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Head trauma (Garcia) Flashcards

1
Q

Objectives (5)

A
  1. Recognize head trauma/TBI
  2. ID CS head trauma and/or TBI
  3. Primary TBI vs secondary TBI
  4. Patient monitoring and management
  5. Prognosis/outcomes
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2
Q

head trauma inc cats vs dogs vs horses

A

Dogs - HBC
Cats - crush inj
Horses - rearing and going backwards, unknown, etc

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3
Q

TBI doesn’t require

A

fractures

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4
Q

Patient assessment (4)

A
  1. Assess life-threatening extraranial things first
  2. ABCs
  3. stabilize systemically
  4. 60% of TBI patients have other major injuries
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5
Q

Extracranial priorities (5)

A
  1. Airway obstruction
  2. Oxygenation - maintain Sp02 > 95%
  3. Ventilation - art blood gas
  4. Volume status
  5. Penetrating wounds - thoracic/abdominal
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6
Q

Initial neuro assessment (3)

A
  1. Level of conciousness
  2. Motor activity
  3. Brain stem reflexes (CN V-XII?!?!)
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7
Q

Modified Glascow Coma Scale (3)

A
  1. Level of Consciousness (1-6)
  2. Motor Activity
  3. Brain Stem Reflexes
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8
Q

About GCS (4)

A
  1. 18 best score
  2. Objective assessment of progression of neuro signs
  3. Aids in prognosis
  4. Do serially
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9
Q

Bilateral Miosis with left pupil pinpoint (2)

A
  1. early severe trauma

2. sympathetic nucleus dysfunction

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10
Q

Asymmetric left-sided mydriasis

A
  1. progressive trauma

- symp nucleus first, then parasympathetic nucleus dysfunction

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11
Q

Normal Brain Physiology (5)

A
  1. Brain gets 15-20% Cardiac Output
  2. CBF: systemic BP and Cerebral metabolic rate and Pa02 & PaCO2
  3. Glucose is primary energy source - no stores
  4. Low tolerance for hypoxia
  5. Autoregulation between MAP 50-150 mmHg
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12
Q

TBI: Primary injury

A

Direct injury of intracranial structures

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13
Q

Examples of direct injury of IC structures (3)

A
  1. Concussion
  2. Contusion
  3. Laceration - vasculature or parenchyma
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14
Q

Types of primary injury that can be addressed (4)

A

Not much we can do

  1. Hematoma
  2. Depressed skull fractures
  3. Foreign bodies
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15
Q

TBI: Secondary injury (3)

A
  1. TBI triggers biochem changes - cell death distant to injury site
  2. Minutes to days after injury
  3. Severity of secondary inj most important determinant of outcome
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16
Q

Brain damage ->

A

Neuronal dysfunction -> cell death

17
Q

Extracranial phenomenon (5)

A
  1. BP alterations
  2. Anemia
  3. Hypercapnia
  4. Infection
  5. Electrolyte abnormalities
18
Q

Intracranial alterations (3)

A
  1. Ischemia
  2. Cerebral edema
  3. Inc ICP
19
Q

Main cause vasodilation

20
Q

Secondary brain inj schematic (7)

A
  1. Cerebral lactic acidosis
  2. Excitotoxicity
  3. Inflammation
  4. ATP depletion
  5. Ischemia
  6. Production of ROS
  7. Accumulation of Na and Ca
21
Q

Cerebral Perfusion Pressure equation

A

CPP = MAP - ICP

  • normal ICP 5-12 mmHg
  • normal CPP 40-120 mmHg: force driving blood into calvarium: O2 and nutrients
22
Q

Monro-Kellie Doctrine

A

Vintracran=Vbrain+Vcsf+Vblood+Vmasslesion

23
Q

Cushing’s reflex

A

Bradycardia with reflex hypertension

24
Q

If there is increased ICP DO NOT

A

hold off the jugular vein

25
Emergency blood screening (6)
Arterial blood gas + PCV/TS 1. Glucose 2. Acid-base status 3. Ventilation (CO2) 4. Perfusion (Lactate) 5. Electrolytes 6. Renal values
26
Cardiovascular and resp assess (5)
1. Blood pressure 2. SpO2 3. Capnography 4. Radiographs 5. T-FAST and A-FAST
27
Imaging considered when (4)
1. Moderate to sev CS of TBI on presentation 2. Failure in imp of CS 3. Deterioration in CS 4. Rule in/out things requiring sx
28
CT (4)
1. Fast 2. IDs acute hemorrhage 3. less spensive 4. gen anesth not req'd
29
MRI
1. anesth req'd (patient must be stable)
30
TBI TX (4)
1. Address EC concerns first 2. Oxygen (flow by or ET tube) - SpO2 > 95% - ventilation (CO2 35-40 mmHg) 3. Fluids (MAP 80-100 mmHg) - blood - crystalloids 4. Pain managment - BE CAREFUL, NO VX - neuro assess first
31
Hypertonic saline
1. Need smaller vol. 2. Imp hemodynamic stat 3. Imp cardiac contractility 4. Dec endothel swelling 5. Immunomodulatory?!?! 6. 3-5 ml/kg IV over 15 followed by crystalloids - can redose I think
32
Mannitol
1. Gold standard?!?! 2. Osmotic diuretic 3. Free radical scavenger 4. Rheological properties 5. May worsen hypovolemia -> arterial hypotension 6. Cause renal injury 7. 0.5-1.5 g/kg IV over 15 min followed by crystalloids 8. Can redose once (I think)
33
Other TX (5)
1. NO CORTICOSTEROIDS 2. Furosemide not recommended 3. Elevate head 4. Nutrition asap 5. Therapeutic hypothermia...?!?!?!
34
Seizure prophylaxis
Not necessary if no seizures - DO TREAT seizures
35
Monitoring (7)
1. BP q2h 2. Continuous ECG 3. Continuous Pulse Ox 4. Neuro assess q4-6 h 5. Serial blood gas 6. Prevent aspiration 7. Prevent pressure sores
36
Prognosis (3)
1. linear correlation between MGCS score and survival w/in 72 hours 2. Presence of hyperglycemia (I think) is poor prognostic indic 3. TIME IS BEST FRIEND

Neuro junior (14 decks)

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