MED/SURG: TRAUMA ASSESSMENT 1 Flashcards
•Primary Survey - A, B, C, D ,E. Done as quickly as possible so that immediate threats to life are rapidly identified and effectively managed.
- A: AIRWAY
- B: BREATHING
- C: CIRCULATION
- D: DYSFUNCTION OF NERVOUS SYSTEM⇒DETERMINE MECHANISM OF INJURY
- E: EXPOSURE
(Auth PPT)
Secondary Assessment
F
G
H
•F = full set of vital signs &
family present
•G = comfort..positioning,
pain
•H = head to toe
assessment and medical
history
•H = head to toe assessment and medical history
TBI
Traumatic Brain Injury
TBI (Primary) defined
Diffuse Axonal Injury
Slide 18
Diffuse axonal injury affects nerve fibers, which can lead to a disruption in nerve communication — affecting a person’s physical and cognitive abilities.
Diffuse axonal injury occurs in about half of all severe head traumas, making it one of the most common traumatic brain injuries. It can also occur in moderate and mild brain injury. A diffuse axonal injury falls under the category of a diffuse brain injury. This means that instead of occurring in a specific area, like a focal brain injury, it occurs over a more widespread area.
In addition to being one of the most common types of brain injuries, it’s also one of the most devastating. As a matter of fact, severe diffuse axonal injury is one of the leading causes of death in people with traumatic brain injury.
TBI TERMS
- Focal (2)
- Diffuse (3)
Focal: Isolated scalp laceration, contact injury
Diffuse: Brain edema, decreased perfusion, anoxia
Brain + ICF + Blood = ?
1500 ml
Intracranial Pressure =
5-15 mlHg
CPP?
Cerebral perfusion pressure
Mean Arterial Pressure = ?
50-150 mmHg
What is happening if…?
- If MAP < 50
- If MAP is > 150
- If MAP < 50 brain not being perfused
- If MAP is > 150 brain being squished
Primary Survey
RAPID ASSESSMENT OF NEUROLOGICAL STATUS (3)
- GLASGOW COMA SCALE
- AVPU: Alert, verbal, Painful, unresponsive
- PUPILS
Pupil Assessment During TBI “D”
- Muscle relaxants administered ____ the only aspect of the neurological exam that can be evaluated ?
- Narcotic
- Sympathomimetic
- Eye Surgery
- Pupils
- Narcotic constricted (meiosis)
- Sympathomimetic dilation (mydriasis): Sympathomimetic drugs are stimulant compounds which mimic the effects of neurotransmitter substances of the sympathetic nervous system such as catecholamines, epinephrine, norepinephrine, dopamine, etc.
- Eye Surgery (can alter or eliminate pupillary reactivity)
Sluggish or Oval pupils causes? (3)
- r/t diabetic neurophathy
- Degenerative
- Impending herniation (brain coming out of head)
Pinpoint pupils causes (3)
Narcotics
Pontine Destruction
Early central herniation
- Bilateral Fixed and dilated pupils are secondary to ?
- Causes?
SEVERE ELEVATIONS OF ICP EQUALS INADEQUATE CEREBRAL PERFUSION
- Inadequate cerebral perfusion
- Diffuse cerebral hypoxia
ONLY ONE PUPIL IS FIXED AND DILATED
UNILATERAL DILATED PUPIL THAT DOES NOT RESPOND TO TO EITHER DIRECT OR CONSENSUAL STIMULATION USUALLY INDICATES
UNILATERAL DILATED PUPIL THAT DOES NOT RESPOND TO TO EITHER DIRECT OR CONSENSUAL STIMULATION USUALLY INDICATES TRANSTENTORIAL HERNIATION
ONLY ONE PUPIL IS FIXED AND DILATED
Pupil does not constrict when light is directed at the pupil but constricts when light is directed into the contralateral pupil (Intact consensual response) is indicative of a
Traumatic Optic Nerve Injury
Irregular Shaped Pupils
Caused by lack of coordination of muscle fibers of the Iris and is midbrain injuries
Concussion can cause brief loss of consciousness but name a few s/s that are not associated with a simple concussion
- Seizure
- muscle weakness
- pupillary changes
- prolonged loss of consciousness
Contrecoup Injury
and
Coup
In head injury, a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was impacted. Coup and contrecoup injuries are associated with cerebral contusions, a type of traumatic brain injury in which the brain is bruised.
Diffuse Axonal Injury
Diffuse axonal injury (damages several areas of the brain at the same time
- What is it?
- What causes it?
- Severe form of brain injury
- Brain tissue and axons tear/shear/break
- This injury can be one of the most devastating leading to major and often permanent neurological disability
Menigenal Layers (7)
- scalp
- skull
- dura mater
- arachnoid mater
- cerebrospinal fluid
- pia mater
- cerebrum
What kind of hematoma is r/t side “t-bone trauma?
Epidural Hematoma
Epidural Hematoma s/s (4)
Pupil dilated on ? side…which side?
- Classical present with a lucid interval prior to becoming rapidly unresponsive
- mild EDH HA or no s/s
- Severe EDH ⇒ decreased LOC
- Pupil dilated on ONE side same side of EDH
Subdural Hematoma
- What blood vessels are in this area?
- VEINS
Subacute or Chronic Subdurals
- What is it?
- Delayed presentation of of the bleed days or weeks after injury
Subdural …slow….to go
- s/s most common
- ___?___like symptoms including (3)
- HA
- Stroke like symptoms
abnormal speech
weakness
numbness
LARGE SUBDURAL CAN LEAD TO INCREASE ICP AND LOSS OF CONSCIOUNESS
Subarachnoid Hemorrhage SAH
Presentation of this bleed depends on MECHANISM OF INJURY
- Wide range of presentation asymptomatic to comatose
- EXPLOSIVE HA
Intracerebral Hemorrhage
Term for “within the brain”
Intraparenchymal
Brain Herniation
- Does what to ICP?
- What type of posturing?
- Pupil status
- LOC?
- GCS?
- Increased ICP
- Decerebate or decorticate
- pupils blown on one side or both
- LOC decreased
- GCS low
Symptoms of MENINGITIS
- BRUDZINSKI “breathing….neck…neck flexes causes hip and knee flex
- KERNIG’S SIGN “Knee is flexed when HIP is flexed” can’t straighten leg when hip is flexed
