head injury Flashcards Preview

MD4001 Pathology > head injury > Flashcards

Flashcards in head injury Deck (34):
1

what is a primary brain injury

occurs at the moment of impact
target prevention, not treatable

2

what is secondary brain injury

effects of trauma on the brain that occur later, e.g. lack of cerebral perfusion, blood glucose, CO2, temp
secondary processes which occur at the cells and molecular level to exacerbate neurological damage

3

what processes can cause secondary brain injury

glutamate release
free radical generation
calcium mediated damage
inflammatory response
mitochondrial dysfunction
early gene activation
oedema
opening of BBB
increased interstitial fluid pressure
neuronal death cascades

4

describe a graph of intracranial volume against intracranial pressure

as intercranial pressure rises pressure slowly increases too until the critical volume where pressure rises exponentially

5

how do you manage head injury

assessment of pt
investigations -CT head

6

who should be sent to hospital

extremes of age
amnesia
LoC
high energy injury
vomiting
seizure
bleeding/clotting disorder

7

describe the eye component of GCS

1 eyes do not open
2 open to pain
3 open to speech
4 open spontaneously

8

what is the verbal component of GCS

1 no response
2 incomprehensible sounds
3 innapropriate words
4 confused
5 oriented

9

what is the motor component of GCS

1 no response
2 extension to pain
3 abnormal flexion to pain
4 normal flexion to pain
5 localizes pain
6 obeys command

10

what GCS constitutes a mild head injury

13-15

11

what GCS constitutes a moderate head injury

9-12

12

what GCS constitutes a severe head injury

8 or less

13

when should you request a ct head

GCS is less than 13 on initial assessment

gcs is less than 15 2 hours after injury

suspected open or depressed skull

basal skull fracture

vomiting

amnesia for events more than 30 mins before impact

14

what are red flags`

LoC
painful headache
vomiting
visual disturbance
clear fluid from ear or nose
bleeding from ears
deafness
difficulty understanding
loss of balance
weakness
difficulty walking

15

how do you treat convulsions in head injury

phenytoin

treat pyrexia

16

what PaCO2 is ideal

4.5-5 kPa

17

what is CPP

cerebral perfusion pressure

18

what is MAP

mean arterial pressure

diastolic pressure + 1/3 pulse pressure

19

what is ICP

intra cranial pressure

20

how do you calculate CPP

MAP - ICP

21

what is cerebral autoregulation

maintains constant blood flow to brain between various MAP

this may be compromised in trauma/ ischaemia

22

what parameters should be maintained after head injury

CPP above 60-70mmHg

systolic should be above 90mmHg

ICP less than 20 mmHg

23

what should you do if the patient is hypotensive

not due to head injury

could be chest trauma
pelvic fracture

stop bleeding and give fluids

24

what features suggest a risk of intracranial mass

high impact injury
retrograde amnesia
coagulopathy
seizure

gcs <12
signs of skull fracture

25

what does periorbital bruising suggest

anterior cranial fossa fracure

26

what does Battle's sign suggest (bruising behind the ear

petrous temporal bone fracture

27

what is an extradural haematoma associated with

skull fracture

middle meningeal artery or venous bleeding

good outcome if treated

28

subdural haematoma

complicates 25% of head injuries

rupture of veins travelling from the brain to the saggital sinus

worse prognosis

29

subarachnoid haemorrhage

ruptured aneurysm or head injury

30

intracerebral head injury

contre coup injury
impact on side of skull

31

what should you say when you contact the neurosurgeons

• Mechanism of injury
• Age of patient
• Respiratory and cardiovascular status
• GCS score & pupil response
• Alcohol/drugs
• Associated injuries
• Results of CT scan

32

what are the signs of herniation

dilated or unreactive pupils
extensory posturing (decerebrate injury)

decrease in gcs of 2 or more

33

what does mannitol do

decreases blood viscosity
osmotic duretic
decrease icp

34

what is the importance of glucose

tight control improves outcome
hypoglycaemia is dangerous

enteral nutritional support