Head and brain injuries Flashcards
(48 cards)
1
Q
What is a meninge?
A
Membranous covering of the brain & spinal cord
2
Q
What are the 3 meninges?
A
1) Dura mater
2) Arachnoid mater
3) Pia mater
3
Q
What are the meninges a common site of?
A
- infection (meningitis)
- intracranial bleeds
4
Q
Describe the dura mater.
A
- In: trigeminal n.
- outermost layer
- directly under skull
- thick, tough, inextensible
- highly vascularized (middle meningeal a.)
5
Q
Describe the arachnoid mater.
A
- middle
- under dura mater
- connective tissue
- AVASCULAR
- no innervation
6
Q
Describe the Pia mater.
A
- Very thing
- covers brain
- Highly vascularized
7
Q
Where is the CSF contained?
A
Sub-arachnoid space (btwn arachnoid and pia mater)
8
Q
What does CSF do?
A
Acts to cushion brain
(watery sac to support brain and absorb impact and shock)
9
Q
What are some head/brain pathologies?
A
- Scalp laceration
- Skull fracture
- Brain contusion
- Intra-cranial bleed
- concussion
- second-impact syndrome
10
Q
Scalp lacerations overview
A
- looks worse than it is
- significant blood loss
- possible sutures necessary
- possible hypovolemic shock
- Blunt trauma
- infection
11
Q
Scalp laceration Tx
A
- Gloves/PPE
- Direct pressure
- Non-adherent sterile gauze
- compression dressing
- referral for sutures (prn)
12
Q
Skull fractures MOI and 3 types
A
MOI: direct blow
Types:
1- Hairline/Linear
2- Depressed
3- Basal (basilar skull)
13
Q
Skull linear fracture description and occurrence
A
- most common (>50% of cases)
- thin line
- simple fracture
- non-fatal
14
Q
S/S and LOC of Linear skull fracture
A
No S/S
no loss of consciousness
15
Q
What is a depressed skull fracture?
A
- bone gets crushed
- part of bone gets displaced in direction of brain
16
Q
Describe a basilar skull fracture
A
- rarest form (extreme force)
- disruption of bones in middle ear (deafness or CSF from nose/ears)
- could be life-threatening (pushes on brainstem)
- temporary or permanent disability
17
Q
What is drainage from the ear called?
A
CSF otorrhea
18
Q
What is the anatomical cause of CSF leak? What does it look like?
A
- Hole of tear in dura mater
- Clear watery drainage
19
Q
What is drainage from the nose called?
A
CSF rhinorrhea
20
Q
What are the causes of CSF leaks?
A
- head injury
- inc. pressure in brain
- poorly functioning shunt
- malformations of inner ear
21
Q
Tx and examination for Skull fracture
A
- Gentle palpation
- Battle’s sign: Mastoid process (behind ear)
- Raccoon eyes: ecchymosis
- CSF (eyes, ears, nose, salty/metallic taste)
22
Q
S/S skull fracture
A
- Bleeding (skull, eyes, ears, nose)
- CSF
- Swelling +tenderness
- Bruising eyes/ears
- Changes in size of pupil
- severe headache
- nausea + comiting
- deformity
- incoherent speech + visual impairment
- difficult balance/coordination
- neck stiffness
- irritable
- photophobia and phonophobia
- hypotension
- drowsiness
- impaired smell, taste, hearing
- Loss of consciousness
- convulsions
23
Q
What’s another way to say cerebral contusion
A
Contusio cerebri
24
Q
Describe a cerebral contusion
A
- Fairly common
- More severe than a concussion
- Structural damage to brain
- Bleeding + swelling
- Increased pressure on brain (ICP)
25
What are the different lengths of effects of a cerebral contusion (3)
1- Short lasting
2- Long lasting
3- Permanent
26
What is the frontal lobe for?
- movement
- impulses
- spoken language
- personality
27
What is the Temporal lobe for?
- written words
- hearing
- memory
28
In which lobes to cerebral contusions mostly occur?
Frontal and temporal lobes
29
What should you look for in the eyes after a cerebral contusion?
Petechial hemorrhage
30
What is intracranial bleeding (hematomas)
Inc. pressure on brain in a confined space
31
What are the 3 types of intracranial hematomas?
1- Epidural hematoma
2- Subdural hematoma
3- Intracerebral hematoma
32
Describe an epidural hematoma.
- Life threatening epidural bleeding
- Fast developing
- btwn dura mater and periosteum
- secondary complication of Traumatic brain injury (TBI)
33
What is the typical MOI of a an epidural hematoma
- Laceration to middle meningeal a.
- With skull fracture
- high velocity blow to temple
34
Epidural hematoma is a complication to look out for after a
concussion
35
S/S of an epidural hematoma are similar to a
concussion
36
What is the LOC for epidural hematoma?
Lucid period and then rapid decline in LOC as bleeding causes pressure in brain and brainstem
"talk and die"
37
Describe subdural hematoma
- most common that requires surgery
- outside brain
- btwn dura mater and arachnoid
- usually change in LOC
- Slow developing (within 24hrs)
38
Describe an intracerebral hematoma (contusion to the brain)
Arterial bleed: fast developing
Venous bleed: slow developing
- Bleeding within brain tissue (intraparenchymal hemorrage)
39
What is the MOI of an intracerebral hematoma?
- skull fracture, other hematoma
- high BP, bleeding disorders, thinning blood meds
40
What is intracranial pressure (ICP)
Pressure exerted by the brain tissue, intracranial blood, and CSF
41
What is the normal ICP
0-15mmHg
42
What are the S/S of ICP
- Dec. LOC
- Inc. pressure feeling on skull
- inc. BP (systolic)
- Dec. HR (via vagus n. and PNS)
- motor dysfunctions
- impaired reflexes
- pupillary abnormalities (PERRLA)
- irregular respirations (Cheyne-Stokes)
43
What is Chyne-stokes ventilation pattern
Slow shall breaths, then deeper more rapid, then return to slow
- periods of apnea
44
The symptoms for ICP are the opposite of the symptoms for
shock
45
What are the pupillary signs of early increasing ICP
- sluggish to light response
- unilateral
- ipsilateral (same side) to lesion
- papilledema or bulging of optic discs
- blurred vision
46
What follows and inc. in ICP
- cerebral perfusion pressure dec.
- leads to cerebral ischemia and hypoxia
47
What are the abnormal postures in late signs of increasing ICP
Decorticate posturing: abnormal flexion
Decerebrate posturing: abnormal extension
48
How do you decrease pressure on the brain?
Burr hole
