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64 Cards in this Set
- Front
- Back
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What is the peak age group for head trauma? Which Sex?
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15-24 males
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For those under 25 the most common cause for head trauma is what?
For those over 75? |
-MVIs
-falls |
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Basilar skull fractures include what signs?
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Battle's sign and bilateral mastoid bruising
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In a basilar skull fracture, CSF leakage may appear as what?
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rhinorrhea or hemotypanum
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For GCS, explain points for eye opening.
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spontaneous-4
to voice-3 to pain-2 none-1 |
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For GCS,explain pointss for verbal response.
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-oriented-5
-confused-4 -inappropriate words-3 -inconprehensible-2 -none-1 |
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For GCS, explain points for motor funciton
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obeys command-6
localized pain-5 withdraws to pain-4 flexion to pain-3 extension to pain-2 non-1 |
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For head trauma, what does blown or dilated pupils indicate?
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that O2, body temp, and BP are all very low!
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What does pinpoint pupils mean for head trauma?
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midbrain damage or infarct, or uveitis from trauma
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What does a unilateral dilated pupil mean for head trauma?
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herniation, which is very bad
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Cheyne-Stokes pattern of breathing indicates what in head trauma?
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cortex damage
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Ataxic or chaotic breathing in head trauma indicates what?
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they are usually preterminal
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What is the imaging method of choice for imaging a pt with LOC as soon as they are stable?
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CT
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For those with a decreasing GCS who are not responding to tx, what should you consider giving to the pt?
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Narcan (narcotics) and Flumazenil (benzos)
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What meds are used for short term seizure management?
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Valium or Ativan
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What meds are used for long term seizure management?
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Dilantin or Phenobarbitol
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What are some signs of increasing ICP?
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-lowering GCS
-hypotension -HA -nausea -vomiting |
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What is Cushing's reflex and what does it usually indicate?
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bradycardia, hypertension and decreased RR and usually means pt is preterminal
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What are some simple measures that can be done for increased ICP while waiting for neurology?
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manage O2, BP, and elevate head of bed
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Tell me about the 3 layers fo the skull.
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-outer table-1.5mm thick
middle layer-diploe of cancellous bone inner table-0.5mm thick |
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Where are the weakest parts of the skull?
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-over temple where the skull is covered only by the masseter
-pertrous temporal ridge -sphenoid wings at skull base -middle fossa -cribiform plate |
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Where is the skull the thickest?
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-glabella (btw eyes)
-occipital protruberance -mastoid process |
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Linear skull fractures are usually what type of energy injuries and are more dangerous when they cross what?
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-lower energy
-more dangerous when they cross the Middle temporal Artery (epidural bleed) |
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Basilar skull fractures are usually associated with a tear of what?
May cause injury to what CN? |
the dura
-V, VI, or VII |
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Depressed skull fractures are usually over what part of the skull?
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frontoparietal region
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The scalp has how many surgical layers?
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3
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Tell me about the 1st layer of the scalp?
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skin, superficial fascia, and galea
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Tell me about the 2nd layer of the scalp?
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middle later with loose connective tissue
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Tell me about the 3rd layer of the scalp?
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periosteium
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What are exsanguinations of the scalp and why are they likely to form?
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infection below the galea that may cause meningitis, brain abcess orosteomyelitis and can happen because the scalp is highly vascular
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For scalp lacerations, how do you control the bleeding?
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with a Penrose drain as a tourniquet from the forehead to occiput if needed (irrigate these copiously
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WHy do you want to close scalp lacerations in one layer?
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because much of the SubQ layer is inelastic
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For scalp lacerations are antibiotics usually needed?
When is stable or suture removal done? |
Abx are usually NOT needed
7-10days |
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For minor blunt trauma to the head, what is the GSC?
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14 or 15
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For PE for minor blunt trauma, what do you want to focus on?
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LOC, allertness, and do frequent reassessment
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What are some low risk findings associated with minor blunt trauma to the head?
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-asymptomatic at exam
-no other injuries -stable GCS and pupil exam -intact orientation and memory -GCS of 14-15 -low energy collision -injury over 24 hrs old -reliable observer |
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For a closed head injury (CHI) how long do you observe and what can be done for pain?
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-36 hrs and give tylenol for pain PRN and NOT ASA or motrin
follow up with PCP in 1-2 weeks |
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What is the definition of a concussion?
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head trauma with one or more of the following:
-LOC or dazed or confused -HA -N/V -amnesia -cognitive or memory problems -vertigo -negative CT findings -neuro exam is non-focal |
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A concussion is a ______ DAI (diffuse axon injury)
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mild
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What is the acute tx for a concussion?
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-ABCs
-neuro exams serially -decide of CT is needed |
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What is the disposition for a concussion? aka when do you admit a pt?
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admit for LOC>5 min
-persistent vomiting -focal findings -poor observation at home -observe in ED for 4-6 hrs -do CHI sheet |
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A mild concussion usually resolves with how long?
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3 months
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What are some symptoms of a post concussion for mild concussion?
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-frequent HA
-neck pain -CN dysfunction -mood shifts |
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What can be used for the tx of post concussion syndrome?
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-serum S-11 and neuron specific enolase
-SSRI -Zofran -sleep aids -suportive |
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What is the definition of a cerebral contusion?
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bruises on the cortical surface, usually impact injury of frontal and temporal lobes
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Cerebral contusions can lead to what?
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-ischemia
-infaction -necrosis -cystic cavities |
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For a cerebral contusion, clinical presentation may be more than how long?
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24 hrs
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Tell me about the hx of a cerebral contusion?
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-brief LOC
-requent confusion -variable neuro exam including normal exam -possibly focus with sensorimotor cortex -seizures and increased ICP may occur |
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What is a common cause of coma without mass lesion or ischemic findings?
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DAI
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What is the most common CT finding after trauma?
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DAI
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What happens in a DAI?
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white matter shear forces tear myelin lining and pull axons apart
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Where are shear forces greatest?
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at grey/white interfaces
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Why are the first 2 weeks of at DAI the worst?
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because axons split and form retraction bulbs
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What areas of the brain are usually affected in a DAI?
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-parasagittal white matter including:
-frontal lobes -medial temporal lobes -cerebellum |
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How is the dx of DAI usually made?
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-positive hx
-possible neg CT scan -positive MRI |
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WHat are subdural hematomas?
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clots btw the dura and the brain and are low pressure venous bleeds that can cause compression, ischemia and infarction
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What percent of subdural hematomas are fatal if intreated?
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60%
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A chronic subdural hematoma can develop how long after injury?
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1-2 weeks
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What is the etiology of an epidural hematoma?
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deformation of temporal skull
-80% in temporarietal region |
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Epidural hematomas may have what?
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a lucid interval
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What are intracerebral hematomas?
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hematomas deep within the brain tissue
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Where are most intracerebral hematomas located/
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frontal and temporal lobes
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Intracerebral hematomas may take how long to fully develop?
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hours to days
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A Penetrating head trauma requires what?
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admission and a surgery consult
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