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C2 > Trauma > Flashcards

Trauma Flashcards

1
Q

what types of axonal and contusional injuries are there

A

rotation (shear) - traumatic axonal and micro-vascular injury
translation (linear) - coup and contro coup contusions
impact and crush

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2
Q

what symptoms/effects show with fronto-temporal contusions after primary injury acute

A

cognitive, affective, behavioural problems, poor judgement and planning, anxiety, impulsivity

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3
Q

what happens in primary injurry after mod/sever TBI

A

can have microhaemorrhages, microbleeds

spastic-ataxic quadriparesis, prolonged PTA, executive problems and cognitive slowing

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4
Q

within how many hours do subdurals need decompression

A

4 hours

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5
Q

what is delirium

A

“(sometimes called ‘acute confusional state’) is characterised by
disturbed consciousness, cognitive function or perception, which has an acute onset
and fluctuating course… can be hypoactive, hyperactive or mixed…and can be
restless, agitated and aggressive (or) withdrawn, quiet and sleepy…. caused by the
direct physiological consequences of a general medical condition.”

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6
Q

what are neuro consequences of severe TBI

A

Hydrocephalus and intracranial hypotension
• Asymmetric spastic-ataxic quadriparesis, +/- (Holmes) tremor
• Hemiparesis, ipsi-lesional (Kernohan) or contra-lesional or both
• Imbalance commonest residual physical problem
• Thalamic pain
• Bulbar problems and incontinence
• Autonomic storms, & hypothalamic and hypothalamic-pituitary axis dysfunction
• ‘Syndrome of the trephined’
• Cranial neuropathies
Particularly with skull-base & facial fractures
May cause bilateral & profound deafness
IX-XII uncommon
Traumatic optic neuropathies vs. Terson’s syndrome
• Incidental carotid/vertebral dissection, hyperextension myelopathies, traumatic
plexopathies, compression mononeuropathies
• Heterotopic ossification
• Post-traumatic epilepsy

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7
Q

what is diagnosis based on behaviour influenced by

A
  • Medical instability
  • Nutritional state
  • Medication eg. AEDs
  • Altered sleep/wake cycle
  • Severe physical impairment
  • Positioning masking ability
  • Repetitive movements
  • Sensory impairments, particularly deafness & blindness
  • Communication & behavioural problems
  • Fluctuating attention and responsiveness
  • Environmental problems
  • New/inexperienced assessor
  • Possibility of covert awareness
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8
Q

what imaging can you use to test brain activity

A

fMRI

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9
Q

Why use Skull radiographs (SXR)

A

can see calvarial fractures, penetrating injuries, radiopaque foreign bodies

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10
Q

what is CT good for in TBI

A

sensitive for mass effect, ventricular size, bone injuries and acute haemorrhage
available, quick

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11
Q

why is CT not good in tbi

A

ionising radiation

might not detect small and non-haemorrhagic lesions, DAI, ICP, cerebral oedema

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12
Q

why is MRI good in TBI

A

sensitive for subacute and chronic brain injuries
DWI improves detection of acute infarction.
FLAIR imaging sensitive for subarachnoid haemorrhage and lesions bordered by CSF

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13
Q

why is MRI not good in TBI

A

limited in acute trauma setting
long imaging times
insensitive to subarachnoid haemorrhage

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14
Q

what is angiography good for

A

dissection depiction.
cta and mra less invasice
mra can reveal carotid or vertebral dissection

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15
Q

what are divisions of primary neuronal injury

A

cortical contusions
diffuse axonal injury
primary brain stem injury

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16
Q

what are divisions of primary haemorrhage

A

subararachnoid
subdural
extradural
intracerebral

17
Q

what is cortical contusion

A

consequence of direct trauma usually against skull

skull impacts on brain forms ‘brain bruise’ can be haemorrhagic

18
Q

what can happen diffuse axonal injury

A

non linear accelerative force
with ct can’t distinguish DAI early on
mri can pick deep in

19
Q

what can vascular injuries lead to

A

dissections, lacerations, occlusions, pseudoaneurysms, arteriovenous fistulas

20
Q

what are vascular injuries caused by often

A

basal skull injuries

21
Q

when is surgery needed for in fractures

A

depressed skull more than full thickness of the skull
open fractures that give rise to pneumocephalus

relieves or prevent CSF leakage, infection, haemorrhage, or vascular compromise

22
Q

what can be used to detect sites of CSF leaks in fractures

A

CT, contrast CT or radionuclide cisternography used for detecting sites of CSF leaks

23
Q

what do foreign bodies cause damage by several mechanisms depneding on size and velocity of:

A

direct laceration
shock-wave transmission
cavitation

24
Q

what is common in secondary injury

A 
territorial arterial infarction
global anoxia and ischemia
pressure necrosis
brain herniation syndromes
delayed haemorrhages
secondary brain stem injuries
25
Q

what is chronic sequelae of head injury characterised by

A 
parenchymal atrophy
residual hemoglobin degradation products
residual hemoglobin degradation products
Wallerian-type axonal degeneration 
demyelination
cavitation
microglial scarring
26
Q

what parts of body to consider with spinal cord imaging

A

anterior 2/3 vertebral body, disc and anterior longitudinal ligament
posterior 1/3 vertebral body, disc and pll
pedicles transverse processes, laminae, articular facets and spinous processes
if 2 columns disrupted = unstable injury

Nice guidelines NG41 - assessment of clinical severity by the Canadian C-spine rule

27
Q

when to do spine multimodal imaging if child or adult

A

child - MRI if strong suspicion otherwise x-ray

adults - CT if by Canadian spine rule or T or L injury
otherwise x-ray or MRI

28
Q

what are mechanisms of cervical injury

A

hyperflexion
hyperextension
axial compression

29
Q

what are upper cervical spine fractures

A 
complex flexion/extension
atlanto-occipital dislocation
odontoid peg fractures
extension- Hangman's fracture
vertical compression - Jefferson's fracture
30
Q

What are lower cervical spine fractures

A

flexion –> flexion teardrop fracture, wedge compression fracture, Clay shoveler’s fracture, bilateral facet joint dislocation

flexion-rotation - unilateral facet joint dislocation

vertical compression - Burst fracture

31
Q

what types of soft tissue spinal injuries are there

A 
anterior subluxation
ligamentous injuries
cord contusion
brachial plexus injuries
vertebral arteries
32
Q

what are types of thoracolumbra spine fractures

A 
wedge compression fractures
burst fractures
chance fractures
spondylolisthesis
spondylolysis

C2 (24 decks)

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