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Surgery > Head injury, Thoracic, Abdominal Injuries > Flashcards

Head injury, Thoracic, Abdominal Injuries Flashcards

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1
Q

Head Injury

Layers of scalp

A
  • S- Skin
  • C- CT
  • A- Aponeurosis
  • L- Loose Areolar T
  • P- Periosteum
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2
Q

Head Injury

Cross section of the head

A

Skull
Dura
Arachnoid
Pia matter

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3
Q

Head Injury

Aneurysm

A

Abnormal dilatation of a Blood vessel

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4
Q

Head Injury

EDH damage site

A

Pterion ( temporal region) Middle meningeal A

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5
Q

Head Injury

Risk of mortality

A

0% if properly Mx

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6
Q

Head Injury

Acute SDH is due to

A

A severe head injury

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7
Q

Head Injury

Acute SDH is damage to

A

Rupture of bridging cortical veins

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8
Q

Head Injury

Acute SDH mortality

A

50%- 100% A KILLER!

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9
Q

Head Injury

Chronic SDH age group

A

> 50 yrs

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10
Q

Head Injury

Chronic SDH is associated with

A
  • Alcoholism
  • Coagulopathy
  • cerebral atrophy
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11
Q

Head Injury

Chronic SDH has a Hx of

A

trivial head injury 2/52 to 6/12 ago

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12
Q

Head Injury

Chronic SDH Sx

A
  • Confusion
  • Headache
  • Vomiting
  • hemiparesis
  • urine incontinence
  • Fluctuating level of consciousness
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13
Q

Head Injury

EDH is bleeding….

A

outside the meninges

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14
Q

Head Injury

SDH is bleeding to

A

underneath the dura

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15
Q

Head Injury

SAH is bleeding ….

A

underneath the sub arachnoid

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16
Q

Head Injury

SAH damage

A

Rupture of berry aneurysm

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17
Q

Head Injury

SAH is due to

A

severe trauma

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18
Q

Head Injury

SAH Sx

A
  • Thunder- clap headache
  • Vomiting
  • Nausea
  • Neck stiffness
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19
Q

Head Injury

SAH headache

A

Worst headache the patient has ever experienced

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20
Q

Head Injury

damages from Head injury is due to

A
  • Due to increased ICP
  • Basal skull fractures
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21
Q

Head Injury

Sx due to increased ICP

A
  • Reduced GCS
  • True lateralizing signs- Ipsilateral pupil dilatation, contralateral hemiparesis
  • Cushing’s triad- bradycardia, HTN, irregular breathing
  • Papilledema
  • False lateralizing signs- 6th Nerve palsy
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22
Q

Head Injury

Cushings triad is due to

A

Tonsillar herniation and compression of the medullary respiratory and vasomotor centres

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23
Q

Head Injury

First part of the brain to herniate

A

Uncus

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23
Q

Head Injury

Contralateral hemiparesis is due to

A

uncal herniation

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24
25
# Head Injury Irregular breathing is
cheyne- stokes breathing
26
# Head Injury cheyne- stokes breathing
Cycles of slowly diminishing respiration leading to apnea followed by increased respiration and hyperventilation
27
# Head Injury Ipsilateral pupil dilatation is due to
same side pupil dilatation is due to compression of the occulomotor nerve. remain dilated and will not constrict
28
# Head Injury 6th nerve palsy
Medial rectus overpowering the lateral rectus and the eye is convergent
29
# Head Injury What is the 6th Cranial nerve
Abducens nerve and it has the longest intracranial course in the brain easily compressed
30
# Head Injury R/ eye dilated and L/side paralysis which side is the bleeding
R/ side
30
# Head Injury Anterior cranial fossa # Sx
* Blood/ CSF from the nose * B/L periorbital hematoma ( Racoon eyes) * Subconjunctival hemorrhage
31
# Head Injury Middle cranial fossa # Sx
* CSF otorrhea * Tinnitus * Vestibulo- cochlear damage * Facial nerve palsy * Hemotympanum
32
# Head Injury Posterior cranial fossa # Sx
Battle's sign- bruising over the mastoid process
33
# Head Injury Battle's sign can be seen in
* Middle cranial fossa # * Posterior cranial fossa #
34
# Head Injury Subconjunctival hemorrhage
Posterior margin cannot be seen. Ask the patient to look at the nose. Cannot see the margin. If it's direct trauma to the eye you can see the margin
35
# Head Injury Key clinical feature in EDH
Lucid interval
36
# Head Injury Lucid interval
An interval during which the persion who was unconscious before **regains consciousness for a small period of time** and then again becomes unconsious.
37
# Head injury Monroe- Kellie doctrine
Increase in one component occurs with the compression of another compartment. Inside the skull being a rigid structure it contains Brain matter( 80%), Blood (10%), CSF (10%)
38
# Head injury Ix
* Xray skull * NCCT
39
# Head injury NCCT indications within the first hour
* GCS <13 at any stage since the injury * GCS <15 2 hours after the admission * Suspected open/ depressed skull fractures * Any sign of basal skull fractures * Post traumatic seizure, epilepsy * More than one episode of vomiting
40
# Head injury NCCT indications within 8 hours
* Post- traumatic amnesia >30 mins * Age >65 years * Dangerous mechanism of injury( RTA, fall from a height) * Coagulopathy
41
# Head injury NCCT findings of EDH
Hyperdense biconvex lesion
42
# Head injury NCCT findings of Acute SDH
Hyperdense crescenteric lesion
43
# Head injury NCCT findings of chronic SDH
Hypodense crescent
44
# Head injury NCCT findings of SAH
Hyperdensity in sulci and citernae
45
# Head injury NCCT what else to look for beside the lesion
* Interventricular extension of hemorrhage * cerebral edema * midline shift
46
# Head injury fresh blood on a NCCT will be shown as
white- hyperdensity
47
# Head injury Old blood on an NCCT will be seen as
black - hypodense
48
# Head injury Mx after ATLS
**TO PREVENT SECONADRY BRAIN INJURY** * Reduce ICP * Correct electrolyte imbalances * Avoid fluid overload * Surgery
49
# Head injury How to reduce ICP
* Prop up by 15 degrees * Raise the head end of the bed and loosen any tight clothing around the neck * Hypertonic saline - 5mL/kg * Controlled hyperventilation
50
# Head injury Hypertonic saline why
less water in saline so water comes from the cells to saline from osmosis.
51
# Head injury Controlled hyperventilation
Leads to reduced CO2. Cerebral vasoconstriction due to reduced CO2
52
# Head injury Correcting electrolyte imbalances
* Hyperthermia * Hypoglycemia * Electrolyte imbalances - hyponatremia
53
# Head injury Surgery
* EDH- immediate craniotomy and evac * Acute SDH- immediate craniotomy/ craniectormy and evac * Traumatic SAH- conservative Mx
54
# Head injury Types of primary brain injury
* Concussion * Laceration * Contusion * Hemorrhage * Diffuse axonal injury
55
# Head injury Secondary brain injury
* Cerebral edema * Brain shift
56
# Thoracic injury Pneumothorax Sx
* Reduced chest expansion * Reduced breath sounds * Increased resonance * Dilated neck veins * Tracheal deviation to opposite side * Tachypnea, dyspnea * Tachycardia * Cyanosis * USe accessory muscles * Hypotension
57
# Thoracic injury Hemothorax Sx
* Reduced chest expansion * Reduced breath sounds * Dull on percussion * Tracheal deviation to the opposite side * Tachypnea, dyspnea * Tachycardia * Hypotension
58
# Thoracic injury Cardiac tamponade Sx
* Becks triad * Kussmaul's sign * Tachycardia * Cyanosis
59
# Cardiac tamponade Beck's triad
* Muffled heart sounds * Engorged neck veins * Hypotension
60
# Cardiac tamponade Kussmaul's sign
Elevated JVP during inspiration
61
# Thoracic injury Rib Fracture and flail chest Sx
* Pain on cough and deep breathing * Impaired ventilation- atelectasis- pneumonia
62
# Tension Pneumothorax pathophys
Collection of air in the pleural space through a one- way- valve
63
# Tension Pneumothorax Causes
* Blunt- tear of lung tissue, bronchi * Penetrating trauma
64
# Hemothorax Pathophys
Blood collected in the pleural space. Damage to intercostal vessels
65
# Hemothorax Sx of arterial Sx and Venous Sx
* Venous- self limiting * Arterial- Massive bleeding, may need surgery
66
# Hemothorax Arterial bleeds are from
Internal mammary arteries
67
# Cardiac tamponade Causes
Penetrating trauma mostly
68
# Cardiac tamponade Pathophys
Presence of fluid under tension in pericardial cavity. Reduced venous return and reduced CO
69
# Cardiac tamponade Is a cardiothoracic emergency. (T/F?)
True
70
# Thoracic injury Rib # Sx
* Lacerate lung parenchyma * Lacerate IC vessels- hemothorax * 10-12 ribs- splenic/ hepatic injury
71
# Thoracic injury Flail chest Sx
* At least 3 or more ribs fractured in two or more places as a segment * Paradoxical movement: The flail segment moves in during inspiration** (LATE SIGN)** * +/- Underlying lung contusion * High risk of haemothorax and pneumothorax

Surgery (2 decks)

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