TRAUMA Flashcards
implies a violent shaking or jarring of the brain and a
resulting transient functional impairment
concussion,
Even in immediately fatal head injuries,
autopsy reveals an intact skull in _______percent of cases
20 to 30
Overall, brain injury
is estimated to be_______ more frequent with skull
fractures than without them and perhaps 20 times more
frequent with severe and multiple fractures
5 to 10 times
Fracture of the
________ often deforms the external auditory
canal or tears the tympanic membrane, with resultant
leakage of CSF (otorrhea); or, blood may collect behind an
intact tympanic membrane and discolor it
petrous pyramid
If the fracture
extends more posteriorly, damaging the __________
the tissue behind the ear and over the mastoid process
becomes boggy and discolored _______
sigmoid sinus,
Battle sign
Basal fracture
of the ________ may also cause blood to leak
into the periorbital tissues, imparting a characteristic
“raccoon” or “panda bear” appearance.
anterior skull
The ______, ________ AND ______ are the ones most liable to injury, but any
one, including the twelfth, may be damaged
olfactory, facial, and
auditory nerves
A fracture in or near
the sella may tear the stalk of the pituitary gland with
resulting_______
diabetes insipidus.
A fracture of the sphenoid bone may lacerate the__________ with blindness from the beginning.
optic
nerve,
diplopia that is worse on looking down and compensatory
tilting of the head indicating a _________
trochlear nerve injury
Injury to the ________ AND ________ of the
trigeminal nerve may be the result of either a basal fracture across the middle cranial fossa or a direct extracranial injury to the branches of the nerves
ophthalmic and maxillary divisions
transverse fractures
through the petrous bone results in ______
immediate
facial palsy,
_____of the petrous bone, the facial palsy then
often being delayed for several days, a sequence that may be misinterpreted as progression of the intracranial traumatic lesion.
longitudinal
fractures
Injury to the eighth cranial nerve because of petrous
fractures results in a loss of hearing or in ________
and _________ coming on immediately after the trauma
postural vertigo
nystagmus
Deafness as a result of nerve injury must be distinguished
from the high-tone hearing loss due to ___________and
from deafness caused by bleeding into the middle ear
and disruption of the ossicular chain
cochlear injury
The rare condition of fracture through
the __________ causes weakness of one side of
the tongue.
hypoglossal canal
A basal fracture through the _______ may lacerate
the internal carotid artery or one of its intracavernous
branches where it lies in the cavernous sinus
sphenoid bone
In CCF, Also, there may be a loss of vision as a result of __________
ischemia of the optic nerve and retina
Some
_______ of fistulas resolve spontaneously, but the
remainder must be obliterated by interventional radiologic
means (by a detachable balloon inserted into the
carotid artery via a transfemoral catheter) or by a direct
surgical repair of the fistula
5 to 10 percent
How to test for CSF in CSF rhinorrhea?
by testing it for glucose with diabetic test tape (mucus has no glucose)
presence of fluorescein or radionuclide-labeled dye that
is injected into the lumbar subarachnoid space and then
absorbed by pledgets placed in the nasal cavity
detect tau protein in the discharge; it is
present only in CSF and not in mucus or blood
Tx of tension pneumocranium
Inhalation
of 100 percent oxygen has a slight salutary effect, but
aspiration of the air is required if the collection is causing
clinical signs.
Depressed skull fractures are of significance only
if the _________or the ________They then are surgically
elevated, preferably within the first 24 to 48 h.
underlying dura is lacerated
brain is compressed
by indentation of bone.
The duration of the
amnesic period, particularly of ______________, is
but one index of the severity of the concussive injury
anterograde amnesia
A majority of patients who
remain in a coma for more than 24 h after a head injury are found to have intracerebral______________
hematomas and contusions.
Blows to the front of the head may produce mainly __________lesions, whereas blows to the back of the head may cause mainly_________ lesions. Blows to the side of the head produce___________
coup
contrecoup
either coup or contrecoup lesions, or both.
Irrespective
of the site of the impact, the common sites of cerebral
contusions are in the_______
frontal and temporal lobes
Relative sparing of the occipital lobes in coupcontrecoup
injury has been explained by the __________and subadjacent tentorium,
smooth
inner surface of the occipital bones
In most cases of severe head injury, there is damage
to the __________by impact with the falx
corpus callosum
all brainstem
hemorrhages when there is mass effect that distorts
the brainstem
Duret hemorrhage
In addition to contusions and extradural, subdural,
subarachnoid, and intracerebral hemorrhages, closed head
injury induces variable degrees of vasogenic edema that
increases during the first ________
24 to 48 h
pulmonary symptoms is associated with a petechial rash
over the thorax, especially in the axillae and also in the
conjunctivea. what is this related to?
Ce re b ra l Fat E m bo l i s m
CEREBRAL FAT EMBOLISM CAUSES widespread ________________
involving both white and gray matter and a few larger
infarcts
petechial hemorrhages and small infarctions,
Most patients with fat embolism recover spontaneously
in ___________, although a mortality rate of up to
10 percent is cited
3 or 4 days
fracture
through the squamous bone and the groove of the middle
meningeal artery, which represents a risk for arterial
bleeding and ________
epidural hemorrhage.
indications of ct scan in head injury
prolonged loss of
consciousness (more than 1 min), severe and persisting
headache, nausea and vomiting, a confusional state, and
any new, objective neurologic signs,
T OR F
in children with head injury, it may be advisable to perform the scans more liberally
T
Canadian CT head rule
age above 60 years, intoxication, more than 30 min of retrograde amnesia, suspected skull fracture, seizure, anticoagulation, and dangerous mechanism of injury,