Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
24 Cards in this Set
- Front
- Back
|
What percent of head injury trauma cause death |
25% |
|
|
What percent of head injury trauma cause death due to MVC |
50% |
|
|
What is primary brain injury |
Initial damage due to force applied |
|
|
What is secondary brain injury |
Results from hypoxia or decreased perfusion
|
|
|
Which can be prevented; primary or secondary brain injury |
Secondary |
|
|
What happens to perfusion of the brain if the intra-cranial pressure (ICP) rises |
Perfusion decreases (i.e. not getting enough blood to brain) |
|
|
If you have a high ICP what event can be devistaing |
Hypotension (because it is already being under perfused) |
|
|
What respiratory action can decrease perfusion of the brain |
Hyperventilation |
|
|
What is the worst thing that can happen if you have increased ICP and why |
Hypoventilating
Hypoventilation will cause vasodilation and increase the ICP reducing perfusion even more |
|
|
What are the clinical findings of a herniation syndrome |
1. Coma (GCS < 9)
AND any of the following:
2. asymmetric, dilated or non-reactive pupils 3. Extensor (decerebrate) posturing |
|
|
What is Cushing's Response |
Increase in ICP causes: 1. Systemic BP increase 2. Bradycardia 3. Respiratory rate decreases
|
|
|
How can most scalp wound be controlled |
Direct pressure or large temporary suture |
|
|
What are some feature of basal skull fracture |
1. May see CSF leak from ear or nose 2. Ring Sign (halo around blood on pillow) 3. Battle sign (mastoid ecchymosis) 4. Racoon Eyes (periorbital ecchymosis bilaterally) 5. Hemotympany (blood behind tympanic membrane) |
|
|
What do you have to beware of with a basal skull fracture |
Nasogastric tube |
|
|
What is a cerebral contusion |
Brain bruise |
|
|
What are some signs of a cerebral contusion |
1. Altered LOC 2. Focal weakness/numbness 3. Personality changes 4. Looks like a CVA (stroke) |
|
|
1. What is Diffuse Axonal Injury common with 2. What are some of the signs 3. What happens to ICP and why 4. What does the CT look like |
1. Severe blunt trauma 2. Coma, seizure, vomiting 3. ICP rises from brain swelling 4. Not seen on CT unless subarachnoid bleeding |
|
|
1. What is the MOA of epidural hematoma 2. What is the pattern of symptoms 3. How do you treat it |
1. Temporal trauma (middle meningeal artery) 2. Initial LOC - lucid interval - LOC 3. Evacuation |
|
|
1. What is the MOA of a subdural hematoma 2. What causes a worse prognosis 3. How is it diagnosed 4. How do you treat it |
1. Tearing of veins 2. Prolonged coma 3. CT 4. Evacuation |
|
|
What does a epidural and subdural hematoma look like on a CT scan |
Epidural = lens shape and does not cross suture line
Subdural = crescent shape |
|
|
How do you manage a head trauma |
1. Stabilize cervical spine 2. Secure and Maintain airway 3. Ventilate at about 10 breaths/min 4. Prevent hypoxia 5. Maintain normocarbia 6. Maintain perfusion |
|
|
According to the Canadian CT head Rules when would you do a CT head |
Needs to meet 1 of the high or medium risk criteria
High: 1. GCS < 15 at 2 hours of injury 2. Open or depressed skull fracture 3. Signs of basal skull fracture 4. Vomit ≥ 2 times 5. ≥ 65 years old
Medium: 1. Amnesia before impact (>30 min) 2. Dangerous mechanism (ejected from car, hit by car, fall from > 3 feet or 5 stairs) |
|
|
Which rule is not part of the Canadian CT rules but you should still do a CT |
If person is on anticoagulants (Warfarin, clopidogrel) |
|
|
How do you manage raised ICP |
1. Optimize cerebral perfusion BP > 100 systolic or MAP of 80 O2 sat > 95% Normal glucose
2. Fluid management NS or R/L Don't over hydrate Don't use hypotonic fluid
3. Diuretic Mannitol (only on advice by neurosurgeon)
4. No steroids
5. Anticonvulsant Diazepam or lorazepam to stop acute seizure Phenytoin or phenobarbital for prophylaxis after |
