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head trauma Flashcards

(66 cards)

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1
Q

what is the primary injury in head trauma?

A

what occurs at the scene, damage is irreversible, may be focal or diffuse, and treat the consequences

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2
Q

What are the secondary injuries in head trauma?

A

occur any time after primary event; potentially prevetable, inflammation, reperfusion, superoxide production, necrosis, apoptosis

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3
Q

Greatest negative affect in head injuries?

A

decreased oxygen

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4
Q

30% of patients are hypoxic on admission for head injuries d/t what 2 causes?

A

central resp depression, chest injuries

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5
Q

What 2 things do you consider first in head injuries?

A

hypoxia and shock

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6
Q

What should you do first in a head injury pt before sedation and paralytics?

A

baseline neuro exam

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7
Q

Signs of compression of oculomotor nerve?

A

dilation and sluggish response

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8
Q

Indication of uncal herniation?

A

maximally dilated and blown pupil

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9
Q

6 positive findings on CT scan?

A

midline shift, distortion of ventricle and cisterns, effacement of sulci in uninjured hemisphere, presence of hematoma in any location of cranial vault, fractures, intracranial air

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10
Q

Severe head injury requires immediate?

A

intubation using c spine stabilization and techniques that avoid increasing ICP

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11
Q

Most frequent type of head injury?

A

scalp laceration

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12
Q

Extensive scalp lacerations can result in?

A

significant blood loss and air embolism

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13
Q

Head injury that results from a violent shock or jarring?

A

concussion

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14
Q

5 sx associated w concussion?

A

transient amnesia, vertigo, nausea, weak pulse, slow respiration

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15
Q

3 types of skull fractures?

A

open, depressed, basilar

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16
Q

Open fractures include those….?

A

with deep scalp lacerations and fractures extending in to the sinuses

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17
Q

What does an open skull fracture require w/in 24 hours?

A

debridement

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18
Q

Linear fractures that occur on the floor of the cranial vault are?

A

basilar skull fractures

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19
Q

This type of skull fracture requires more force to cause than other fractures?

A

basilar

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20
Q

4 signs of basilar skull fracture?

A

blood in sinuses, CSF leak from nose/ears, racoons eyes (periorbital ecchymosis), battle’s sign (retroaricular ecchymosis or bruising over the mastoid process)

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21
Q

Highest mortality rate and most common of all cranial lesions?

A

subdural hematoma

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22
Q

Where is subdural hematoma located?

A

between brain and dura

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23
Q

Subdural hematoma usually caused by?

A

accel decel

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24
Q

Shape of subdural hematoma?

A

crescent

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25
Treatment of subdural hematoma?
immediate surgical decompression
26
What shape and where is an epidural hematoma?
biconvex and located between dura and skull
27
Usual cause of epidural hematoma?
torn middle meningeal injury
28
5 sx of epidural hematoma?
HA, vomiting, seizure, HTN, difficulty breathing
29
What is characteristic of epidural hematomas?
have brief LOC followed by periods of lucidness. often walk and die though
30
Treatment for small epidural hematoma w no pressure on brain?
observation
31
Deterioration of neuro status is sx of this?
cerebral hematoma
32
Cerebral hematoma presence on CT often delayed for how long?
24-48 hours
33
3 determinants of cerebral hematoma pt outcome?
cerebral hypoxia, GCS, hematoma volume
34
Caused by sudden decel or rotational forces that most often occur at gray white matter junction?
diffuse axonal injury
35
Best diagnostic tests for diffuse axonal injury?
MRI
36
DAI causes downstream deafferentation and disconnection in the brain stem which leads to?
coma
37
Sx of DAI?
immediate loss of conscious, most have no period of lucidity
38
Most frequent cause of persistent vegetative state following trauma?
DAI
39
CPP is?
difference between MAP and ICP or CPV, whichever is highest
40
normal upper limit of ICP?
10-15
41
ICP monitoring is recommended in?
all pts with GCS
42
6 sx of increased ICP?
HA, vomiting, papilledema, drowsiness, LOC, behavioral changes
43
Cushing's reflex?
HTN, bradycardia, irregular respirations
44
Cushing's reflex is probably due to?
medullary ischemia
45
Methods to decrease ICP via CSF?
mannitol, drain, hypertonic solution
46
Methods to decrease ICP via brain?
mannitol, hypertonic sltn, lasix, decompressive craniectomy, resection of contusion or other mass lesion, blood volume
47
Methods for controlling ICP via blood volume?
mannitol, hyperventilation, hypothermia, head elevation, neutral neck position, deep prop or barb sedation/paralysis, control of seizures
48
Brain receives what % of CO?
15
49
CBF remains constant d/t adjustment of?
cerebral vascular resistance
50
3 things that abolish autoregulation?
trauma, certain anesthetics, hypoxia
51
is CO2 a dilator or constrictor?
dilator
52
Doubling PaCO2 does what to blood flow?
doubles
53
Why is BP exceeding that of autoregulation bad?
can cause disruption of BBB and lead to cerebral edema
54
4 components of resuscitation of head trauma pts?
hyperventilation, secure the airway, diuretics, intravascular volume expansion
55
etomidate dose for head trauma?
0.2-0.3 mg/kg
56
lido dose for head trauma
1.5 mg/kg
57
What gas do you avoid in head trauma pts?
nitrous
58
Goal for CPP and MAP in head trauma pts?
60-70; 70-80
59
how does hypervent reduce ICP?
vasoconstriction reducing blood flow
60
Brain is rich in what coagulant?
tissue thromboplastin
61
FFP indicated when INR exceeds what level?
1.4
62
When should platelets be given to a head trauma pt?
plts
63
Preferred fluid in head traumas?
hypertonic or isotonic crystalloid
64
Neurosurgical patients should be hyperventilated until?
dura is open
65
What do you want the MAP to be in a neurosurgical pt?
at least 80
66
Why should you avoid nitrous in head pts?
increases CMRO2, ICP, and CBF

6903 (12 decks)

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