Trauma CNS

Question 1

A GCS of 9-12 with LOC 20 min to 6 hours is considered..

Answer 1

moderate brain injury

Question 2

Aftern initial TBI, how likely are you to have a second injury?

Answer 2

3x risk

Question 3

How many people have ssx over a year after a mild TBI?

Answer 3

15%

Question 4

What are some secondary injuries that could occur after a primary impact injury?

Answer 4

intracranial hematoma

edema

ischemia

Question 5

To detect a mild TBI, what may not work?

Answer 5

simple orientation questions

Question 6

What bones could be broken if you have a basilar skull fx?

Answer 6

orbital roof

sphenoid

petrous or mastoid portion of temporal bone

Question 7

A pt has bilateral bruising over her eyes. What is this called? What does it mean?

Answer 7

raccoon eyes - anterior fossa

85% of the time there is a basilar skull fx; don’t blow nose, cough, or strain

Question 8

Battle’s sign is bruising where? what does this mean?

Answer 8

behind the ear

posterior fossa blood

Question 9

Male pt hit his head, had a lucid interval, and we have recognized the source of bleeding as the middle meningeal artery. This was a…

Answer 9

epidural hematoma

Question 10

About twice as common as epidural hematoma, subdural hematoma is usually due to an injury of…

Answer 10

bridging veins or cortical lac

Question 11

Main tx of epidural or subdural hematoma focus on…

Answer 11

pain relief

sleep issues

mood behavioral issue

Question 12

For an uncomplicated concussion, I will tell my pt …

Answer 12

physical and cognitive rest for 24 h minimum with gradual return to activity

to eliminate or reduce pain, mostly daily HA prophylaxis rx

Optimize sleep

Question 13

What are the upper limits of normal on ICP?

Answer 13

20-25 mmHg

Question 14

Who can tolerate higher ICP?

Answer 14

children

Question 15

Cerebral perfusion pressure (CPP) is blood flow to the brain and can be limited if…

Answer 15

BP is low and or the ICP is high

Question 16

ssx of ICP (late) are…

Answer 16

pupillary dilation - uncal herniation

abducens palsies - central herniation

Question 17

What three things imply impending herniation? What is this triad called?

Answer 17

Cushings Triad

• elevated systolic BP
• widening pulse pressure
• bradycardia

Question 18

What is probably the best kind of herniation you could have in the brain?

Answer 18

transcalvarial - because you can actually do something about it

Question 19

Repeated TBI after an initial injury may lead to..

Answer 19

life threatening cerebral edema

Question 20

In second impact syndrome, pt can develop a loss of..

Answer 20

autoregulation of blood flow creating hyperemia and edema

develops coma with a high fatality rate

Question 21

What injuries do you see in Shaken Baby Syndrome?

Answer 21

neuronal shear injuries, near midline on one scan

retinal hemorrhages

Question 22

What are ssx of brain injury in young children?>

Answer 22

listlessness, tiring easily, irritable, change in eating or sleeping patterns, loss of balance