Flashcards in Head Trauma Deck (42):
what is the only opening in the skull
foramen magnum(floating surrounded by csf)
What is the anatomy of the head
1)scalp 2)skull 3)dura mater 4)archanoid 5)subarchanoid space 6) pia mater 7)brain
What do the ventricles produce and how much
CSF and 1 ml every 3 mins
what is coup contracoup
"4 collision concept" car strikes tree, head strikes the windshield, brain strikes inside skull, brain rebounds and hits inside of occipital skull
when does the max swelling in the brain occur
what does DECEREBRATE mean
Abnormal Extension outwards
What does DECORTICATE mean
Abnormal Flexion inwards
when should we CT scan
GCS <13, Suspect basal skull fracture, head of c-spine injury suspected
what are signs of basal skull fracture
Racoon eyes and battle sign(bruising behind the ear)
what is a cerebral contusion
brusing/swelling of brain tissue, swelling can be rapid and severe, may present as CVA
what is a diffuse axonal injury
most common with severe blunt trauma, diffuse injury, generalized edema, subarchanoid bleeding, seizure activity, coma/vommiting, may develop into herniation syndrome
what is Anoxic brain injury
injury related to o2, poor outcome
where can an intracranial hemorrhage occur
1)skull and dura 2) dura and arcahnoid 3) directly into the brain tissue
What is an epidural hematoma?
bleeding within the epidural space between the bone and dura mater
what is the bleeding often caused by?
by a tear in the middle meniginal artery that runs along inside the skull in temporal/parietal region
what is a subdural hematoma?
bleeding between dura mater and archanoid mater(subdural space)
what is the bleeding
what is this common in
what is a subarchanoid hemorrhage
subarachnoid space between arachnoid mater and pia mater, usually a result of aneurismal rupture or bleeding rom arteriovenous malformation
common in what kind of people
cocaine abusers/ bleeding disorders
what is intracerebral hemorrhage
bleeding within the brain tissue;cerebrum/white matter;may result from blunt/penetrating trauma
What is the Tx?
supportive therapy and possible surgical intervention
what is herniation syndrome"coning"
caused by increase in pressure in cranial vault
what are symptoms of it?
increase in ICP, dilation of pupils, coma, cushings reflex
what is cushings triad?
hypertension, bradycardia, irregular respirations
what happens in herniation syndrome?
bruising/swelling towards the spinal cord and trying to push brain down on brainstem compressing it.
what does the brainstem control
breathing, HR and temp
what is the TX
The only time HYPERVENTILATION is indicated, want co2 in the 25-30 or 30-35 range
other txs are?
mannitol, ICP drain, phenobarbital(last resort) will cause an induced coma
what is ICP
insertion of a catherter into the lateral ventricle , used for measurement and drainage of CSF
what is the usual number for CSF
what is the formula for CPP?
What happens if ICP goes up
then BP must go up as well to maintain CPP
when should we ICP?
when GCS is <8 after resuscitation, when CT scan is abnormal(hematoma, contusion, edema)
When do we ICP if CT normal
age >40, systolic bp <90, decerebrate or decoritcate
what is the normal CPP in adults
70-90mmhg, minimum should be >50mmhg for adequate perfusion
what Bp is preffered to keep CPP
if there is an decrease in CO2 in the brain what occurs
what will happen if paco2 is low causing vasoconstriction
will decrease ICP
where do we want to keep co2 levels
where do we wanna keep peep and aw press
low side for both