Trauma 2 Flashcards
(84 cards)
what is Cushing reflex (due to ICP)
bradycardia
hypertension
slow RR
what does a GCS of 3-8 indicate?
traumatic brain injury
what does a GCS of 9-12 indicate?
moderate traumatic brain injury
what does a GCS of 13-15 indicate
normal
what should you get in a suspected head injury
non-contrasted head CT
what artery is usually injured in a epidural hematoma
middle meningeal
what usually causes a epidural hematoma
blow to the head
is there a low or high association w/ intraparenchymal injury w/ a epidural hematoma
low
classic presentation of epidural hematoma
brief LOC
lucid interval
rapid neurologic decline
what will a epidural hematoma look like on a CT
lens or convex shape
Tearing of bridging veins between the dura mater and the surface of the brain
Usually diffuse, rotational force applications to the brain
Acute subdural hematoma (ASDH)
what will an acute subdural hematoma look like on CT?
crescent shaped
do epidural or subdural hematomas have a worse prognosis
subdural due to parenchymal damage
Occur in the elderly
Atrophy of the brain put the bridging veins under stretch allowing for injury with much less force
May present up to several months after the injury
Blood may be several cm thick
chronic subdural hematoma
tx for a chronic subdural hematoma
burr hole or craniotomy
is outcome better for chronic subdural hematoma or ASDH?
chronic
Hemorrhage mixed with brain
Site of direct blow or the point opposite (contracoup)
Presentation depends on site
intraparenchymal contusions
Immediate and transient LOC or decrease consciousness after strike to head often with amnesia
Grading systems of severity mostly in athletics
concussion
Common in those suffering a traumatic brain injury
Trauma more common cause of SAH than ruptured aneurysm
Must rule out ruptured aneurysm
traumatic subarachnoid hemorrhage (SAH)
Axons sheared at boundary between gray and white matter during rapid acceleration/deceleration
Occurs in up to 50%of with severe injury
Diffuse axonal injury (DAI)
presentation of diffuse axonal injury
Presentation is a mild concussive state of confusion to depressed level of consciousness
what will diffuse axonal injury look like on CT
CT – multiple small hemorrhages (<1cm) throughout the brain at the junction of the gray and white matter
what do you do for seizure management for head injuries
anticonvulsant for 7 days
phenytoin or levetiracetam
how to prevent secondary brain injurys
elevated HOB drain CSF fluid sedation/ paralysis osmotic agents and diuretics managed respirator to avoid elevated CO2