Trauma-Morgan Flashcards
How do you classify head injuries?
by mechanism (closed, penetrating) severity morphology: skull fractures, intracranial lesions
What are some examples of closed head injuries?
high velocity: auto accidents
low velocity: assault
What are some examples of penetrating head injuries?
gun shot wounds
What is the lowest & highest possible glascow coma score?
lowest: 3
highest: 15
What is considered a mild, moderate, severe head injury?
Mild: 14-15. Talking & confused
Moderate: 9-13. Maybe not talking.
Severe: 8 or less. Comatose, intubated, paralyzed
What type of CT do you want with a head injury patient?
non contrast
want to see blood as white
Glasgow coma scale + ____ gives you a neurological baseline.
eye/pupil exam
When should the GCS be taken for a patient?
after BP & O2 normal
before sedative meds
What can a low BP & low O2 do to the GCS?
cause a decreased level of consciousness
Why don’t we hyperventilate the brain anymore?
used to do it so that the vessels would constrict & intracranial pressure would go down.
but the damaged areas of the brain don’t get good bloodflow & become hypoxic
What are the 3 components of GCS?
EMV Eye opening (1-4) Motor response (1-6) Verbal Response (1-5) Total: 3-15
What earns each score for eye opening? 1-4.
4: spontaneous
3: response to speech
2: response to pain
1: nil
What earns each score for the motor response? 1-6
6: obeys motor commands
5: localizes
4: withdraws
3: abnormal flexor response
2: extensor response
1: nil
What earns each score for the verbal response? 1-5
5: oriented
4: confused conversation
3: inappropriate words
2: scream, groan, moan
1: no response
What would earn a score of 3 on GCS?
doesn’t open eyes
flaccid
doesn’t talk or make sounds
What else should you check with eyes?
pupil response: bad if dilated & unresponsive to light
corneal reflex
What is dolls eye?
you turn the head sharply to one side & the eyes remained centered
tests brain stem function
What is the oculovestibular reflex?
ice water in ear, bad if eyes don’t move.
What types of skull fractures might you see?
vault: linear or stellate, depressed or not. OVER THE BRAIN.
basilar: w/ CSF leak maybe, w/ cranial nerve palsy maybeUNDER THE BRAIN
What types of intracranial lesions might you see?
focal: subdural, epidural
diffuse: concussions, diffuse axonal injury
What can hematomas look like?
can seem like a depressed skull fracture b/c of hard edges & a soft center
need a CT to find out
Basilar skull fractures make up ___% of head injuries. How can you best visualize them?
25% head injuries
visualized w/ CT
Where do basilar skull fractures usu happen?
petrous bone
anterior cranial fossa & cribriform plate
clival fractures
**can get longitudinal, transverse, anterior fossa fractures
What are some common evidences of a basilar skull fracture?
bruise on the mastoid (battle's sign) blood behind the ear drum (hemotympanum) raccoon eyes-bruised eyelids CSF leak pneumocephalis **need to watch them
What is pneumocephalus?
gas in the brain
Should you give antibiotics to patients w/ a basilar skull fracture?
probably not unless they develop meningitis
What do you test the CSF fluid for w/ a basilar fracture?
glucose
beta-2-transferrin
What usu causes an epidural hematoma?
arterial bleed, middle meningeal artery w/ temporal fracture
talk & die
What usu causes a subdural hematoma?
tearing of veins, brain lacerations
present w/ headache, neuro deficits focal, decreased concentration
can be weeks or months later
What is a cerebral contusion?
focal injury
coupe-contra coupe pattern
can become surgical hematomas
usu in frontal & temporal lobes
What do cerebral contusions look like on CT?
salt & pepper lesions
What are intracerebral hematomas?
hematoma w/i brain
need to monitor
What is a diffuse axonal injury?
loss of consciousness past 6 hours
can be in a coma for months
What is second impact syndrome?
head injury during post-concussive symptoms
loss of auto regulation, dilated blood vessels, diffuse cerebral swelling, increased ICP, brain herniation & death
Where do we try to keep ICP? CPP?
ICP: less than 20
CPP: greater than 70
What is a possible treatment for increased ICP?
craniectomy, make it large. brain herniates safely out.
Should you use steroids or anti-seizure meds to treat high ICP?
no.
no, unless they have a condition.
T/F Mannitol is given w/ TBI.
True.
What is the ASIA impairment scale?
A: complete, no motor, sensory, sacral sparing
B: incomplete, only sensory
C: incomplete, motor function preserved, w/ some key muscles <3 motor grade
D: incomplete, more than half key muscles, more than 3 motor grade
E: sensory & motor normal.
What are some reflexes you look for w/ severe spinal cord injuries?
beevor's sign cremateric reflex anal cutaneous reflex bulbocavernosus reflex priapism, could be spinal cord injury from loss of sympathetics
What are some incomplete spinal cord injuries?
brown-sequard
anterior, posterior, central cord
What should you look for w/ central cord syndrome?
disproportionately greater weakness in upper extremities, look at the hands
burning pain in the hands
What happens w/ brown sequard?
spinal cord hemisection
What is the treatment of spinal injuries?
ABC stabilize examine maintain BP, O2, Na No steroids!
