26. Trauma

Question 1

definition of contact injury?

Answer 1

kinetic energy applied directly to skull and brain

Question 2

examples of contact injuries?

Answer 2

skull fractures, epidural hematomas, gunshot wounds

Question 3

two types of skull fractures?

Answer 3

open/closed

Question 4

closed skull fracture treated how?

Answer 4

most will heal without treatment

Question 5

open skull fracture: main concern?

Answer 5

infection. elevation, debridement are impt.

Question 6

epidural hematoma: associated with what kind of injury?

Answer 6

fracture, usually to temple/MMA

Question 7

epidural hematoma: depressed level of consciousness is often due to what?

Answer 7

the hematoma itself. removal of the hematoma usually improves consciousness.

Question 8

what is unusual about gunshot wounds?

Answer 8

different from other contact injuries because total KE is MUCH higher than with other contacts (baseball bat, for example)

Question 9

what are 2 prognostic factors for gunshot wounds?

Answer 9

level of consciousness,bullet trajectory (bihemispheric is worse)

Question 10

what underlies most serious brain injuries?

Answer 10

deceleration injury.

Question 11

why is deceleration so devastating?

Answer 11

brain is made up of discrete regions of differing density. things move at different rates, tear at junctions.

Question 12

subdural hematoma: what can cause the tearing of the bridging vein?

Answer 12

rotational injury. even if you take out the blood, there may still be damage due to the rotation.

Question 13

what is evidence that there may be rotational damage in addition to a subdural hematoma?

Answer 13

the shift of the midline may be bigger than the space taken up by the hematoma. due to rotational damage.

Question 14

acute subdural hematoma: mortality?

Answer 14

50-70%

Question 15

chronic subdural hematoma: occurs in what group?

Answer 15

elderly. they have atrophied brains, allows more space for blood to collect.
also, bridging veins are stretched because of atrophied brain. easier to damage.

Question 16

chronic subdural hematoma in an elderly person: presentation?

Answer 16

may takes weeks for symptoms to appear: confusion, headache, focal deficit

Question 17

acute v chronic hematoma: appearance on imaging?

Answer 17

acute: clot is HYPER dense
chronic: blood products break down, become the same density as CSF.

Question 18

what was the belief about the connection between ICP and prognosis?

Answer 18

belief that if you treated high ICP and normalized it, that prognosis is better.

Question 19

Initial efforts at control of ICP were largely directed at controlling what?

Answer 19

cerebral blood volume

Question 20

what two impt things are in the numerator of Pouseille’s Law (generally)?

Answer 20

radius and cerebral perfusion pressure

Question 21

if body maintains a constant flow (Q), if you increase pressure, what should happen with radius?

Answer 21

decrease.

Question 22

why is having a decreased radius of cerebral vasculature helpful?

Answer 22

lowers total area, lowers ICP.

Question 23

what should the cerebral perfusion pressure be?

Answer 23

disagreement about this: <70? 50?

Question 24

note: there is not clear consensus on whether the primary goal should be control of ICP or CPP.

Answer 24

good to know.

Question 25

was there found to be a difference in outcome between monitoring ICP and the usual imaging/clinical evaluation when managing head trauma pts?

Answer 25

not statistically significant.

Question 26

what physician revolutionized care and rehab of spinal injury patients?

Answer 26

Guttman

Question 27

with a complete spinal injury, what is the functional outcome? what pct will regain ability to walk?

Answer 27

no motor or sensory function below lesion. | 5% will walk

Question 28

with an incomplete spinal injury, what is the functional outcome? what pct will regain ability to walk?

Answer 28

some preservation of function below the lesion. | prognosis highly variable

Question 29

use of steroids for spinal injury?

Answer 29

modest benefit, controversial. most people have stopped using steroids.

Question 30

if spinal cord decompression surgery is performed, what is the benefit?

Answer 30

not sure: the relationship between the degree of canal compromise and the degree of neurological deficit is unclear

Question 31

relationship between deformity of spinal injury and neuro outcomes?

Answer 31

some evidence that increasing degree of deformity is associated with increased pain

Question 32

which type of hematoma is associated with contact injury? deceleration injury?

Answer 32

contact: epidural. due to ripping of MMA deceleration: subdural. due to rotation/tearing of bridging veins

Question 33

Monro-Kellie hypothesis?

Answer 33

The cranial compartment is incompressible, and the volume inside the cranium is a fixed volume. The cranium and its constituents (blood, CSF, and brain tissue) create a state of volume equilibrium, such that any increase in volume of one of the cranial constituents must be compensated by a decrease in volume of another. Zero sum game.

Question 34

equation for cerebral perfusion pressure?

Answer 34

CPP = MAP - ICP