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Semester 3 > Case 10 - acute head trauma > Flashcards

Case 10 - acute head trauma Flashcards

(55 cards)

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1
Q

how many people per 100000 of the population will suffer a head trauma

A

453 per 100,000

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2
Q

what is the percentage that are considered moderate to severe

A

10.9%

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3
Q

how many admissions throughout the year

A

350,000

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4
Q

what are the risk factors for a head trauma

A

male
young (15-30) and old (65+ tend to be more low impact and falls )
urban areas
substance misuse including alcohol

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5
Q

what are primary preventions put in place

A

seat belts
helmets
alcohol prevention and limits
health and safety

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6
Q

what is the first aid carried out for suspected head trauma

A

ABC + C-spine

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7
Q

what is pHEMS

A

pre hospital emergency medicine

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8
Q

what is ATLS

A

trauma protocol

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9
Q

what is involved in the history part of the assessment

A

From patient and collateral (passersby or paramedics or family)
Time - when did it occur and was patient just found
Mechanism - high impact or fall form standing?
Conscious level - at worst: this is very important as can be a worrying sign
Seizures
PMHx (past medical history) / DHx (drug history)

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10
Q

what is the A-E of the assessment protocol

A

Patency
Other injuries, apnoea, hypoxia
Other injuries, hypotension, heart ray
GCS, pupils, C-spine (10% of head injury patients have a c spine injury as well)
Primary survey (entire body)

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11
Q

what are the signs of a base of skull fracture

A

racoon eyes
battle sign
haemotypanum - bleeding behind the ear drum
- CSF leak - clear fluid from the nose

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12
Q

what percentage have a concurrent C-spine injury

A

5-10% have a concurrent C spine injury

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13
Q

glasgow coma score diagram

A
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14
Q

what are the NICE guidelines for a CT

A

perform a CT head within 1 hour of the risk factor being identified

GCS less than 13 on initial assessment in the emergency department

GCS less than 15 after 2 hours after the injury on assessment in the ED

Suspected open or depressed skull fracture

Any sign of basal skull fracture - panda eyes, fluid leaking or Battle’s sign

Post traumatic seizure

Focal neurological deficit

More than 1 episode of vomiting

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15
Q

what adults who have had loss of consciousness or amnesia since the injury would have a CT within 8 hours of the head injury

A

age 65 or older
any history of bleeding or clotting disorders
dangerous mechanism of injury
more than 30 mins retrograde amnesia of events immediately before the head Injury

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16
Q

what is the primary in brain injury

A

the original insult

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17
Q

what is the secondary in brain injury

A

the damaged caused after

caused by:
hypoxia
hypotension/hypertension
raised inter cranial pressure

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18
Q

types of head trauma diagram

A
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19
Q

what is a diffuse axonal injury

A

when the brain moves back and forth in the skull cavity - ricochets

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20
Q

what is an extradural haematoma

A

any bleeding that happens within the potential space between the skull and the dura

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21
Q

what is the bleeding usually from in an extradural haematoma

A

middle meningeal artery

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22
Q

what is the conscious pattern in an extradural haematoma

A

usually lose consciousness immediately but then regain consciousness

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23
Q

what are the other symptoms of extradural haematoma

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A

ongoing headache and then become increasingly drowsy after some hours

24
Q

CT scan of an extradural haematoma

25
when do sub dural haematomas usually occur
these occur following trauma but more frequently from falls
26
what is the consciousness pattern with sub dural haematomas
gradual loss of consciousness
27
where is the bleeding from in a sub dural haematoma
venous bleed and between venous bridging veins
28
sub dural haematoma on CT scan
29
effects of secondary brain injury
30
what is the murno Kellie
everything managed in the brain must be done so in equilibrium
31
what are the three components to the murno Kellie
brain CSF blood (venous and arterial)
32
can there be a degree of compensation
yes but only for so long
33
pathophysiology diagram
34
diagram explaining how to measure the CPP needed
35
what is normal ICP in the brain
10mmHg
36
when does autoregulation stop working
when blood pressure drops below 50
37
when will cerebral vasculature start to dangerously constrict
when BP is over 150
38
how do you measure inter cranial pressure
neurosurgeons place inter cranial pressire wires in parenchymal or intra dural space
39
what is normal range for ICP
5-12mmHg
40
what happens if you have a higher ICP than the mean arterial pressure
means that there is no blood flow going into the brain - no pressure to push blood into the brain
41
diagram showing the left being normal and right being abnormal
42
what is the equation for cerebral perfusion pressure
MAP - ICP
43
what is MAP
the number in brackets beside BP
44
what is the bit we are most concerned about
CPP
45
what is the importance of venous drainage
if we can ensure there is adequate venous pressure this can improve overall pressure
46
what are the signs of schema
hypoxia Hypotension Loss of auto regulation raised ICP Oedema Haematoma Hydrocephalus - when haematoma obstructs the ventricular system: no ability to drain CSF and increase pressure Vasospasm Microvascular pathology
47
what is cytotoxic oedema
initial mechanism Fluid retained in cytoplasm Loss of NaK ATPase Glutamate gated Ca channels open Ca draws water in
48
what is vasogenic cytotoxic
delayed mechanism (48 hours) gets worse after 48 hours Breakdown of blood brain barrier Fluid and protein extravasation into parenchyma
49
what is a subfalcine herniation syndrome
midline shift on CT
50
what is a transtentorial herniation syndrome
pressure on the brainstem oculomotor nerve - pupils
51
what is tonsillar herniation syndrome
through foremen magnum medulla - cardiorespiratory centre
52
what is the medical management Maintain physiology:
MAP >90 or CPP >60 Normocapnia Normothermia Avoid hypoxia Improve venous drainage head up No restrictions Reverse coagulopathy Anti-epileptics if indicated
53
what does the prognosis rely on
age presenting GCS co-morbities episodes of hypoxia or hypotension pupillary response duration ICP >20 country
54
what is the website you can use for head injure prognosis
CRASH website very overall and average and not individual to the patient
55
GCS outcome score diagram

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