Head Trauma

Question 1

frontal lobe

Answer 1

goal-oriented motor, cognitive functions, emotions

Question 2

occipital lobe

Answer 2

visual perception

Question 3

parietal lobe

Answer 3

touch, pain, limb position, size/shape, perception

Question 4

temporal lobe

Answer 4

perceive/localize sound, visual form/color, emotions

Question 5

what is the left and right hemisphere separated by

Answer 5

falx cerebri (part of dura)

Question 6

component of brainstem

Answer 6

midbrain
pons
medulla

Question 7

reticular activation system

Answer 7

midbrain and upper pons

state of alertness

Question 8

dura mater 2 layers

Answer 8

periosteal (attached to inner skull)

meningeal- forms falx cerebri

Question 9

what is the dura mater

Answer 9

Dense connective tissue tough, thick

**Vascular (dural sinuses)

Question 10

is the arachnoid mater vascular

Answer 10

no

Question 11

what is arachnoid mater

Answer 11

Nonvascular connective tissue THIN, FILAMENTOUS

Adjoins but does not adhere to the dura mater forming a potential space (subdural space → subdural hematoma)

Question 12

pia mater

Answer 12

Very thin, delicate

Adheres to surface of the brain and spinal cord and invaginates along cortical surface.

Question 13

Space between arachnoid mater and pia mater and what does it contain

Answer 13

subarachnoid space

– contains CSF and veins/arteries

Question 14

T/F- Patients can bleed out and die from scalp lacs if not managed appropriately

Answer 14

TRUE

Question 15

what is intracranial pressure (ICP)

Answer 15

The pressure exerted by fluids (like CSF) inside the skull on brain tissue

Question 16

ranges of ICP in mmHg that are:
normal
above
severe

Answer 16

10 mm Hg = Normal
>20 mm Hg = Abnormal
>40 mm Hg = Severe

Question 17

in compensated and decompensated states of a brain bleed, what are the two things to be decreased

Answer 17

CSF

venous volume

Question 18

what type of ICP device can monitor ICP and drain CSF

Answer 18

intraventricular

Question 19

what does CCP stand for and how do we measure it (equation)

Answer 19

Cerebral Perfusion Pressure

CPP= MAP-ICP

Question 20

what is CPP

Answer 20

CPP is net pressure gradient that drives oxygen delivery to brain tissue, but NOT actually CEREBRAL BLOOD FLOW

Question 21

normal range of CCP

Answer 21

60 to 70 mmHG

Question 22

what does low CCP mean

Answer 22

brain is not being profused properly

Question 23

5 Hs of secondary brain injury

Answer 23

Hypotension
Hypoxia
Hypoglycemia
Hyperthermia
Hypocapnia

Question 24

what should you do in the primary survey of head trauma

Answer 24

ABCDEs

immobilize the C spine

Question 25

A

Answer 25

Airway “less than 8 intubate” 8 and below LOL (Referring to GCS-glascow coma scale) Loss of gag/inability to clear secretions *Get GCS before intubating

Question 26

B

Answer 26

Breathing - avoid hypoxia - CO2 range = 35-42mmHg

Question 27

C

Answer 27

Circulation - hypotension - Normal Saline is the crystalloid of choice in - Cushings Reflex: hypertesion, bradycardia, irregular respirations

Question 28

what should the SBP NEVER be less than

Answer 28

90mmHg

Question 29

T/F-INTRACRANIAL HEAD BLEEDS DO NOT CAUSE HYPOTENSION

Answer 29

TRUE!

Question 30

what is cushings reflex

Answer 30

hypertesion, bradycardia, irregular respirations | increased ICP

Question 31

D

Answer 31

Disability GCS Document initial exam before meds Pupillary Response Rule out other causes!

Question 32

3 categories of GCS

Answer 32

eye opening response best verbal response best motor response

Question 33

GCS comatose pt

Answer 33

8 or less

Question 34

GCS-eye opening response

Answer 34

spontaneously- 4 to speech- 3 to pain- 2 none-1

Question 35

BCS- best verbal response

Answer 35

``` oriented to time place and person-5 confused-4 inappropriate words-3 incomprehensible words-2 unresponsive - 1 ```

Question 36

GCS- best motor repsonse

Answer 36

``` obeys commands moves to localized pain-5 flexion withdrawal from pain-4 abnormal flexion (decorticate)-3 abnormal extension (decerebrate)-2 no response-1 ```

Question 37

E

Answer 37

Exposure completely undress rewarm for hypothermia

Question 38

most important part of secondary survey

Answer 38

anticoagulants

Question 39

components of secondary survey

Answer 39

``` Head to Toe Physical Exam ONLY AFTER Primary Survey is STABLE HPI PMHX Allergies Medications Anticoagulants Past Surgical Hx Family Hx Social Hx ```

Question 40

most important labs

Answer 40

coags

Question 41

radiology: head CT and cervical spine CT are both done withOUT....

Answer 41

CONTRAST

Question 42

Mild Brain injury GCS

Answer 42

13-15 & a mechanism | aka a concussion

Question 43

symptoms/sign of mild brain injury

Answer 43

Symptoms: confusion, amnesia, +/- loss of consciousness, HA, dizziness, vertigo, imbalance, nausea, vomiting, mood and cognitive disturbances, sensitivity to light/noise, sleep disturbances Signs: stumbling, inability to walk in a straight line, vacant stare, delayed verbal expression, inability to focus attention, disorientation, slurred speech, emotionality, memory deficits

Question 44

for mild TBI, what criteria must be met for outpt observation

Answer 44

``` GCS 15 NO ANTICOAGULANTS NO Seizure Caregiver at home Head CT negative (if indicated) ```

Question 45

when for mild TBI is there an admission

Answer 45

``` If GCS <15 or + ANTICOAGULANTS or + Seizure or - Caregiver at home or + Head CT ```

Question 46

moderate TBI, GCS and s/sxs

Answer 46

GCS 9-12 Symptoms: may have similar complaints to Mild TBI/Concussion if able to communicate? Signs: decreased GCS (ex: withdrawing to pain, confused, opens eyes to pain), pupillary reaction/dilation altered

Question 47

Severe TBI GCS and s/sxs

Answer 47

GCS 3-8 Symptoms: …they probably won’t be able to tell you complaints Signs: …decreased GCS (ex: no motor response, incomprehensible sounds, opens eyes to pain), pupillary asymmetry, unilateral or bilateral fixed and dilated pupils bradycardia, irregular respirations, hypertension, posturing)

Question 48

epidural hematoma Collection between dura and skull

Answer 48

``` Collection between dura and skull 80% Skull Fx *Arterial Bleeding *Middle meningeal arteries Lenticular/Biconvex shape Space Occupying lesion Herniation likely if untreated ```

Question 49

s/sxs of epidural hematoma most imp

Answer 49

Initial, brief LOC—lucid interval—rapid neuro deterioration Fixed dilated pupil on the unilateral side as herniation

Question 50

subdermal hematoma

Answer 50

- 30% of TBIs - shearing force of VENOUS bridging veins between DURA and ARACHNOID - CONCAVE hematoma - space occupying lesion

Question 51

most imp to know about s/sxs of subdermal hematoma

Answer 51

Many be relatively asymptomatic-nonfocal!

Question 52

acute vs chronic subdural hematoma color

Answer 52

Acute subdural = white | Chronic subdural = black

Question 53

Traumatic Subarachnoid Hemorrhage (TSAH)

Answer 53

Venous bleeding in subarachnoid space (between the arachnoid and pia mater) Usually associated with other hemorrhage *Non space occupying May increase ICP—blocks outflow of CSF from 3-4th ventricle ***If isolated SAH– Consider Aneurysmal Cause Signs and Symptoms: HA, signs and symptoms associated with other types of bleeds as discussed

Question 54

cerebral contusions

Answer 54

- “Bruise of the brain tissue” - Occurs primarily in the cortical tissue when the brain collides with bony protuberances on the inside surface of the skull - Frontal/Temporal lobes most common - Contusions are frequently associated with edema which can cause elevated ICP

Question 55

MC type of skull fx

Answer 55

Linear Skull Fractures

Question 56

MC location of linear skull fxs

Answer 56

temporoparietal, frontal, occipital

Question 57

when are linear skull fxs sig imp

Answer 57

They cross the middle meningeal groove in the TEMPORAL BONE or major venous dural sinus