis

Answer 28

■ benzodiazepines, phenytoin, phenobarbital

■ steroids are of no proven value

Question 29

if HI with signs of increased ICP, management:

Answer 29

■ 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)

Question 30

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

Answer 30

24