L16: Head Trauma Flashcards
Mayo clinic mild head injury is:
- Glasgow coma score: _______
- Loss of consciousness: _________
- Loss of consciousness: _________
- No _______________
Mayo clinic mild head injury is:
- Glasgow coma score: 13-15
- Loss of consciousness < 30 mins
- Loss of consciousness < 30 mins
- No cerebral bleed (normal imaging)
Factors assessed by Glasgow coma scale?
Injury below red nucleus (________) => _________________
Injury above red nucleus (__________) => ______________
Injury below red nucleus (decerebrate), internal rotation of arms => all limbs extended
Injury above red nucleus (decorticate)=> arms flexed, legs extended
Epidural vs. Subdural Hematoma?
Radiological appearance?
Epidural: Lemon Shaped
Subdural: Banana Shaped
What artery is usually injured in an epidural hematoma?
What is the Monroe-Kellie Hypothesis?
What is used to check compensated/decompensated Intracranial Pressure?
Cushing Reflex: HYPERTENSION and BRADYCARDIA => trying to drive cerebral blood flow.
Increased intracranial pressure reduces cerebral perfusion, and the resultant cerebral ischemia causes massive sympathetic activation.
Look at optic disks!: Pappiloedma Present (>6 Hours raised ICP)
Sixth nerve palsy?: Lateral Recutus innervated by CNVI (abducens nerve). Check Abduction of the eye!
Significance of double blood supply from the Anterior Cerebral Artery?
Circle of Willis if blockage => Compensation
Perfectly symmetrical supply to both sides of the brain during development
Tonsil should not be more than 5mm below
Management of raised intracranial pressure?
Sign of Middle Cranial Fossa Injury?
Artery Involved?
Involves posterior auricular artery
Sign of Fracture of anterior cranial fossa?
Periorbital Ecchymosis
Sites for cerebrospinal fluid leakage?
What bone do we expect to be fractured when observing Cerebrospinal Fluid Otorrhoea?
Suspect Temporal Bone fracture
What is this sign called? What do we expect the cause to be?
Hemotympanum: blood behind temporal membrane
Middle cranial fossa fracture (Battles sign commonly seen too)
How do we determine if discharge is CSF?
Old test is presence of Glucose (glucose oxidase paper)
Better test is Beta2 transferrin located only in:
- Cerebrospinal fluid
- Perilymph
- aqueous humour of eye
At what Glasgow Score do we immediately Induce and intubate?
GCS <8 n=> Rapid sequence induction and intubation
Paralyze w/ neuromuscular blocker => Anesthetic => Intubate (Pressure on cricoid to compress esophagus)
Common Problems after Head injury?
Post traumatic epilepsy after severe head injury
Endocrine dysfunction is often overlooked
