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122 Cards in this Set
- Front
- Back
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What is the most frequent cause of trauma death?
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Head Injury
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Galea Aponeurotica
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Connective tissue sheet covering the superior aspect of the cranium.
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Cranium
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Vaultlike portion of the skull encasing the brain.
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Sutures
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Pseudojoints that join the various bones of the skull to form the cranium.
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Intracranial Pressure (ICP)
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Pressure exerted on the brain by the blood and cerebrospinal fluid.
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Meninges
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Three membranes that surround and protect the brain and spinal cord.
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Dura Mater
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Tough layer of the meninges firmly attached to the interior of the skull and interior of the spinal column.
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Pia Mater
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Inner and most delicate layer of the meninges. It covers the convolutions of the brain and spinal cord.
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Arachnoid Membrane
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Middle layer of the meninges.
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Cerebrospinal Fluid
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Fluid surrounding and bathing the brain and spinal cord (the elements of the central nervous system).
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Cerebrum
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Largest part of the brain. It consists of two hemispheres seperated by a deep longitudinal fissure. It is the seat of consiousness and the center of the higher mental functions such as memory, learning, reasoning, judgement, intelligence, and emotions.
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Where does the crossing of nerve impulses from one side of the body to the other take place?
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Just below the medulla oblongata.
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Cerebellum
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Portion of the brain located dorsally to the pons and medulla oblongata. It plays an important role in the fine control of voluntary muscular movements.
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Brainstem
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The part of the brain connecting the cerbral hemispheres with the spinal cord. It is comprised of the medulla oblongata, the pons, and the midbrain.
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Midbrain
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Portion of the brian connecting the pons and cerebellum with the cerebral hemispheres.
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Hypothalamus
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Portion of the brain important for controlling certain metabolic activities, including regulation of body temperature.
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Thalamus
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Switching station between the pons and the cerebrum in the brain.
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Ascending Reticular Activating System
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A series of nervous tissues keeping the human system in a state of consciousness.
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Pons
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Process of tissue responsible for the communication interchange between the cerebellum, the cerebrum, the midbrain, and the spinal cord.
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Medulla Oblongata
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Lower portion of the brainstem containing the respiratory, cardiac, and vasomotor centers.
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Though the brain accounts for only 2% of the body's total weight, it consumes about what percent of the body's oxygen?
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20%
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Cerebral Perfusion Pressure
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The pressure moving blood through the brain.
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Autoregulation
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Process that controls blood flow to brain tissue by causing alterations in the blood pressure.
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Zygoma
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The cheekbone.
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Maxilla
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Bone of the upper jaw.
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Mandible
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The jawbone.
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Nares
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The openings of the nostrils.
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Pinna
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Outer, visible portion of the ear.
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Semicircular Canals
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The three rings of the inner ear. They sense the motion of the head and provide positional sense for the body.
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Orbit
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The eye socket.
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Vitreous Humor
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Clear, watery fluid filling the posterior chamber of the eye. It is responsible for giving the eye its spherical shape.
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Retina
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Light- and color-sensing tissue lining the the posterior chamber of the eye.
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Aqueous Humor
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Clear fluid filling the anterior chamber of the eye.
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Iris
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Pigmented portion of the eye. It is the muscular area that contricts or dilates to change the size of the pupil.
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Pupil
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Dark opening in the center of the iris through which light enters the eye.
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Sclera
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The "white" of the eye.
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Cornea
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Thin, delicate layer covering the pupil and the iris.
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Conjuctiva
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Mucous membrane that lines the eyelids.
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Lacrimal Fluid
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Liquid that lubricates the eye.
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The presentation of scalp wounds makes them what?
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Difficult to assess.
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What do scalp wounds do?
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Bleed heavily.
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Scalp/ head injuries can present as what?
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Raised Hematoma
Depression Disguised by a Normal Contour |
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What is one of the thinnest and most frequently fractured cranial bones?
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Temporal Bone
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Retroauricular Ecchymosis
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Black and blue discoloration over the mastoid process (just behind the ear) that is characteristic of a basilar fracture. (Also called Battle's sign.)
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Bilateral Periorbital Ecchymosis
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Black and blue discoloration of the area surrounding the eyes. It is usually associated with basilar skull fracture. (Also called racoon eyes.)
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How does the "Halo Test" work?
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It detects the presence of cerebrospinal fluid. If CSF is present, it will difuse faster across a paper towel or gauze because it is thinner than blood.
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When is the "halo" sign most reliable?
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When associated withfluid leaking from the ear.
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If you are unsure whether or not the fluid leaking from the ear is water or CSF. What is another way to determine what it is?
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The glucose level of CSF is normally half of the blood. Check the glucose level of the fluidand compare it to the patients blood glucose level.
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A cranial fracture, by itself, is a skeletal injury that will heal with time. However, the forces necessary to fracture the skull are often sufficient to induce what?
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Brain Injury
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Coup Injury
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An injury to the brain occuring on the same side as the site of impact.
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Contrecoup Injury
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Occuring on the opposite side; an injury to the brain opposite the site of impact.
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Types of Focal Brain Injuries
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Cerebral Contusion
Intracranial Hemorrage Epidural Hematoma Subdural Hematoma Intracerebral Hemorrage |
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Types of Diffuce Brain Injuries
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Concussion (mild to moderate diffuse axonal injury)
Moderate Diffuse Axonal Injury Severe Diffuse Axonal Injury (formerly, brainstem injury) |
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Epidural Hematoma
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Accumulation of blood between te dura mater and the cranium.
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Subdural Hematoma
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Collection of blood directly beneath the dura mater.
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Who should you suspect a subdural hematoma with?
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A medical (non trauma) patient who demonstrates neurological signs and symptoms.
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Intracerebral Hemorrhage
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Bleeding directly into the tissue of the brain.
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Diffuse Axonal Injury (DIA)
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Type of brain injury characterized by shearing, strectching, or tearing of nerve fibers with subsequent axonal damage.
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Concussion
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A transient period of unconsciousness. In most cases, the unconsiousness will be followed by a complete return of function.
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What does a concussion do?
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It disrupts the electrical activities of the brain without causing detectable injury to the brain itself.
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Cerebral Perfusion Pressure =
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CPP = MAP - ICP
Cerebral Perfusion Pressure = Mean Arterial Pressure - Intracranial Pressure |
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What seriously compounds existing head injuries?
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Low blood pressure and poor respiratory exchange.
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Signs and Symptoms of Brain Injury
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Altered Level of Consciousness
Altered Level of Orientation Alterations in Personality Amnesia Cushing's Triad Vomiting (often without nausea) Body Temperature Changes Changes in Reactivity of Pupils Decorticate Posturing |
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Retrograde Amnesia
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Inability to remember events that occured before the trauma that caused the condition.
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Anterograde Amnesia
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Inability to remember events that occured after the trauma that caused the condition.
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Cushing's Reflex
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Response due to cerebral ischemia that causes an increase in systemic blood pressure, which maintains cerebral perfusion during increased intracranial pressure.
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Cheyne-Stokes Respirations
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Respiratory pattern of alternating periods of apnea and tachypnea.
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Cushing's Triad
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The combination of increasing blood pressure, slowing pulse, and irregular respirations in response to increased intracranial pressure.
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What is essential in the patient with head injury because it directs your care?
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The recognition of cerbral herniation.
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In the pediatric patient, intracranial hemorrage may significantly contribute to what?
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Hypovolemia
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Glasgow Coma Scale
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Scoring system for monitoring the neurologic status of patients with head injuries.
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What evaulation should be done on all suspected head injuries?
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Evaluate the eyes.
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Patients with serious facial soft-tissue injuries are likely to have associated injury, especially what?
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Basilar skull fractures and spine injuries.
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Le Fort Criteria
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Classification system for fractures involving the maxilla.
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With a Le Fort II injury, the midface and zygoma move concurrently. This results in what?
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The "dish-face" description often given to this injury.
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Le Fort Facial Fracture I
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Slight instability to maxilla, no displacement.
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Le Fort Facial Fracture II
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Fracture of both maxilla and nasal bones.
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Le Fort Facial Fracture III
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Fracture involving entire face below brow ridge.
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Diplopia
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Double vision.
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Blood or fluid draining from a patients ear suggest what?
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Basilar Skull Fracture
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Hyphema
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Blood in the anterior chamber of the eye, in front of the iris.
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What can happen with hyphema?
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It is a sight threatening injury.
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Occasionally, blood will completely fill the anterior chamber resulting in what?
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An "eight-ball" hyphema. This can be easily missed without close examination.
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Acute Retinal Artery Occlusion
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A nontraumatic occlusion of the retinal artery resulting in a sudden, painless loss of vision in one eye.
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Retinal Detachment
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Condition that may be of traumatic orgin and presents with patient complaint of a dark curtain obstructing a portion of the field of view.
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Most trauma surgeons feel that any injury that penetrates the most superficial muscle should be what?
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Surgically Explored
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Although determining the patient's level of orientation may add a few seconds to the initial assessment, assessing trends in orientation can be critical to rapid identification of what?
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Brain Injury
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If a patient was wearing a helmet, be sure to do what at the hospital?
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Tell the emergency department staff.
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To avoid manipulation of the airway that can increase ICP, use procedures such as deep suctioning, oropharyngeal airway use, or endotracheal intubation when?
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As a last resort, and then performed quickly by an experienced provider
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Venilations for the serious head injury patient (GCS<8) are guided by what?
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Capnography
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Whats an early sign of building intracranial pressure?
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A slow and strong (bounding) pulse.
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Hypotension with increased ICP carries high rates of morbidity and mortality. Maintain a blood pressure of at least what?
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90 mmHg
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Carefully inspect and palpate the head for what?
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Bleeding and other signs of injury.
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Raccoon eyes and Battle's sign are very late signs of basilar skull fracture and are not likely to be recognized when?
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During field assessment and care.
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Consensual Reactivity
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The response of both eyes to changes in light intensity that affect only one eye.
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Restricted eye movement suggests what?
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Eye muscle entrapment, nerve compression, or injury and paralysis.
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Any penetration of the lateral neck muscle should heighten your index of suspicion for what?
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A serious neck injury.
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Question the head, face, or neck injury patient frequently to identify what?
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Any increase or decrease in awareness and any changes in injury symptoms.
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Patients with a Glasgow Coma Scale score of _____ or less should be immediately intubated.
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8
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At the conclusion of the rapid trauma assessment, you should do what next?
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Determine the need for rapid transport.
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What is of special concern for the head injury patient?
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The blood glucose level.
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A slowing pulse rate, increasing systolic blood pressure, and the development of erratic respirations are signs of what?
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Increasing Intracranial Pressure
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What is a sign that a patient has cerebral hypoxia?
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The patient's eyes become dull and lackluster.
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What is a sign that indicates intracranial injury?
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If one pupil becomes sluggish, nonreactive, then dilated.
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If the patient actively vomits, release cricoid pressure immediately, as holding theesophagus closed during active vomiting could result in what?
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Its Rupture
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When should you intubate an unresponsive patient?
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Intubate early, and consider intubation for any patient with a reduced level of consciousness.
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Who should attempt intubation?
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If possible, have the most experienced care provider attempt intubation to reduce the length of the procedure and vagal stimulation.
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Why is oral intubation difficult in a patient with facial trauma?
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Because landmarks may be distorted, blood may flow into the airway, and the head must remain in the neutral position.
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When is confirmation of tube placement especially important?
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When the tube was placed blindly.
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The tube is most likely in the trachea if....
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If you hear good breath sounds bilaterly, detect no epigastric sounds, and see the chest wall move equally with each breath.
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What is becoming the gold standard for confirmation of initial and continuing endotracheal tube placement?
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Waveform Capnography
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Why should you give a patient with crichothyrotomy a very long time to exhale?
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Because the airway is now extremely restricted.
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How can you facilitate exhalation of crichothyrotomy?
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By placing a second needle adjacent to the first needle.
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Any patient who has sustained a significant head injury or who displays any indication of lowered level of consciousness, orientation, or arousal is a candidate for what?
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High flow, high-concentration oxygen.
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How should you handle fluid administration for any patient with significant head injury and who shows signs of shock compensation?
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Provide aggressive fluid resucitation.
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What is the first-line drug used in the care of the patient with suspected head injury?
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Oxygen
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Fasciculations
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Involuntary contractions or twitching of muscle fibers.
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What are two things to remember about neuromuscular blockers?
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They do not affect the patient's level of conciousness and all conscious patients should be sedated before administration of one of these agents.
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The empiric use of dextrose in the head injury patient is what?
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Contraindicated
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What should you do when transporting head injury patients?
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Limit external stimulation, such as the use of red lights and sirens, and try to provide a smooth ride.
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How can you remove particles from the white of the eye?
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Pull down the lower lid while the patient looks up or pull up the upper lid while the patient looks down.
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How can you remove hard lenses from the eye?
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With a moistened suction cup.
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