CHAPTER 16: MANAGEMENT OF PATIENT WITH NEUROLOGIC TRAUMA

Question 1

describes an injury that is the result of an external
force and is of sufficient magnitude to interfere
with daily life and prompts the seeking of
treatment.

Answer 1

Traumatic Brain Injury (TBI) or craniocerebral trauma

Question 2

Classifications of Head Injury

Answer 2

Primary Injury
Secondary Injury

Question 3

consequence of direct contact to the head/brain
during the instant of initial injury, causing extracranial
focal injuries (e.g., contusions, lacerations, external
hematomas, and skull fractures)

Answer 3

Primary Injury

Question 4

evolves over the ensuing hours and days after the
initial injury and results from inadequate delivery of
nutrients and oxygen to the cells

Answer 4

Secondary Injury

Question 5

Minor injury but the scalp bleeds profusely because blood vessels constricts poorly; May result in an abrasion, contusion, laceration

Answer 5

Scalp Injury

Question 6

Break in the skull due to forceful trauma; may occur with or without brain damage.

Answer 6

Skull Fracture

Question 7

Types of Skull Fracture

Answer 7

Simple Linear
Comminuted
Depressed
Basilar

Question 8

Skull Fracture: Break in the continuity of the bone

Answer 8

Simple Linear

Question 9

Skull Fracture: Splintered on multiple fracture line

Answer 9

Comminuted

Question 10

Skull Fracture: Bone fragments are embedded into brain tissue

Answer 10

Depressed

Question 11

Skull Fracture: Fracture at the base of the skull

Answer 11

Basilar

Question 12

What are the clinical manifestations of basilar fracture?

Answer 12

Battle’s Sign - mastoid bruising (ilalim ng ears)
Racoon’s Eye - ecchymosis in the eyes
Otorrhea - CSF escape in the ears
Rhinorrhea - CSF escape in the nose

Rationale: Basilar fracture tends to traverse to the paranasal sinus thus produce hemorrhage in the nose, pharynx & ears

Question 13

Mastoid bruising

Answer 13

Battle’s Sign

Question 14

Ecchymosis in the eyes

Answer 14

Racoon’s eye

Question 15

CSF escape in the ears

Answer 15

Otorrhea

Question 16

CSF escape in the nose

Answer 16

Rhinorrhea

Question 17

Medical Management for non-depressed

Answer 17

Close monitoring for 24 hrs; mgh; no surgery

Question 18

Medical Management for depressed

Answer 18

require surgery with elevation of the skull and débridement, usually within 24 hours of injury.

Question 19

Mechanisms of Brain Injury

Answer 19

Closed (Blunt) Injury
Open Brain Injury

Question 20

head accelerates & then rapidly decelerates or collide with another object & brain tissue is damaged but there is no opening through skull or dura

Answer 20

Closed (Blunt) Injury

Question 21

an object penetrates the skull, enters the brain, damages the soft brain tissue or when blunt trauma is severe that it opens the scalp, skull and dura to expose the brain

Answer 21

Open Brain Injury

Question 22

Type of Brain Injury: the brain is BRUISED and damaged in a specific area because of severe acceleration–deceleration force or blunt trauma

Answer 22

Contusion

Question 23

Type of Brain Injury: Hematomas are collections of blood in the brain that may be epidural (above the dura), subdural (below the dura), or intracerebral (within the brain)

Answer 23

Intracranial Hemorrhage

Question 24

Collection of blood in the epidural (extradural) space between the skull and the dura mater.

Answer 24

Epidural Hematoma

Question 25

a collection of blood between the dura and the brain, a space normally occupied by a thin cushion of fluid

Answer 25

Subdural Hematoma

Question 26

Medical Management of Intracerebral Hemorrhage and Hematoma

Answer 26

➢control of ICP ➢careful administration of fluids, electrolytes, ➢antihypertensive medications

Question 27

Surgical Management of Intracerebral Hemorrhage and Hematoma

Answer 27

> craniotomy or craniectomy permits removal of the blood clot and control of hemorrhage

Question 28

temporary loss of neurologic function with no apparent structural damage of the brain. ; mechanism of injury is usually blunt trauma from an acceleration–deceleration force, a direct blow, or a blast injury

Answer 28

Concussion

Question 29

results from widespread shearing (tearing) and rotational forces that produce damage throughout the brain—to axons in the cerebral hemispheres, corpus callosum, and brainstem.

Answer 29

Diffuse Axonal Injury

Question 30

3 Cardinal Signs of Brain Death

Answer 30

Coma the absence of brainstem reflexes Apnea

Question 31

Test to Confirm Brain Death

Answer 31

cerebral blood flow studies electroencephalogram (EEG) transcranial Doppler brainstem auditory-evoked potential,

Question 32

A tool for assessing a patient's response to stimuli

Answer 32

Glasgow Coma Scale Scores range from 3 (deep coma) to 15 (normal)

Question 33

What does the GCS contain?

Answer 33

Eye-opening response Best verbal response Best motor response

Question 34

What is used to assess LOC at regular intervals?

Answer 34

GCS Rationale: changes in the LOC precede all other changes in vital and neurologic signs.

Question 35

What is monitored at frequent intervals to assess the intracranial status?

Answer 35

Vital Signs

Question 36

Vital Signs: Signs of increasing ICP include:

Answer 36

✓ slowing of the heart rate (bradycardia), ✓ increasing systolic blood pressure ✓ widening pulse pressure (Cushing reflex) ✓ respirations become rapid ✓ blood pressure may decrease ✓ pulse slows further ✓ temperature is maintained at less than 38°C ✓ Tachycardia and arterial hypotension may indicate that bleeding is occurring elsewhere in the body

Question 37

Which areas do SCI commonly occur?

Answer 37

C5, C6, C7, T12, L1 Rationale: This area has a greater range of mobility in the vertebral column in this areas

Question 38

Causes of SCI

Answer 38

MVA Gun shots Falls Sports injuries

Question 39

SCI Classification: result of the initial insult or trauma, usually permanent

Answer 39

Primary Injury

Question 40

SCI Classification: resulting from SCI include edema and hemorrhage

Answer 40

Secondary injury

Question 41

TYPE of SCI: ➢signifies loss of both sensory and voluntary motor communication from the brain to the periphery, resulting in paraplegia or tetraplegia

Answer 41

Complete Spinal Cord Lesion

Question 42

TYPE OF SCI: ➢denotes that the ability of the spinal cord to relay messages to and from the brain is not completely absent

Answer 42

Incomplete Spinal Cord Lesion

Question 43

➢complete injury in the thoracic area causes complete paralysis in the legs but the arms can still function

Answer 43

paraplegia

Question 44

➢paralysis of all four extremities; formerly called quadriplegia

Answer 44

tetraplegia/quadriplegia