Chapter 8: Head Trauma Flashcards Preview

PHTLS > Chapter 8: Head Trauma > Flashcards

Flashcards in Chapter 8: Head Trauma Deck (34)
Loading flashcards...
1
Q

Leading cause of TBI in the elderly population

A

Falls

2
Q

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

A

CN III

The oculomotor nerve

3
Q

Cerebral blood flow is maintained by what two things

A
  1. An adequate cerebral perfusion pressure

2. Autoregulation

4
Q

CPP (Cerebral perfusion pressure)=

A

MAP-ICP

5
Q

Normal CPP

A

70 to 80 mmHg

6
Q

The most important factor for the brain is

A

Cerebral blood flow

7
Q

Adequate CPP is

A

60-70 mmHg

8
Q

SBP greater than ___ is desirable for neurologically injured patients

A

90

9
Q

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

A

Secondary injury mechanisms

10
Q

Primary brain injury

A

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

11
Q

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

A

Secondary brain injury

Hematoma, Hypoxia, Hypotension

12
Q

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

A

Coning

13
Q

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

A

Cheyene- Stokes ventilations

14
Q

Consistently rapid, deep breaths

A

Central neurogenic hyperventilation

15
Q

Erratic ventilatory efforts that lack any discernible pattern

A

Ataxic breathing

16
Q

Cushing’s phenomenon

A

Increases BP

Decreases HR

17
Q

Intracranial causes of secondary injury

A
  1. Mass affect and herniation (most often)
  2. Cerebral Edema
  3. Intracerebral hematomas
  4. Intracranial hypertension
  5. Ischemia
18
Q

Leading cause of TBI in those under 65 years of age

A

MVA

19
Q

Extracranial causes

A
  1. Hypotension
  2. Hypoxia
  3. Anemia
  4. Hypoglycemia and hyperglycemia
  5. Hypocapnia and hypercapnia
  6. Seizures
20
Q

2 most significant predictors of poor outcome from TBI

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

2. Amount of time spent with SBP less than 90

21
Q

Maintain an SP02 above ___ in brain injured patients

A

Above 90%

95% is optimal

22
Q

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

A

1 mm in pupil size

23
Q

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

A

More than 2 points

24
Q

Most common facial bone fracture

A

Nasal bone

25
Q

The second most common type of facial fracture

A

Mandibular fractures

26
Q

Le Fort I fracture

A

Horizontal detachment of the maxilla from the nasal floor

27
Q

Le Fort II fracture

A

Pyramidal fracture

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

28
Q

Le Fort III

A

Involves facial bones being fractured off the skull

Craniofacial disjunction

29
Q

Endotracheal intubation is generally contraindicated in the presence of a

A

Laryngeal injury

30
Q

The hallmark of a concussion

A

Post Traumatic amnesia

31
Q

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

A

GCS less than or equal to 8

32
Q

Normal ventilatory rate should be used when assisting ventilation in patients with TBI

___/min for adults

___/min for children

___/min for infants

A

10/min for adults

20/min for children

25/min for infants

33
Q

Warning signs of increased ICP and herniation

A
  1. Decline in GCS score of two points or more
  2. Sluggish or nonreactive pupil
  3. Hemiplegia or Hemiparesis
  4. Cushing’s phenomenon
34
Q

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

A

20/min for adults

30/min for children

35/min for infants