Chapter 8: Head Trauma

Question 1

Leading cause of TBI in the elderly population

Answer 1

Falls

Question 2

Which cranial nerve controls pupillary constriction and provides an important tool in the assessment of a patient with a brain injury

Answer 2

CN III

The oculomotor nerve

Question 3

Cerebral blood flow is maintained by what two things

Answer 3

1. An adequate cerebral perfusion pressure

2. Autoregulation

Question 4

CPP (Cerebral perfusion pressure)=

Answer 4

MAP-ICP

Question 5

Normal CPP

Answer 5

70 to 80 mmHg

Question 6

The most important factor for the brain is

Answer 6

Cerebral blood flow

Question 7

Adequate CPP is

Answer 7

60-70 mmHg

Question 8

SBP greater than ___ is desirable for neurologically injured patients

Answer 8

90

Question 9

Primary focus in the management of TBI is to identify and limit or stop

Answer 9

Secondary injury mechanisms

Question 10

Primary brain injury

Answer 10

Direct trauma to the brain and associated vascular injuries that occur at the time of the original insult

Question 11

Ongoing injury processes that are set in motion by the primary brain injury

Answer 11

Secondary brain injury

Hematoma, Hypoxia, Hypotension

Question 12

The process of forcing the posterior fossa contents into the foramen magnum is referred to as

Answer 12

Coning

Question 13

Shallow breaths that become deeper and more rapid and then return to slow shallow breaths

Answer 13

Cheyene- Stokes ventilations

Question 14

Consistently rapid, deep breaths

Answer 14

Central neurogenic hyperventilation

Question 15

Erratic ventilatory efforts that lack any discernible pattern

Answer 15

Ataxic breathing

Question 16

Cushing’s phenomenon

Answer 16

Increases BP

Decreases HR

Question 17

Intracranial causes of secondary injury

Answer 17

1. Mass affect and herniation (most often)
2. Cerebral Edema
3. Intracerebral hematomas
4. Intracranial hypertension
5. Ischemia

Question 18

Leading cause of TBI in those under 65 years of age

Answer 18

MVA

Question 19

Extracranial causes

Answer 19

1. Hypotension
2. Hypoxia
3. Anemia
4. Hypoglycemia and hyperglycemia
5. Hypocapnia and hypercapnia
6. Seizures

Question 20

2 most significant predictors of poor outcome from TBI

Answer 20

1. Amount of time spent with an ICP greater than 20

2. Amount of time spent with SBP less than 90

Question 21

Maintain an SP02 above ___ in brain injured patients

Answer 21

Above 90%

95% is optimal

Question 22

When examining the pupils, a difference of greater than ___ is considered abnormal

Answer 22

1 mm in pupil size

Question 23

Patients whose GCS deteriorates by more than ____ points during transport are at particularly high risk for ongoing pathological process

Answer 23

More than 2 points

Question 24

Most common facial bone fracture

Answer 24

Nasal bone

Question 25

The second most common type of facial fracture

Answer 25

Mandibular fractures

Question 26

Le Fort I fracture

Answer 26

Horizontal detachment of the maxilla from the nasal floor

Question 27

Le Fort II fracture

Answer 27

Pyramidal fracture Includes the right and left maxilla, the medial portion of the orbital floor, and nasal bones

Question 28

Le Fort III

Answer 28

Involves facial bones being fractured off the skull Craniofacial disjunction

Question 29

Endotracheal intubation is generally contraindicated in the presence of a

Answer 29

Laryngeal injury

Question 30

The hallmark of a concussion

Answer 30

Post Traumatic amnesia

Question 31

All patients with a severe TBI should be considered for intubation. What GCS parameters requires intubation ?

Answer 31

GCS less than or equal to 8

Question 32

Normal ventilatory rate should be used when assisting ventilation in patients with TBI ___/min for adults ___/min for children ___/min for infants

Answer 32

10/min for adults 20/min for children 25/min for infants

Question 33

Warning signs of increased ICP and herniation

Answer 33

1. Decline in GCS score of two points or more 2. Sluggish or nonreactive pupil 3. Hemiplegia or Hemiparesis 4. Cushing's phenomenon

Question 34

Controlled therapeutic hyperventilation may be considered for obvious signs of herniation. Ventilatory rates of ___ should be used ___/min for adults ___/min for children ___/min for infants

Answer 34

20/min for adults 30/min for children 35/min for infants