Neurological Trauma Flashcards
(84 cards)
1
Q
How does injury occur in an acceleration/deceleration injury?
A
compression, tension and shearing injuries
2
Q
name for brain tissue injury directly at the site of impact and at teh pole opposite of the site of impact?
A
coup-countrecoup injury
3
Q
Blast injuries primarily affect which part(s) of the brain?
A
hippocampus and brain stem
4
Q
How does hyperventilation lower ICP?
A
causes cerebral vasoconstriction
5
Q
When is hyperventilation used in the treatment of a brain injury?
A
- when symptoms of brain herniation are present or if ICP is severely high
- causes vasoconstriction by reducing PaCO2
6
Q
What is the goal PaCO2 when hyperventilating a patient with suspected herniation?
A
25-30 mmHg
7
Q
What is the goal SBP for 50-60 y/o with brain injury?
A
> 100 mmHg
8
Q
What is the goal SBP for > 15 y/o with brain injury?
A
> 110 mmHg
9
Q
What does AVPU stand for when assessing neuro status?
A
- Awake
- responds to Verbal stimuli
- responds to Painful stimuli
- Unresponsive
10
Q
What does the glasgow coma scale assess?
A
- eye opening
- verbal response
- motor response
11
Q
What is the score range for the GCS?
A
- 3-15
- 3 = worst score
- 15 = best scores
12
Q
A patient is considered comatose with a GCS score of?
A
8 or less
13
Q
Term for flexion of upper extremities with inward rotation and extension of lower extremities
A
decorticate
14
Q
term for rigidity and abnormal extension of upper extremities and lower extremities
A
decerebrate
15
Q
What condition should be considered when pupils are sluggish, unequal or enlarged with no response?
A
increased intracranial pressure or herniation
16
Q
What labs should be drawn on a TBI patient?
A
- tox screen
- CBC
- BMP or CMP
- Coagulation panel
17
Q
What is the initial imaging study for a TBI patient?
A
non-contrast CT
18
Q
What are the categories of injury related to TBI?
A
- primary head injury
- skull fracture
- brain injury
19
Q
What is the most common head injury?
A
scalp laceration
20
Q
What are signs of hypolemia?
A
- increased HR
- decreased BP
21
Q
How to treat a scalp laceration?
A
- monitor for hypovolemia
- assess for skull fracture then apply direct pressure
- suture/staple
22
Q
Lidocaine 1% with epinephrine should not be use where on the head?
A
nose or ears
23
Q
Types of skull fractures?
A
- simple
- depressed
- basilar
24
Q
Description of a simple skull fracture?
A
no displacement of bone or interface of the outside environment with the intracranial contents
25
Description of a depressed
bone tables and fragments depressing the thickness of the skull with exposure of the intracranial contents with the outside environment
26
Type of skull fracture with no displacement of bone or interface of the outside environment with the intracranial contents
simple skull fracture
27
Type of skull fracture where the bone tables and fragments depressing the thickness of the skull with exposure of the intracranial contents with the outside environment
depressed bone fracture
28
Treatment of a depressed bone fracture?
- surgery often required
- prophylactic broad-spectrum antibiotics
- tetanus is indicated
29
Description of a basilar fracture?
fracture in the anterior or posterior skull base
30
Raccoon eyes are associated with which type of fracture?
basilar fracture with anterior skull based compartment involvement
31
Term for periorbital ecchymosis related to an anterior skull base fracture?
raccoon eyes
32
Term for mastoid ecchymosis related to a posterior skull basilar fracture?
battle sign
33
Battle sign is associated with which type of fracture?
basilar fracture with posterior skull base involvement
34
Signs of a basilar fracture?
- raccoon eyes
- battle signs
- otorrhea
- rhinorrhea
35
Treatment of a basilar fracture?
- lumbar drain to divert CSF and minimize ICP
- surgical repair
- prophylactic antibiotics
- intubation and OG
36
What are considerations for placement of a gastric tube in a patient with a skull fracture?
- use oral gastric tube and intubation
| - avoid nasal route
37
Term for transient, reversible alteration in brain function?
concussion
38
What is the most common location of a concussion?
the temporal lobe
39
Consider imaging of a concussed patient if?
- GCS < 15 at 2hr
- GCS < 14 anytime
- EtOH/drugs suspected/noted
- concern for skull fracture
- age > 60 or < 16
- coagulopathy suspected
- focal deficit
- Loss of consciousness > 5 min
- seizure activity noted
- vomiting > 2 times
- persistent, severe HA
40
Term for regions of hemorrhagic necrosis and bruising of the brain
contusion
41
Most common sites of contusion lesions in the brain?
orbitofrontal or anterior temporal regions
42
Consider starting which types of prophylaxis treatment for brain contusions?
antiepileptic and seizure precautions
43
Bleeding into the epidural space between the skull and dura mater is called?
epidural hematoma
44
Lenticular shape that does not cross suture lines noted on a brain CT is indicative of?
an epidural hemorrhage
45
Evaluation and treatment of an epidural hematoma?
- noncontrast CT
- neurosurgical consult
- medical therapy
- surgical intervention
46
bleeding between the dura mater and arachnoid or pia layers?
subdural hematoma
47
What is the most frequent type of intracranial bleeding?
subdural hematoma
48
How long does it take for an Acute subdural hematoma to develop?
minutes to hours
49
How long does it take for a chronic subdural hematoma to develop?
days or weeks, generally in the elderly
50
Caused by the accumulation of blood between the arachnoid and pia surface?
subarachnoid hemorrhage
51
Symptoms of a epidural hematoma?
- initially unconscious, wakes up without deficit and then deteriorates
- deterioration may be rapid
52
S/S of an acute subdural hematoma?
- drowsiness
- agitation
- confusion
- HA
- unilateral or bilateral pupil dilation
- hemiparesis
53
S/S of a chronic subdural hematoma?
- usually in the elderly
- HA
- memory loss
- personality changes
- incontinence
- ataxia
54
S/S of traumatic subarachnoid hemorrhage?
- HA
- reduced LOC
- nuchal rigidity
- hemiplegia
- ipsilateral pupil abnormalities
55
Diffuse axonal injury is commonly observed with which type of movement?
rapid acceleration/deceleration of the head d/t shearing forces
56
Mild coma r/t a diffuse axonal injury lasts?
6-24 hrs
57
Moderate coma r/t a diffuse axonal injury lasts?
> 24 hrs
58
Severe coma r/t a diffuse axonal injury lasts?
prolonged and with decorticate/decerebrate posturing
59
Blown pupils are indicative of what type of brain injury?
cerebral herniation
60
What are the signs of Cushing triad r/t TBI?
1 ) HTN with widening pulse pressure
2) decreased RR
3) bradycardia
- elevated ICP is a late sign
61
Treatment of cerebral edema/elevated ICP/herniation?
- elevate HOB > 30 degrees
- opioids to lower ICP
- drain CSF
- hypothermia
- paralysis
62
Preferred choice of sedation in treatment of cerebral edema/elevated ICP/herniation?
- short acting opioids
- fentanyl
- remifentanil
63
What is the max dose of propofol for the treatment of cerebral edema/elevated ICP/herniation?
5mg/kg/hr
64
What is the dosage for a fentanyl gtt to treat cerebral edema/elevated ICP/herniation?
2-5 mcg/kg/hr
65
What is the dosage of propofol in the treatment of cerebral edema/elevated ICP/herniation?
20-75 mcg/kg/hr
66
Dexmedetomidine (precedex) gtt dosage in the treamtne of cerebral edema/elevated ICP/herniation?
0.2-0.7 mcg/kg/hr
67
Midazolam (versed) gtt dosage in the treatment of cerebral edema/elevated ICP/herniation?
0.2-1 mg/hr
68
diazepam (valium) dosage in the treatment of cerebral edema/elevated ICP/herniation?
2.5-10 mg single dose
69
lorazepam (ativan) dose in the treatment of cerebral edema/elevated ICP/herniation?
0.5-2 mg single dose
70
Cisatracurium (Nimbex) dosage in the treatment of cerebral edema/elevated ICP/herniation?
- 0.1-0.2 mg/kg bolus
| - 1- 10 mcg/kg/min continuous
71
Nimbex is titrated to?
train of four
72
Why is Mannitol the drug of choice in an emergency situation when brain herniation is pending?
- creates an osmotic gradient across the blood-brain barrier that pulls water from the CNS into the intravascular space
- decreases blood viscosity
73
Hyperosmolar therapy with Mannitol to treat brain herniation should be avoided in what patients?
- in shock
- HF
- significant renal disease
74
What does CPP stand for?
cerebral profusion pressure
75
Prophylactic anti-seizure treatment should last no longer than how many days?
7 days
76
How many cervical vertebrae are there?
7
77
How many thoracic vertebrae are there?
12
78
What are the parts of the spinal cord?
- ascending tracks
- descending tracks
- gray matter
- white matter
- meningeal layer
79
What are the parts of the meningeal layer?
- pia mater
- arachnoid
- dura mater
80
Types of spinal injury?
- complete
| - incomplete
81
Types of incomplete spinal cord injuries?
- Anterior cord syndrome
- Posterior cord syndrome
- Central cord syndrome
- Brown-Sequard syndrome
- Cauda equina syndrome
82
Anterior cord syndrome is cause by what type of injury?
hyperflexion injury
83
What is tested for in a BMP?
a. Bicarb
b. BUN
c. Creatinine
d. Calcium
e. Chloride
f. Glucose
g. Potassium
h. Sodium
84
What is tested for in a CMP?
a. Albumin
b. Alkaline phosphatase (ALP)
c. ALT
d. AST
e. Bicarb
f. Bilirubin
g. BUN
h. Creatinine
i. Calcium
j. Chloride
k. Glucose
l. Potassium
m. Sodium
n. Total protein
