TRAUMA Flashcards
5 layers of the scalp
- Skin
- Connective tissue
- Aponeurotic galea
- Loose areolar tissue
- Pericranium
How many bones in the skull
22 bones
8 cranial bones
14 facial bones
Sutures
what are they
4 types
immovable joints that hold the skull together
- Coronal (frontal and parietal)
- Sagittal (two parietal)
- Lambdoidal (parietal to occipital)
- Squamous (parietal to temporal)
What are fontanells
soft spots between cranial bones
4 major parts of the brain
brain stem, diencephalon, cerebrum, cerebellum
brain stem parts
- Continuous with spinal cord
- Pons
- Midbrain
- Medulla
diencephalon
- Located above the brain stem
- Thalamus
- Hypothalamus
- Pineal gland
cerebrum
- Supported on top of diencephalon and brain stem
- Surface is a thin layer of gray matter
BBB function, what crosses easily
- Protection
- Prevents passage of substances
- Consists of tightly sealed blood capillaries
- O2, CO2, ETOH and most anaesthetic agents cross easily
- Lipid soluble or carrier mediated to cross BBB
Difference between BBB and normal cells
BBB has tight junctions
CSF purpose, produced where, normal volume, circulates where
- Another protective mechanism
- Carries O2, glucose and other required chemicals from blood to neurons to neuroglia
- Removes wastes and toxic substances
- Circulates through the subarachnoid space, around the brain and spinal cord and through the ventricles
- Produced at the choroid plexus (each ventricle of the brain)
- Reabsorbed through the arachnoid villi
- Volume is 80-150ml
Medulla oblongata
Continuation of spinal cord
* White matter contains sensory and motor tracts
* Several nuclei (masses of grey matter) two major are cardiovascular centre and rhythmicity centre, touch, vibration, swallowing, vomiting, coughing, hiccupping and sneezing
Pons
- Consists of both nuclei and tracts
- Bridge that connects parts of the brain with one another
- Helps control breathing
- Cranial nerve (V,VI,VII and VIII) involvement
midbrain
- Connects pons to diencephalon
- Contains motor neurons and conduct nerve impulses
- Co-ordinate muscle movements
- Cranial nerve (III and IV)
thalamus
Contributes to regulation of autonomic activities and maintenance of consciousness
Hypothalamus
Controls ANS
* Controls pituitary gland and production of hormones
* Regulates emotional and behavioural patterns
* Regulates eating and drinking
* Controls body temp
* Regulates circadian rhythm and state of consciousness
pineal gland
produces melatonin
cerebellum
Consists of two hemispheres
* Surface is called the cerebella cortex (grey matter)
* White matter
Functions
* Receives sensory input
* Coordinates complex sequence of skeletal muscle contractions
* Regulates posture and balance
* Essential for skilled motor activities
Spinal column - hyoid bone
- Does not attach to any other bone
- Located between mandible and larynx
- Supports the tongue
vertebral column structure
The vertebral column 33 vertebrae
* 7 Cervical
* 12 thoracic
* 5 lumbar
* 5 sacral
* 4 coccyx
Spinal cord occupies the vertebral column from which landmarks
C1-L2
spinal cord ascending pathways vs descending pathways
- Ascending pathways are sensory tracts
- Descending pathways are motor tracts
how does the motor pathway causes movement in brain and spinal cord
Voluntary movement originates from the frontal lobe of the cerebral cortex
* Cross to opposite side of the medulla
* Descend down the corticospinal tract
* Lower motor neurons innervate skeletal muscle
* Cervical nerve fibres innervate upper extremities
* Sacral fibres innervate lower extremities
affarent vs efferant nerves
aff –> towards spine
eff –> away
spinal nerves
how many pairs and where do they innervate
- 8 cervical
- 12 thoracic (innervate thorax, buttocks and part of upper arm)
- 5 lumbar (innervate groin and lower extremities)
- 5 sacral (perianal nerves and voluntary contraction of anal and bladder sphincter)
- 1 coccygeal
spinal nerves posterior and anterior roots
posterior (dorsal)= sensory impulses
anterior (ventral) = motor impulses
cervical plexus
- First 4 cervical nerves
- Innervate muscles of the neck
- Phrenic nerve innervates the diaphragm
brachial plexus
- C5 to C8 and T1
- Supplies motor control and sensation to upper extremities
- Includes ulnar and radial nerves
sacral plexus
sciatic nerve
LIVER
solid or hollow
description
solid organ
extremely vascular - 30% of total CO
3 major roles - metabolism, secretes bile, filters and stores blood
Spleen
solid organ
LUQ
blood filter and resovoir up to 200ml
kidneys
found in retroperitoneal space of T12-L3
moves with inspiration and expiration
pancreas
solid organ
exocrine and endocrine organ
produces fluid containing enzymes, electrolytes and bicarbonate
located behind the stomach L) side
small bowel
divided into 3 sections–> duodenum, jejnum, ileum
7m long
large bowel
1.2m long
4 sections, cecum, colon, rectum and anal canal
3 major components of bones
matrix of collagen (35%)
mineral matrix and calcium and phosphate
bone cells
types of bone cells
osteoblasts, osteocytes, osteoclasts
Osteoblasts
* Present on all bone surfaces
* Synthesis and secretion of collagen and protein
* Helps with the healing process
Osteocytes
* Forms from osteoblasts trapped in the matrix
* Control of calcium release
* Continues process of remodelling
Osteoclasts
* Near bone surface
* Destroy dead bone
* Reabsorption of bone
what is compact cortical bone
- Outer parts of all bone
- Forms shaft of long bones
- Encloses marrow cavities
what is the haversian system
about distribution of nutrients consist of canals, blood vessels, connective tissue, nerve fibres and lymphatic vessels
which type of bones produce RBC
what about as we get older?
long bones
flat bones as we age
cancellous (spongey bone)
located
contains
Located
* End of long bones
* Vertebrae
* Flat bones
Organised in lattice system
Contains
* Haversian canals
* Red blood cells (RBC production)
* Converted to yellow bone marrow
classification of bones
Long
short - tarsals
flat- skull
irregular - verterbrae
define compartment syndrome
increased pressure within a restricted space
what is fat embolism syndrome
- Results from long bone fractures, intramedullary manipulation, blunt trauma
- Fat emboli escapes and enters venous circulation
- Defined as a triad of hypoxia, petechia and neurological impairment
- Sx present within 12-60 hours
- Major petechial rash, respiratory and cardiac symptoms, neurological changes
- Minor SIRS
what is occult haemorrhage
- Non traumatic, more associated with chronic health conditions
- Often sub clinical no obvious major external haemorrhage, nil major symptoms or diagnostic signs
- Can present with other s/s such as SOB secondary to anaemia, lethargy
- Consider anticoagulation effects
- Days rather than minutes
haemostatic response to bleeding
3 stages
vasoconstriction -platelet activation and coagulation cascade
shock index equation
=HR/SBP
once you have a HR above SBP you should be concerned
anything above 0.9 = bad
