Trauma Flashcards
What is the leading cause of TBI?
falls (esp in elderly)
What is the primary mechanism of preventing spinal cord injury?
avoid injury
What are the 3 components of the Glasgow Coma Scale?
Eye
Verbal
Motor
What are the levels of the Eye component of the Glasgow Coma Scale?
Best eye response
- No eye opening
- Eye opening to pain
- Eye opening to veral command
- Eyes open spontaneously
What are the levels of the Verbal component of the Glasgow Coma Scale?
best verbal response
- No verbal response
- incomprehensible sounds
- inappropriate words
- confused
- oriented
What are the levels of the Motor component of the Glasgow Coma Scale?
best motor response
- no motor response
- extension to pain
- flexion to pain
- withdrawl from pain
- localizing pain
- obeys commands
What numbers constitute a mild, moderate & severe glasgow coma score?
Mild : 13-15
Moderate : 9-12
Severs : 3-8
What are the signs of elevated intracranial pressure?
- Early
- headache
- confusion
- vomiting without nausea
- papilledema
- Later (if brain is displaced)
- pupillar dilation - uncal herneation
- abducens palsies - central herniation
What are signs of impending herniation?
- deteriorating neuro exam
- cushing’s response
- elevated systolic BP
- widening pulse pressure
- bradycardia
What is the name of this sign?
What does it mean?
battle’s sign
posterior fossa injury
What is the name of this sign?
What does it mean?
Racoon eyes
anterior fossa injury
What are the contents of of the skull & relative percentages?
- Brain (80%)
- Blood (12%)
- arteris
- capillaries
- veins
- venous sinuses
- Cerebrospinal fluid (8%)
What is the name of the concept that an increase in the volume of one of the compartments of the cranium myst be offset by an equal decrease in another compartment, otherwise intracranial pressure will rise?
Monro-Kelli Doctrine
What buffer accounts to Cranial Reserve?
CSF compartment
Diffuse axonal injury is what type of finding?
nonsurgical
What is axonal shear injury & how does this type of injury occur?
Really, anything that cause a shearing force
- impact from behind, cause brain to accelerate forward
- collides with anterior skull & bounces off
- coup/contracoup type injury
- axons are twisted & torn from the force
- Injured axons will start dying
What are the grades of Diffuse Axonal Injury Scale?
- Grade 1: cortical region
- Grade 2: corpus collosum
- Grade 3: back part of midbrain
What type of injury is shown in the provided image?
Symptoms?
Surgical indication?
Epidural hemorrhage (convex/lens shaped)
lucid interval - then pass out
YES - surgery is indicated
What type of injury is shown in the provided image?
Risk factors?
Surgical indication?
Subdural hemorrhage (concave/crescent-shaped)
Elderly; EtOH abuse
YES - surgery idicated
What type of injury is shown in the provided image?
Most common locations?
Surgical indication?
Intracerebral hemorrhage (contusion)
Bony areas
YES - surgery is indicated
What are the steps to mild TBI managemetn?
- Identify victim
- altered LOC / memory impairment
- Remove victim from play / work to prevent further injury (2nd injury before full recovery = worse outcomes)
- Examination
- <25 on SAC is abnormal
Often recover quickly & fully - do not require hospitalization
Why is it important to follow the TBI guidelines?
patients 2x more likely to survice when following guidelines
What situations can cause cerebral herniation?
- injury due to
- direct damage
- ischemia
Identify the type of herniation indicated on the provided image:
What are the signs of poor outcome in a severe TBI?
- hypothermia
- hypotension
- hypoxia
At what timepoint after a TBI does edema peak?
48-96 hrs
What level for what amount of of elevated intracranial pressure is probably damaging?
>20-25 mmHg for > 10-15 min
What is the compartment & mechanism of treatment for elevated intracranial pressure for each of the following interventions?
Hyperventilation
Head positioning
Osmolar therapy
Metabolic suppression
- Hyperventilation
- arterial blood (vasoconstriction)
- Head positioning
- venous blood (facilitate outflow)
- Osmolar therapy
- normal brain tissue (remove interstitial water)
- Metabolic suppression
- arterial blood (vasoconstriction through neurovascular coupling)
What are the two solutions that can be given to patients to induce hyperosmolar therapy?
mannitol
hypertonic saline
What management is not recommended for patients with severe TBI?
prophylactic hypothermia, steroids, prophylactic antibiotics
What is the protocol for seizure prophylaxis in patients with severe TBI?
phenytoin or levetiracetam - for 7 days
What is the “level of injury” for spinal cord injury?
lowest spinal cord segment with intact motor & sensory function
What is the criteria for cervical spine clearing without imaging?
awake
no focal neurao deficit
no midline cervical tenderness
not intoxicated
What are the symptoms of central cord syndrome?
“man in a barrel”
- moto weakness both upper extremities w/ sparing lower extremities & sacrm
- proximal weaker than distal
- pain & temperature sensation reduced
- proprioception & vibration spared
What are the symptoms anterior cord syndrome?
- loss of touch, pain, temperature
- loss of motor below level
- intact proprioception & vibration
What are the symptoms of Brown-Sequard syndrome?
Lateral half spinal cord
- loss ipsilateral motor, touch, proprioception & vibraion
- loss contralateral pain & temp sensation
What is the leading cause of mortality in spinal cord injury patients?
DVT
What is the management for DVT prophylaxis in spinal cord injury patients?
LMWH preferred
if unable - consider IVC filter
What is the significange of SCI at C1-C2?
full loss phrenic nerve function
What is the significange of SCI at C3-C4?
partial phrenic nerve function
(shallow breathing, no voluntary cough)
What is the significange of SCI at T1-T7?
partial paralysis of intercostal muscles
(imparired cough / deep inspiration)
Which exam is to best prognostic indicator for TBI?
GSC (initial exam)
lower initial score - worse the prognosis
What are the different levesl of SCI?
- A - complete injury
- no motor or sensory function below lesion
- B - incomplete injury
- sensory but no motor function
- C - incomplete injury
- some motor strength (<3)
- D - incomplete injury
- motor strength >3
- E - none
- sensory & motor normal
What is the worse SCI prognosis?
grade A for >24 hr
