Chapter 34 - Head and Spine Trauma Flashcards by B B

Are the terms head trauma, head injury, and Traumatic brain injury (TBI) interchangeable?

No.

Head trauma is an umbrella term under which head injury and TBI are differentiated.

Pg 1713

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Head injury definition

Injuries to soft tissues of scalp and/or bony structures of head and skull, NOT INCLUDING FACE

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Traumatic Brain Injury

Impairment in brain function caused by an external force

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Cranial vault is___________.

the cranial space that encases and protects the brain.

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In addition to protecting the brain, what is another primary function of the cranial vault?

Hematopoises

the production of blood cells and platelets

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In a basilar skull fracture, where is the most common place for CSF to drain from?

Nose

Pg 1714

Ears are less common

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What is the most metabolically active organ of the body?

Brain

Pg 1714

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Cerebral cortex controls_______.

Skeletal muscle movement

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Frontal lobe controls______.

Voluntary motor action
Personality traits filtering raw emotional impulses

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Parietal lobe controls________.

Processes sensory info from skin and joints.

Proprioception

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Occipital lobe is responsible for______.

Processing visual info

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Cerebellum is responsible for________.

Posture & equilibrium and coordinating skilled movements.

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Branchial plexus is where?

C5 -T1 = controls upper extremities

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Lumbar plexus is where?

L1 - L4 = supplies skin and muscles of abdominal wall

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Sacral plexus is where?

L4 - S1 = supplies buttocks, perineum and most lower limbs

Origin of Pudendal and sciatic nerves

Pg 1718

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Spinal injury at or above T6 can disrupt what kind of communication?

Sympathetic

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Another name for the craniosacral system?

Parasympathetic nervous system

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Is the vagal nerve affected by spinal injury?

No, it leaves the medulla within the carotid artery sheath and does not travel the spinal cord

Pg 1719

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If the patient has a TBI, what else do they have until proven otherside?

C-Spine injury

Pg 1719

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Repeatedly asking the same questions is

Perseveration

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High risk velocity crash for vehicles occurs at > _____ mph.

For motorcycles, pedestrian vs vehicle, bicycle?

Greather than 40 mph

Motorcycle, et al = 20+ mph

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What is the Brain Trauma Foundation’s 90-90-9 rule?

A single drop of SpO2 below 90% dramatically increases death rate
A single drop of systolic BP below 90 mmHg dramatically increases death rate
A single drop of 2 points in GCS or GCS of less than 9 dramatically increases death rate

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What is the brain’s respiratory center?

Pons and medulla

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Where do the intercostal muscles innervate?

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Why do we NOT hyperventilate a patient with high intercranial pressure (ICP)?

1. Causes vasoconstriction and shunt blood away from brain 2. This drop cerebral perfusion pressure and the brain goes ischemic.

When does the Brain Trauma Foundation recommend hyperventilating a head injury?

For brief periods ONLY with signs of cerebral herniation. Pg 1722

When ETCO2 drops below 25, what happens to the vasculature?

Vasoconstricts With head injury = anoxia and brain ischemia Pg 1722

Why is thermoregulation an issue with neurogenic shock?

There may be significant sensory loss, and the patient will take on the temperature of the environment.

Should we administer dextrose containing products to patients with cerebral edema? Why or why not?

No, it can worsen the cerebral edema. The exception is if their BGL is at 45 mg/dL or less. Pg 1723

What is the cause of hypotension from neurogenic shock? How can you tx that?

1. The loss of sympathetic tone results in uninhibited vagal stimulation 2. Atropine (vagolytic) or dopamine (vasopressor). Possible pacing for refractory bradycardia. Fluids may bit be indicated. Pg 1723

What does hypothermia do to oxygen in the body?

Impairs oxygen ability to unbind from hemoglobin =coagulapathy and acidosis

What are petechial hemorrhages indicative of when located in the eye?

Red pinpoints in the sclera of the eye from ruptured tiny vessels. **This finding indicates that the baby was shaken,** although this finding may not be present in every case of shaken baby syndrome.

What do petechial hemorrhages indicate in an infant?

Shaken baby syndrome

On a rigid backboard, how quickly does the tissue of the pressure points show signs of hypoxia in a healthy adult?

30 minutes - Skin breakdown will be faster in an unhealthy adult.

Is sluggish pupil response an early or late sign of increased ICP?

Early pg. 1727

What else does a sluggish pupil response possibly indicate?

Cerebral hypoxia pg 1727

Which nerve is being pressured when pupils are sluggish or fixed?

Oculomotor Nerve CN III pg 1727

What is nystagmus?

A condition in which your eyes make rapid, repetitive, uncontrolled movements — such as up and down (vertical nystagmus), side to side (horizontal nystagmus) or in a circle (rotary nystagmus).

What is it called when the patient is experiencing abnormal sensations such as "pins and needles," hyperacute pain to touch, or electric shocks?

Hyperesthesia

What is the Babinski reflex?

Patient older than 2 years, the toes move upward in response to stimulation of the sole of the foot.

Does head injury include traumatic insults to the brain or face?

No. It is an injury to the scalp or skull, not including the brain or face pg. 1732

The leading cause of death relating to TBI from a fall is at which age?

65+

What causes bleeding to reoccur to a head laceration that is caused by body system and not additional trauma?

Re-evaluate the wound for signs of continued bleeding. Bleeding can recur once vital signs return to normal and the sympathetic nervous system has receded. pg 1733

What are the 4 types of skull fracture?

Linear Depressed Basilar Open

Fracture of the___________ represents 75% of basilar skull fractures.

temporal bone 1734

Patients with leaking CSF are at risk for____________________.

bacterial meningitis pg 1735

The Brain Trauma Foundation defines hypoxia in the setting of TBI as an oxygen saturation level of less than ____________%. Hypoxia and hypotension (systolic blood pressure less than __________ mm Hg) are among the five most powerful predictors of poor outcomes in the patient with a TBI.

90% 90 mm HG pg 1736

The patient is in a MVC and head hits the windshield. Rapid deceleration produces compression injury (or bruising) to the ___________ of the brain along with stretching or tearing of the____________ of the brain

anterior portion posterior portion. Of the Coup-Contrecoup, this is the Coup. pg 1736

The normal ICP is ____ to ____ mm Hg, and the normal MAP is ____ to ____ mm Hg.

5 to 15 mm Hg (ICP) 85 to 95 mm Hg (MAP) pg 1737

Does the pulse pressure narrow or widen with increased ICP?

Widens, as well as increased blood pressure both systolic and diastolic Pg1737

When the Oculomotor nerve is impinged, does the pupil contract or dilate?

Dilate. The oculomotor nerve (CNIII) delivers parasympathetic impulses. Without it, the eye dilates. pg. 1738

Cushing triad

Bradycardia Hypertension (widening pulse pressure) Respiratory changes

A cerebral concussion occurs when the brain is jarred in the skull. This kind of mild, diffuse brain injury is usually caused by rapid _________-__________.

acceleration-deceleration pg. 1738

The shearing angulated/rotational forces that cause a concussion release ___________ into the extracelluar space.

Potassium pg. 1738

What is the effect of Potassium in the extracellular space of the brain?

Depresses neuronal activity pg. 1738

Is the only way to receive a concussion by direct blow to the head?

No. This may happen when the head changes direction quickly. pg 1741

How long after the concussion may a patient experience signs and symptoms?

3 - 6 months after the initial concussion This is Postconcussion Syndrome, and requires a physician evaluation. pg 1741

Which is more deadly, Postconcussion Syndrome or Secondary Concussion Syndrome?

Secondary Concussion Syndrome Death can occur as quickly as 2 to 5 minutes after the injury, and children and young adults are the most likely to develop this condition. Because of its rapid onset and high rate of mortality, a second concussion that occurs within 7 to 10 days of a previous concussion necessitates immediate transport to the closest facility with neurosurgical capability. pg 1740

Is a concussion a focal or diffuse (general) injury?

Diffuse. A cerebral concussion occurs when the brain is jarred in the skull. This kind of mild, diffuse brain injury is usually caused by rapid acceleration-deceleration. pg 1738

In a cerebral contusion, brain tissue is _______ and ________ in a local area.

Bruised and damage

How long can an epidural hematoma remain in the lucid period before the patient relapses into unconsciousness?

1 hour to 24 hours pg 1744

Most common intracranial hemorrhage? a. Epidural b. Subdural c. Subarachnoid

b. Subdural pg 1744-45

Blood🩸 mixing with the CSF causes meningeal irritation. What are two symptoms of this irritation?

Nuchal rigidity (neck) Headache pg. 1745

Where does CSF circulate? a. Epidural Space b. Subdural Space c. Subarachnoid Space

c. Subarachnoid Space pg. 1745

Blood🩸 mixing with the CSF causes meningeal irritation. What are two symptoms of this irritation?

Nuchal rigidity (neck) Headache pg. 1745

With head traumas, the ETCO2 should be maintained between _____ & _____ mm Hg unless signs of herniation are present, in which case it should be maintained between ____ & ____ mm Hg.

35 and 40 30 and 35

With head traumas, elevate the head of the stretcher or backboard about a ____ to ____ angle if possible to facilitate the drainage of CSF and venous blood from the cranial vault.

15° to 30°

Do patients with head trauma tend to go hypothermic or hyperpyrexia?

Hyperpyrexia pg 1746

MAP = __________________

DBP + 1/3 (SBP − DBP) pg. 1059

When the MAP exceeds __________ mm Hg, the pressure breaches the blood-brain barrier, and fluid leaks out, increasing intracranial pressure.

150 mm Hg pg. 1059

Chapter 34 - Head and Spine Trauma Flashcards

(70 cards)