PDF - Trauma Flashcards
Impact of diffuse and linear force on skull?
Diffuse force - typically produces linear skull fracture
Focal / localized force - depressed skull fracture
What does leakage of CSF from ear / nose signal?
Greater risk of infection developing in CSF / brain
What causes brain contusion?
Angular or rotational, not linear, acceleration of brain
- Explains why woodpecker survives without brain injury
What is cerebral autoregulation?
Vasoconstriction or dilation to preserve optimal cerebral flow despite fluctuation in systemic blood pressure
over a range of 60 to 140
CPP = MAP - ICP
What is cushing’s response?
- Elevation of systemic blood pressure in response to increased ICP to preserve cerebral blood flow
- Bradycardia
- Slowed respiratory rate
Cause fixed and dilated ipsilateral pupil?
Uncal herniation: medial temporal lobe compression against midbrain
What causes respiratory failure?
Tonsillar herniation: shifting of lower brain stem and cerebellar tonsils down the foramen magnum
Pathology subdural?
Focal laceration of bridging cortical veins, which empty into larger venous sinuses
- Clot forms beneath dura compressing cortex
Rx subdural?
Surgical removal hematoma after imaging
Who is at risk for subdural?
Elderly atrophic brain since cortical bridging veins are stretched over a larger subdural space
- Always consider in confused elderly patient
Pathology epidural hematoma?
Rupture of a MMA orvein, rarely from a torn venous sinus
- Clot forms between skull and dura often after temporal bone fracture lacerating MMA
Presentation epidural?
Initial LOC followed by a lucid interval, then neurological worsening
How to treat increased ICP?
Hyperventilation: reduces arterial pCO2, causing cerebral arterial vasoconstriction, reducing intracranial blood volume ICP
Definition concussion?
Trauma-induced AMS that may involve LOC, typically including a brief period of confusion and amnesia
Rx concussion?
Removal from sport or combat, and period of rest and therapy
