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88 Cards in this Set
- Front
- Back
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What is the leading cause of TBI between 5 and 65years old
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MVC
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What is the leading cause of TBI in the Pediatric and Elderly population
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Fals
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What is the other most covering of the head called
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Scalp
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What are the layers of the scalp
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Galea aponeurotica and periostum
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What are names of the meninges
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Dura,
Arachonid Pia |
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Which meninges is a tough tissue and is applied to the inner table or inside of the skull
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Dura Mater
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What is a common etology for epidural hematomas
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A tear of the middle mentingeal artery
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What two meningeal layers are on the other side of the subdural space
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Arachnoid
Pia |
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Which menigneal layer is the last layer and is adhered to the brain
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Pia Matter
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What runs on top of the Pia Matter
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Cerebral blood vessels
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What runs on top of the cerebral blood vessel
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The Arachnoid membrane
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Why would bleeding from the arachnoid membrane result in bleeding in the subarachnoid space
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Because the cerebral blood vessels run on the surface of the brain but beneath the arachnoid membrane
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What are all of the layers of the human head from outside to inside
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Skull
Epidural Space Perosteum Dura Matter Subdural space Arachnid membrane Vessels in the subachnoid space Pia mater |
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What are the 3 major parts of the brain
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Cerebrum, Cerebellum and Brainstem
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What are the 4 sub-parts of the cerebrum and what are they used for
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What are the 4 sub-parts of the cerebrum and what are they used for
Frontal-Contains emotions, motor function and expression of speech on the dominant side Parietal-Contains sensory function and spatial orientation Temporal-Regulates certain memory functions; contains the area of speech reception and integration in all right handed and the major of left handed individuals Occipital- vision |
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What is the cerebrum used for
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Sensory, motor and higher intellectual functions
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What is the Cerebellum used for
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Coordinators movement
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What is the brainstem used for
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Control basic life functions-resp. pulse. BP
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What are the two parts of the brainstem
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brainstem
midbrain and upper pons |
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What is the Reticular activating system(RAS) used for
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Arousal and alertness
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Were do the 12 cranial nerves originate from
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Brain and brain stem
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Which Pressure is created with in circulatory system when the heart is resting and not pumping.
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Diastolic pressure
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Which is the name of the pressure when the pressure is at the maximum pressure generated at the peak of cardiac contraction
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Systolic
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What is the name of the average pressure for the entire cardiac cycle
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Mean Arterial Pressure
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What is the formula for MAP
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MAP=Diastolic Pressure+1/3 Pulse Pressure
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What is Cerebral Perfusion Pressure
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The amount of Pressure that is needed to push block through the cerebral circulation and thus maintain blood flow, o2 and glucose delivery
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What happens when there is an increase in ICP and why
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The amount of pressure need to push block through the brain also increases.
Because everything takes up space in skull, which produces pressure, anything that takes up more space will increase the pressure in the skull |
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What are the normal ranges for MAP,CPP,ICP
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MAP=85-95mmHG
CPP=70-80mmHg ICP=below 15mmHg |
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What is the most important factor for the human brain
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Cerebral Blood flow
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Autoregulation
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The work of the brain to maintain blood flow through a range of changing conditions
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What is the formula to understand auto regulation
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Pressure=Flow x Resistance
Which means CPP=CBFx Cerebral Vascular resistance(CVR) |
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Were should the Systolic blood pressure be at with a neurologically inj. Pt
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Greater then 90mmHg
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Why does hyperventilation help pt with a head inj.
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It helps reduce ICP. By reducing the arterial carbon dioxide partial pressure by increasing the rate at which Co 2i is blown of the lungs. This reduced Pac02 chagnes the acid base balance in the brain resulting in casonstriction. This cerebral vasoconstriction reduce the instravacular volume of the Bain reducing cerebral blood volume
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What are the two Categories of a TBI
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Primary and secondary
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What is a primary inj. of a TBI
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Direct trauma to the brain and associate vascular structure
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What is a 2econdary brain injury
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The ongoing injury processes that are set in motion by the primary injury
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What are the most common inj. of primary and second TBI
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Hematoma and hypoxia and hypotension
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What are some mechanisms that cause secondary TBI
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Mass effect and subsequent elevated ICP and mechanical shifting on the brain
Hypoxia Hypotension and inadequate CBF Cellular mechanism including every failure |
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Decorticate Posturing
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Flexion of the upper extremities and rigidity and extension of the lower extremities
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Decrebrate Posturing
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All extremities are extended and arching of the spine may occur
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Cushing’s phenomenon
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Increased in blood pressure and bradycardia, cheyne storke ventilations. Very, very, very bad sign
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Herniation Syndrome
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Describes how the swelling brain because it is contained in a fully enclosed space can sustain mechanical damage
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Signs and Syndromes of herniation
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Blown pupil, abnormal motor findings, contra lateral weakness, decrebrate and decorticate prostrating, cheyne stroke ventilations, ataxic breathing
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What is cheyne stoke ventilations
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Repeating cycle of slow shallow breathes that become deeper and more rapid and then return to slow shallow breaths
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What are common causes of airway compromise in pt with TBI
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Emesis hemorrhage and swelling from facial trauma
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What is an essential effort to limit secondary brain inj.
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Adequate oxygen delivery and airway
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Linear fx account for what percent of skull fx
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80%
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If the dura mater is torn what can happened
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CSF may leak from an open skull fx
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A closed non-depressed skull fx may mean what
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An increase risk of intracranial hematoma
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What are some trauma injuries that can happen to the eye and orbit
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Eye Lid laceration
Corneal abrasion Subconjunctival hemorrhage Hyphema Open Glove |
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What are the mid face fractures called
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Le Fort fx
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Le Fort I fx
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Detachment of the maxilla fround the nasal floor(Mouth fx)
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Le Fort II fx
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R and L. maxillae, medical portion of the orbital floor and nasal bones(Nose fx)
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Le Fort III Fx
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Facial bones fx off the skull(orbrt, upper nose fx)
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What are some Signs and Symptoms of a laryngeal injure
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Change in voice, neck contusion or loss of prominence of the thyroid cartilage, Subcutaneous emphysema
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What might be life saving if a trauma pt has a laryngeral fx
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Surgical cricothryotomy
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What are some signs and symptoms of a midface fracture?
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Loss of normal facial symmetry,
May appear flattend Unable to close the jaws or teeth Facial pain and numbness |
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What is the most common complaint of a patient with a mandibular fracture
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Usual alignment of the upper and lower teeth
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What typically causes fractures of the larynx
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A blunt blow to the anterior neck and larynx
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Aside from profound hemorrhage what else is a risk with a injured cervical vessels
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Air embolism
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When is a field diagnosis of a concussion made
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When the pt shows any transient alteration in neurologic function
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What is the hallmark sign of a concussion
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Posttraumatic amnesia
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What are some neurologic signs and symptoms of a concussion
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Vacant stare
Delayed verbal/motor response Confusion and inability to focuss attention Disorientation Slurred or incoherence speech Lack of coordination inappropriate emotions Memory defects Inability to memorize and recall |
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What usually accompany a concussion
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Severe headache, dizziness and nausea and vomiting
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What should the EMT do if a pt has signs of a concussion and has N/V on a secondary survey
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Immediately transport
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Intracranial hematomas can be divide in to what 3 types
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Epidural, subdural and intercerbral
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What is a epidural hematoma
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Bleeding between the dura mater and the skull
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Epidural hematomas often result from what
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Low velocity impact to the temporal bone with a fx of the middle menigeal artery.
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What is the classic clue for a epidural hematoma
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Pt has a brief loss of consciousness then comes back then has a rapid decline in consciousness
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What is a subdural hematoma
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A bleed between the dura matter and the brain
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What is more common a subdural or a epidural hematomra
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Subdural
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What causes the bleeding in a subdural hematorma
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From a veins bleed from the bridging veins
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What is a pt most likely to present with if they have a subdural hematoma
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Headache, visual disturbance, personality changes, difficulty speaking, hemiparesis, hemiplegia.
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What might a subdual hematomra be mistaken as
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Stroke
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Were would EMT’s frequently encounter pts with subdural hematomras
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Long term care facilities
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What is a subarachnoid hemorrhage
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Bleeding under the arachnoid membranes
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What is a subarachnoid hemorrhage associated with
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Ruptured cerebral aneurysms
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What are the breathing rates that should be used when assisting ventilation in Pt w/ TBIs
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10bpm for adults
20breahts/min for children 25breaths/min infants |
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How much tidal vol. should be sufficient for an adult pt to maintain adequate oxygenation with out inducing hypobaric
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350-500ml at 10breahts/min
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What can the EMT do in the fild if the pt is showing signs of hernination
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Hyperventilation
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What should the rates be for hyperventiatlion
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20breahts/min for adults
25breahts/min for children 30 breaths/min for infants less then 1 year |
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Why shouldn’t a pressure dressing be applied to an open skull inj.
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An increase in Pressure may cause an increase in ICP
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What should the SBP be at to preserve cerebral perfusion
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90-100mmHg
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IV fluids should flow at what amount until shock develop
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125ml/hr
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Prehosptial care of TBI is primarily focused on what
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Reversing and preventing factors that cause secondary brain inj.
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Why should the drugs diazepam, lorazepam and midazolam be watched carefully
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Ventilatory depression
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What should the radio report to the hospital included
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MOI, intial GCS score and any changes.
Focal sings, vitals, serious injuries, and response to manaagment |
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What are some warning sings of possible increased ICP
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Decline of GCS of two or more points
Development of sluggish or non reactive pupil Hemiplegia/hemiparesis Cushing phenomenon |
