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Neuro junior > Head trauma (Garcia) > Flashcards

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

A

CO2

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
Q

Emergency blood screening (6)

A

Arterial blood gas + PCV/TS

  1. Glucose
  2. Acid-base status
  3. Ventilation (CO2)
  4. Perfusion (Lactate)
  5. Electrolytes
  6. Renal values
26
Q

Cardiovascular and resp assess (5)

A
  1. Blood pressure
  2. SpO2
  3. Capnography
  4. Radiographs
  5. T-FAST and A-FAST
27
Q

Imaging considered when (4)

A
  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
Q

CT (4)

A
  1. Fast
  2. IDs acute hemorrhage
  3. less spensive
  4. gen anesth not req’d
29
Q

MRI

A
  1. anesth req’d (patient must be stable)
30
Q

TBI TX (4)

A
  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
Q

Hypertonic saline

A
  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
Q

Mannitol

A
  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
Q

Other TX (5)

A
  1. NO CORTICOSTEROIDS
  2. Furosemide not recommended
  3. Elevate head
  4. Nutrition asap
  5. Therapeutic hypothermia…?!?!?!
34
Q

Seizure prophylaxis

A

Not necessary if no seizures - DO TREAT seizures

35
Q

Monitoring (7)

A
  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
Q

Prognosis (3)

A
  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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