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EMRG 1230 - Neuro > Neurological Disorders - Trauma > Flashcards

Neurological Disorders - Trauma Flashcards

1
Q

What defines a Primary head Injury

A

An injury that occurs as a result of initial direct Injuries, and direct force applied to the head. Includes tissue and vascular damage

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2
Q

What is a secondary Head injury

A

Occurs as a result of hypoxia, decreased perfusion, cerebral edema, infection and hemorrhage

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3
Q

What is the initial response to brain bruising

A

Vasodilation and increased blood flow to the area of injury. Increased intra cerebral pressure surrounding the site, then decreases blood flow.

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4
Q

How does a normally functioning brain adjust to the O2 and CO2 concentrations

A

Changes in the concentration of O2 and CO2 in blood and CSF activate chemoreceptors. Impulses are sent to the respiratory center to increase or decrease respiratory rate

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5
Q

What is Intracranial Pressure?

A

The pressure inside the cranium as a result of brain tissues, blood and CSF

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6
Q

What is the normal intracranial pressure

A

5-15mm hg, 15 is upper limit of normal

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7
Q

What is the cerebral Perfusion Pressure?

A

The pressure needed to maintain blood flow to the brain

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8
Q

What is the normal cerebral perfusion pressure level. What happens if it lowers too much?

A

70-80 mmHg, if it drops below 60mmHg, the chances of death are doubled

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9
Q

What does MAP stand for, and what is the normal range

A

Mean arterial pressure, 70-100mmHg. less than 60 is deadly for main organs

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10
Q

What does CPP= MAP- ICP mean?

A

Cerebral perfusion pressure is equal to mean arterial pressure subtract intracranial pressure

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11
Q

What happens when ICP=MAP

A

blood flow stops

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12
Q

What are the early signs of ICP

A

CSF is shifted to spinal cavity and decreased cerebral blood flow (effective short term then hypoxic)

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13
Q

What are the early physical S/S of ICP

A

Severe headache, Vomiting (projectile), Papilledema (swelling of optic disc and ICP), seizures. S/S increase in severity

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14
Q

What is Crushing’s reflex

A

A neurological response to increased ICP. bradycardia, increased systolic pressure, irregular respirations. Goal is to increase blood supply to the brain

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15
Q

How is ischemia relieved in the brain

A

Systemic vasoconstriction (^ BP), baroreceptors in carotid arteries respond by slowing the HR. chemoreceptors respond to low co2 by slowing respirations. Improved circulation relieves ischemia by lowering ICP - as ICP increases again system repeats.

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16
Q

What happens when Crushing’s response can not keep up?

A

As ICP continues to rise, the mechanism can not keep up. If the pressure rises to a critical point where perfusion is impossible, deterioration and death occurs

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17
Q

What happens if severe ischemia and elevated ICP is not fixed

A

severe ischemia and neuronal death prevent circulatory control and BP drops, Resp control is destroyed= irregularity, death is inevitable.

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18
Q

What is cerebral herniation syndrome?

A

Brain swelling forces tissues downward through the foramen magnum (space in skull connecting to spinal cord). Places pressure on the brain stem

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19
Q

Signs and Symptoms of cerebral herniation syndrome

A

decreased LOC, coma, dilated pupil on same side, paralysis on opposite side, decerebrate posturing, hypertension, bradycardia

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20
Q

What is the treatment for Cerebral herniation syndrome

A

hyperventilation, one breath every 3 seconds

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21
Q

Why do scalp injuries appear worse than they are? How are they treated

A

The tissue is vascular, and bleeds significantly. Treated with direct pressure (if no skull injuries)

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22
Q

What should you do in respect to skull injuries

A

Suspect injury with large contusion, leave protruding objects in place, transport immediately.

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23
Q

What are 6 types of brain Injuries (CCCCAD)

A

Concussion, cerebral contusion, closed head injuries, contrecoup, anoxic brain, diffuse axonal injury

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24
Q

What is a Contrecoup Injury?

A

A brain injury where the brain is injured on the opposite side of point of trauma

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25
Q

What history and S/S are associated with a Concussion

A

Mild blows to the head causing excessive brain movement. Reversible, but brief disruption of neural function (Loc, confusion, amnesia). S/S; headache, dizziness, tinnitus, nausea.

26
Q

What is a cerebral Contusion

A

bruised brain tissue with ruptured small blood vessels. Swelling may be rapid and severe

27
Q

Signs and symptoms of Cerebral Contusion

A

Prolonged unconsciousness, altered LOC, personality changes, profound confusion, persistent amnesia, abnormal behavior, focal neurological signs

28
Q

What is a basilar fracture and what is a distinctive sign

A

Fracture at the base of the skull, often accompanied with CSF leaking through ears and nose. Dark discoloration around eyes and behind ears

29
Q

What is a depressed skull fracture

A

Displacement of a piece of bone below the level of the skull, compressing brain tissue. Impaired blood supply, high ICP

30
Q

Diffused Axonal Injury

A

Most common head injury caused by severe blunt trauma. Diffuse (large area) injury. Stretching, shearing, tearing of nerve fibers from brain moving back and fourth

31
Q

Complications of a Diffuse Axonal Injury

A

generalized edema, subarachnoid bleeding, with irritation to surrounding tissues, herniation syndrome possible, often results in permanent vegetative state. S/S; seizure, coma, vomit

32
Q

What is an Anoxic Brain injury

A

lack of oxygen to the brain, decreased perfusion. 4-6 minutes of anoxia is irreversible

33
Q

What are some events/ injuries that may cause an anoxic brain injury?

A

cardiac arrest, airway obstruction, drowning

34
Q

What is a closed head injury?

A

Injury to brain where skull is not fractured, brain tissue damaged by force, blood vessels may rupture. Contrecoup injuries.

35
Q

Can spinal cord injuries be temporary?

A

Yes, they can be temporary or permanent, but nerves in the spinal cord do not regenerate

36
Q

What causes a spinal cord injury

A

Results from a fracture or dislocation of vertebrae which stretches, compresses or tears the spianal cord

37
Q

What kind of spinal injury causes irreversible loss of function below the injury

A

A complete transection. Partial may allow for some recovery

38
Q

What has to happen to a compressed spinal cord

A

it must be relieved quickly, as to maintain blood supply

39
Q

What is the first stage of a spinal cord injury and what does it include?

A

Early stage; all neurological activity below injury ceases to function. At cervical level, affects BP control, body temp, bowels/bladder func. May last days to weeks

40
Q

What is the second stage of a spinal cord injury, and what does it include.

A

Recovery; gradual return of reflex activity, may have the loss of pain/sensation.

41
Q

What does a Permanent loss of reflexes from a spinal injury cause

A

para/quadriplegia

42
Q

Where is an Epidural Hematoma?

A

Between skull and Dura

43
Q

Where is a subdural hematoma?

A

between the dura and the arachnoid

44
Q

Where is a sub arachnoid hemorrhage?

A

between arachnoid and pia

45
Q

What is an intracerebral hematoma

A

Bleeding directly into the brain tissues

46
Q

What causes an epidural hematoma?

A

Usually results from a fracture, tearing of a meningeal artery, leading to a quick and deadly outcome. ARTERIAL BLEED

47
Q

Signs and Symptoms of an Epidural Hematoma

A

head trauma with LOC, lucid interval, and then ^ ICP, rapid death

48
Q

What causes a Subdural Hematoma

A

Venous bleed, slower. Associated with injury to underlying brain tissues. More common.

49
Q

How are subdural hematomas classified?

A

Acute: diagnosed 24 hours - days later,
Sub-acute: diagnosed over a week

50
Q

What are subarachnoid hemorrhages associated with?

A

traumatic bleeding from vessels at the base of brain (aneurysms)

51
Q

S/S of subarachnoid Hemorrhage

A

Sudden, severe headache, initially localized but becomes diffuse secondary to meningeal irritation. As bleeding continues, ICP^

52
Q

What causes intracerebral hemorrhage

A

Bleeding in the brain (frontal/temporal most common) caused by blunt or penetrating trauma.

53
Q

S/S of Intracranial hemorrhage

A

Different based on location, Altered LOA, patterns like CVA, high mortality

54
Q

What are the general S/S of head injuries ?

A

seizures, cranial nerve impairment, otorrhea or rhinorrhea (leaking CSF from ears or nose), Otorrhagia (ear bleed), fever.

55
Q

What is the treatment for head trauma pts

A

LOC, Airway and ventilation, Circulation, cerebral herniation syndrome (check pupils, decerebrate posture, paralysis, hypertension), Hyperventilate pts

56
Q

What is the typical End tidal value for head trauma pts?

A

30-35

57
Q

What GCS values indicate the severities of head trauma?

A

Mild: 13-15
Moderate: 8-12
Severe: less than 8

58
Q

What are the differences between Neurogenic and Hypovolemic Shock?

A

Neurogenic: bradycardia, warm and dry skin, no significant blood loss, paralysis and loss of spinal reflexes

Hypovolemic: Tachycardia, cool pale diaphoretic skin, evident blood loss, no paralysis

59
Q

What are the signs of a Basal Skull Fracture?

A

Racoon’s eyes, Otorrhea (CSF from ears), Rhinorrhea (CSF from nose), Mastoid Bruising

60
Q

What does deviation in pupil size indicate?

A

CNS involvement or CNS

61
Q

What does the deviation of pupil position indicate?

A

Cranial Nerve involvement

62
Q

What do fixed dilated pupils indicate?

A

Cerebral anoxia or brainstem involvement

EMRG 1230 - Neuro (4 decks)

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