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Flashcards in Head Trauma Deck (16):
1

How do you calculate the CPP and what are your targets?

CPP= MAP - ICP
map target 80
ICP target <15
Ideal CPP > 60

2

3 components of Cushing reflex

Hypertension bradycardia and irregular respirations

3

Describes decorticate posturing and the level of injury it implies

Flexion upper extremities, extension lower extremities
Injury to corticospinal tract above brainstem

4

Describe decerebrate posturing and what injury it implies

Extension arms and legs with flexion hands feet toes
Injury to brainstem

5

2 maneuvers to test brainstem function

Oculocephalic and oculovestibular

6

Clinical findings of uncal herniation syndrome

Non reactive dilated ipsilateral pupil
Pupil down and out
Contralateral hemiparesis

7

8 management steps in elevated ICP patient

Intubate with RSI
elevate head of bed to 30 degrees
Avoid hypotension (SBP>90)
Hyperosmotic agents (mannitol 1g/kg or hypertonic saline 150 cc)
Relative hyperventilation 35-40 CO2 target as temporizing measure
Reverse anticoagulation
Seizure prophylaxis (careful in tox trauma)
Antibiotics for penetrating injuries

8

Epidural hematoma:
CT findings
anatomical location of space
culprit vessel
Management

Biconvex lens shape, does not cross suture lines
Potential space between skull and dura
Temporal skull fracture and middle meninges artery tear
Surgical emergency needs drainage stat
Less common in elderly

9

Subdural hematoma:
CT findings
Anatomical location
Culprit vessels
Management

Crescent shaped, crosses suture lines
Between dura and arachnoid mater
Bridging veins
Management depends on acuity and extent
Consider in alcoholics and elderly (more space for shearing of bridging veins)

10

Subarachnoid hemorrhage:
CT findings
Anatomical location
Culprit vessels
Management

Blood in ventricles, basilar cistern, hemispheric sulci and fissures
Subarachnoid space
Subarachnoid vessels
Neurosurgical consult for ?surgical management. Nimodipine is for spontaneous aneurysm rupture not traumatic SAH

11

5 bones of skull base

Frontal
Occipital
Temporal
Ethmoid (cribiform plate)
Sphenoid

12

6 signs and 2 symptoms basal skull fracture

Vertigo
Hearing loss
Hemotympanum
Battle sign
Raccoon eyes
Csf leak -- otorrhea
Csf leak -- rhinorrhea

13

Imaging study of choice, management for most, complication of basal skull fracture

Ct head, most conservative management, meningitis (role for prophylactic antibiotics controversial)

14

3 descriptors of skull fractures

Comminuted, linear, depressed

15

When is operative repair indicated in skull fractures

More than one full thickness of skull-- risk of brain compression

16

Types of skull fractures suggesting child abuse

Crossing suture lines
Multiple eggshell fractures
Occipital impression fractures