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MED/SURG: TRAUMA > MED/SURG: TRAUMA ASSESSMENT 1 > Flashcards

MED/SURG: TRAUMA ASSESSMENT 1 Flashcards

1
Q

•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
  1. A: AIRWAY
  2. B: BREATHING
  3. C: CIRCULATION
  4. D: DYSFUNCTION OF NERVOUS SYSTEM⇒DETERMINE MECHANISM OF INJURY
  5. E: EXPOSURE

(Auth PPT)

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2
Q

Secondary Assessment

F

G

H

A

•F = full set of vital signs &

      family present

•G = comfort..positioning,

     pain

•H = head to toe

      assessment and medical

       history
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3
Q

•H = head to toe assessment and medical history

A
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4
Q

TBI

A

Traumatic Brain Injury

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5
Q

TBI (Primary) defined

Diffuse Axonal Injury

Slide 18

A

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.

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6
Q

TBI TERMS

  1. Focal (2)
  2. Diffuse (3)
A

Focal: Isolated scalp laceration, contact injury

Diffuse: Brain edema, decreased perfusion, anoxia

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7
Q

Brain + ICF + Blood = ?

A

1500 ml

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8
Q

Intracranial Pressure =

A

5-15 mlHg

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9
Q

CPP?

A

Cerebral perfusion pressure

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10
Q

Mean Arterial Pressure = ?

A

50-150 mmHg

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11
Q

What is happening if…?

  1. If MAP < 50
  2. If MAP is > 150
A
  1. If MAP < 50 brain not being perfused
  2. If MAP is > 150 brain being squished
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12
Q

Primary Survey

RAPID ASSESSMENT OF NEUROLOGICAL STATUS (3)

A
  1. GLASGOW COMA SCALE
  2. AVPU: Alert, verbal, Painful, unresponsive
  3. PUPILS
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13
Q

Pupil Assessment During TBI “D”

  1. Muscle relaxants administered ____ the only aspect of the neurological exam that can be evaluated ?
  2. Narcotic
  3. Sympathomimetic
  4. Eye Surgery
A
  1. Pupils
  2. Narcotic constricted (meiosis)
  3. 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.
  4. Eye Surgery (can alter or eliminate pupillary reactivity)
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14
Q

Sluggish or Oval pupils causes? (3)

A
  1. r/t diabetic neurophathy
  2. Degenerative
  3. Impending herniation (brain coming out of head)
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15
Q

Pinpoint pupils causes (3)

A

Narcotics

Pontine Destruction

Early central herniation

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16
Q
  1. Bilateral Fixed and dilated pupils are secondary to ?
  2. Causes?

SEVERE ELEVATIONS OF ICP EQUALS INADEQUATE CEREBRAL PERFUSION

A
  1. Inadequate cerebral perfusion
  2. Diffuse cerebral hypoxia
17
Q

ONLY ONE PUPIL IS FIXED AND DILATED

UNILATERAL DILATED PUPIL THAT DOES NOT RESPOND TO TO EITHER DIRECT OR CONSENSUAL STIMULATION USUALLY INDICATES

A

UNILATERAL DILATED PUPIL THAT DOES NOT RESPOND TO TO EITHER DIRECT OR CONSENSUAL STIMULATION USUALLY INDICATES TRANSTENTORIAL HERNIATION

18
Q

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

A

Traumatic Optic Nerve Injury

19
Q

Irregular Shaped Pupils

A

Caused by lack of coordination of muscle fibers of the Iris and is midbrain injuries

20
Q

Concussion can cause brief loss of consciousness but name a few s/s that are not associated with a simple concussion

A
  1. Seizure
  2. muscle weakness
  3. pupillary changes
  4. prolonged loss of consciousness
21
Q

Contrecoup Injury

and

Coup

A

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.

22
Q

Diffuse Axonal Injury

Diffuse axonal injury (damages several areas of the brain at the same time

  1. What is it?
  2. What causes it?
A
  1. Severe form of brain injury
  2. Brain tissue and axons tear/shear/break
  3. This injury can be one of the most devastating leading to major and often permanent neurological disability
23
Q

Menigenal Layers (7)

A
  1. scalp
  2. skull
  3. dura mater
  4. arachnoid mater
  5. cerebrospinal fluid
  6. pia mater
  7. cerebrum
24
Q

What kind of hematoma is r/t side “t-bone trauma?

A

Epidural Hematoma

25
Q

Epidural Hematoma s/s (4)

Pupil dilated on ? side…which side?

A
  1. Classical present with a lucid interval prior to becoming rapidly unresponsive
  2. mild EDH HA or no s/s
  3. Severe EDH ⇒ decreased LOC
  4. Pupil dilated on ONE side same side of EDH
26
Q

Subdural Hematoma

  1. What blood vessels are in this area?
A
  1. VEINS
27
Q

Subacute or Chronic Subdurals

  1. What is it?
A
  1. Delayed presentation of of the bleed days or weeks after injury
28
Q

Subdural …slow….to go

  1. s/s most common
  2. ___?___like symptoms including (3)
A
  1. HA
  2. Stroke like symptoms

abnormal speech

weakness

numbness

LARGE SUBDURAL CAN LEAD TO INCREASE ICP AND LOSS OF CONSCIOUNESS

29
Q

Subarachnoid Hemorrhage SAH

Presentation of this bleed depends on MECHANISM OF INJURY

A
  1. Wide range of presentation asymptomatic to comatose
  2. EXPLOSIVE HA
30
Q

Intracerebral Hemorrhage

Term for “within the brain”

A

Intraparenchymal

31
Q

Brain Herniation

  1. Does what to ICP?
  2. What type of posturing?
  3. Pupil status
  4. LOC?
  5. GCS?
A
  1. Increased ICP
  2. Decerebate or decorticate
  3. pupils blown on one side or both
  4. LOC decreased
  5. GCS low
32
Q

Symptoms of MENINGITIS

A
  1. BRUDZINSKI “breathing….neck…neck flexes causes hip and knee flex
  2. KERNIG’S SIGN “Knee is flexed when HIP is flexed” can’t straighten leg when hip is flexed
33
Q
A

MED/SURG: TRAUMA (13 decks)

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