Head & facial Trauma

Question 0

What is emesis?

Answer 0

Vomiting

Question 1

Describe management principals of maxillofacial injuries

Answer 1

Spinal precautions
Keep airway clear (teeth, vomit, blood)
Consider airway adjuncts
Control bleeding

Question 2

What is a medication for epistaxis?

Answer 2

Cophenylcaine

Question 3

Name 5 ear injuries

Answer 3

Lacerations and contusions
Thermal injury
Chemical injury
Traumatic perforations 
Barotitis (injury from pressurisation)

Question 4

Name 4 eye injuries

Answer 4

Foreign bodies
Blunt eye injuries
Penetrating eye injuries
Chemical injuries

Question 5

What medication used for eye injuries (and spinal)?

Answer 5

Ondansatron

Question 6

Name 5 types of anterior neck injury

Answer 6

Haematoma or oedema
Lacerations & punctures
Vascular injury
Laryngeal/tracheal injury
Oesophageal injury

Question 7

2 types of TBI

Answer 7

Primary injury: occurs at time of impact. Irreversible

Secondary injury: occurs minutes or days after primary injury and worsens outcome. A result of hypoxia, seizure or oedema.

Question 8

Name 4 types of skull fracture

Answer 8

Open
Linear
Depressed
Basilar

Question 9

Describe mild diffuse brain injury

Answer 9

Transient alteration in neurological function.
No abnormality in CT scan
May have: headache, retrograde or anterograde amnesia, confusion, dizziness, nausea and vomiting.
Resolves spontaneously without defect.

Question 10

Describe Axonal Injury

Answer 10

Shearing and stretching of nerve fibres leading to diffuse brain injury.
Occurs with acceleration deceleration MOI

Question 11

Describe Focal Injury

Answer 11

Specific, grossly observable brain lesions
Bleeding, contusions, oedema, haemorrhage
Bleeding often resulting from skull fracture

Question 12

Name 4 types of intracranial haematomas

Answer 12

Epidural
Subdural
Subarachnoid
Intra cerebral

Question 13

What is the Monro-Kellie Doctrine?

Answer 13

The total intracranial volume is fixed because of the inelastic nature of the skull.
Volume is filled by the brain, blood and CSF, if injury occurs and occupies space some other structure needs to be forced out.
Volume of blood and CSF is reduced, if this isn’t sufficient the brain will be forced out of the foramen magnum.

Question 14

Describe Focal Injury- Contusions

Answer 14

Bruising of the brain tissue at level of cortex or deeper within lobes.
Greater neurological deficits and abnormalities.

Question 15

Describe Epidural Haematoma

Answer 15

It is a rare focal injury.
Arterial bleeding between cranium and dura.
Signs: raised ICP, headache, lethargy.

Question 16

Describe Subdural Haematoma

Answer 16

A Focal injury resulting from blunt trauma.
Generally venous bleed so slower progression than epidural bleed.
Signs: headache, lethargy, nausea, vomiting, posturing and paralysis.

Question 17

Describe Subarachnoid Haemorrhage

Answer 17

It is a Focal head injury with bleeding into subarachnoid space.
Common finding in TBI patients.
Results from tearing of small pia vessels.
Signs: sudden severe headache, photophobia (light hurts head) vomit

Question 18

Describe Intracerebral Haematoma

Answer 18

Bleeding anywhere within brain.

Can be caused by either blunt or penetrating trauma.

Question 19

What is the Cushing’s Triad?

Answer 19

Increased BP
Irregular breathing
Decreased HR
It is a physiological nervous system response to ICP.

Question 20

What is Cheyne-Stokes breathing?

Answer 20

Unusual pattern of breathing.

Characterised by deeper faster breathing, followed by gradual decrease, resulting in apnoea.

Question 21

Name 3 types of ICP

Answer 21

Mild elevation
Moderate elevation
Marked elevation

Question 22

Signs of mild elevation ICP

Answer 22

Increased BP
Normal pupils
Cheyne-Stoke respirations
Patient attempts to localise and remove from painful stimuli

Question 23

Signs of Moderate Elevated ICP

Answer 23

Widened pulse pressure and bradycardia
Pupils sluggish or non reactive
Central neurogenic hyperventilation
Decerebrate posturing

Question 24

Signs of Marked elevation ICP

Answer 24

Fixed and dilated pupils Ataxic or absent respirations Flaccid paralysis Irregular pulse rate

Question 25

What is the Cerebral Perfusion Pressure (CPP) formula?

Answer 25

CPP= MAP-ICP When one goes up the other goes up also

Question 26

What is management for TBI

Answer 26

Aim to prevent secondary injury All patients have c-spine injury until proven otherwise Ondansatron must be administered LOC most important assessment Continual reassessment compared with initial examination vital

Question 27

What is the key head injury management rule?

Answer 27

90- maintain BP >90 90- maintain O2 >90% 30- consider head elevation of 30% 4- maintain BSL >4mmol

Question 28

What drug is used for sedation of combative head injury patients?

Answer 28

Midazolam