Trauma Flashcards
What is a primary brain injury
Happens in the moment of incident when excessive energy is transferred to the head
What are the can diffuse head injury be split into
Axonal
Concussion
What is a diffuse Axonal injury
Axons are sheared, torn, stretched away from cell body
What is diffuse concussion injury
Brain jarred towards and then away from site of injury can self resolve
What can focal brain injuries be split in to
Contusion
Intercranial haemorrhage
They are focused on specific area of brain
Type of intercranial haemorrhage
Epidural Extradural Subdural Subarachnoid Intracerebral
Secondary brain injury is
When the brain tissue does not have adequate perfusion
Head injuries bad signs
Low blood pressure
Hypoxia
Asymmetry pupils
Monroe Kellie doctrine is
Skull is rigid container any increase in component causes an increased icp and can cause herniation
Work out CPP
CPP = MAP -ICP
What will happen if ICP rises
The CPP will decrease unless the blood pressure increases
What does cpp need to be
60 or above
Management of head injury
If isolated head injury give fluids to maintain blood pressure at 110
If not isolated then maintain blood pressure at 90
Give TXA on route
Give O2
Assist ventilation if needed
What is normal capnography
35-45 mmHg
Head injury considerations
PHEA
RSI
What is pupil asymmetry a sign of
Herniation
Early signs of increasing ICP h
Vomiting Headache Dizziness Amnesia Visual disturbances Altered LOC Seizures
Late signs of increased ICP
Cushing triad
Hypertension with widening pulse pressure
Bradycardia
Irregular respiration e.g cheynes stokes
Pupils changes
Coma
Posturing
What is normal ICP
5-15 mom Hg
Work out MAP
DBP+ 1/3 of pulse pressure
What’s in Cushing triad
Hypertension (widening pulse pressure)
Irregular respiration
Bradycardia
Isolated head injury give fluids when…
Systolic below 110
Head injury and limb injury give fluids when…
Below 90 systolic
Head injury and torso injury give fluids when
Below 60 systolic
TXA dose
Give when
Don’t give
1g over 10 minutes
Obvious bleeding, gcs less than 12 in head injury.
Don’t give if bleeding started 3 hours ago, bleeding has stopped
With a child when should you intervene with breathing
If it’s 1/2 normal resp rate or 3 times normal resp rate
What nerve is control pupils
Oculomotor
What does cheynes stokes breathing mean
It is bodies way of correcting ph level and decreasing co2
What does central neurological breathing mean
Decreased stimulation of brain stem by sustained hyperventilation to decrease CO2
What does biots breathing mean
Represent damage to brain stem
What position can reduce ICP
30 degree head up position
Order of spinal nerves
Cervical - 8 Thoracic - 12 Lumbar - 5 Sacral - 5 Coccygeal - 1
31
Below shoulders paralysis is
C4
Below waist paralysis is
T12
Hauswalds biomechanics
Injury is done at time of impact rather than any movement after. An alert patient will develop a position of comfort
How many ribs are there
12
10 attached to sternum
2 floating
Where are rib fractures most common
4-8
What can malposition of needle decompression result in
Cardiac tamponade
Ineffective
Too small to drain area
Becks triad is for and what is it
Cardiac tamponade
Distant or muffled heart sound
JVD
Hypotension
How much blood can u lose in a pelvic injury
1-2L
Where should I apply cat tourniquet
On single bone
Above knee
Above elbow
When should u use celox ?
Pack wound where u can see it
Do not use on head
What does HOTT stand for and is used for
Hypovolaemia
Oxygenation
Tamponade
Tension pneumothorax
Traumatic cardiac arrest
What would unilateral dilated pupil mean
Compression of the oculomotor nerve
Bilateral dilated pupils mean
Midbrain injury
Cocaine
Irregular pupils indicated
Orbital trauma
Conjugate gaze deviation is and indicates
Sustained shift in horizontal gaze to one side.
Indicates lesion in Frontal lobe, brain stem, basal ganglia
Small pin point pupils
Pontine injury (injury to pons)
Heroin
