Neurosurgery, C75 P721-743 Flashcards Preview

Section III Subspecialty Surgery P517 > Neurosurgery, C75 P721-743 > Flashcards

Flashcards in Neurosurgery, C75 P721-743 Deck (201)
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1

HEAD TRAUMA
What is the incidence?
P721

70,000 fatal injuries/year in the United
States, 500,000 head injuries per year

2

HEAD TRAUMA
What percentage of trauma
deaths result from head
trauma?
P721

50%

3

HEAD TRAUMA
Identify the dermatomes:
P721 (picture)

(see Picture)

4

HEAD TRAUMA
What is the Glasgow Coma
Scale (GCS)?
P721

GCS is an objective assessment of the
level of consciousness after trauma

5

HEAD TRAUMA
GCS SCORING SYSTEM
Eyes?
P721

Eye Opening (E)
4—opens spontaneously
3—opens to voice (command)
2—opens to painful stimulus
1—does not open eyes
(Think: “4 eyes”)

6

HEAD TRAUMA
GCS SCORING SYSTEM
Motor?
P722

Motor Response (M)
6—obeys commands
5—localizes painful stimulus
4—withdraws from pain
3—decorticate posture
2—decerebrate posture
1—no movement
(Think: 6-cylinder motor)

7

HEAD TRAUMA
GCS SCORING SYSTEM
Verbal?
P722

Verbal Response (V)
5—appropriate and oriented
4—confused
3—inappropriate words
2—incomprehensible sounds
1—no sounds
(Think: Jackson 5 = verbal 5)

8

HEAD TRAUMA
GCS SCORING SYSTEM
What indicates coma by GCS
score?
P722

< 8 (Think: “less than eight—it may be
too late”)

9

HEAD TRAUMA
GCS SCORING SYSTEM
What does unilateral,
dilated, nonreactive pupil
suggest?
P722

Focal mass lesion with ipsilateral
herniation and compression of CN III

10

HEAD TRAUMA
GCS SCORING SYSTEM
What do bilateral fixed and
dilated pupils suggest?
P722

Diffusely increased ICP

11

HEAD TRAUMA
GCS SCORING SYSTEM
What are the four signs of
basilar skull fracture?
P722

1. Raccoon eyes—periorbital
ecchymoses
2. Battle’s sign—postauricular
ecchymoses
3. Hemotympanum
4. CSF rhinorrhea/otorrhea

12

HEAD TRAUMA
GCS SCORING SYSTEM
What is the initial
radiographic neuroimaging
in trauma?
P722

1. Head CT scan (if LOC or GCS 15)
2. C-spine CT
3. T/L spine AP and lateral

13

HEAD TRAUMA
GCS SCORING SYSTEM
Should the trauma head CT
scan be with or without IV
contrast?
P722

Without!

14

HEAD TRAUMA
GCS SCORING SYSTEM
What is normal ICP?
P722

5 to 15 mm H(2)O

15

HEAD TRAUMA
GCS SCORING SYSTEM
What is the worrisome
ICP?
P723

>20 mm H(2)O

16

HEAD TRAUMA
GCS SCORING SYSTEM
What determines ICP
(Monroe-Kelly hypothesis)?
P723

1. Volume of brain
2. Volume of blood
3. Volume of CSF

17

HEAD TRAUMA
GCS SCORING SYSTEM
What is the CPP?
P723

Cerebral Perfusion Pressure = mean
arterial pressure—ICP (normal CPP is
>70)

18

HEAD TRAUMA
GCS SCORING SYSTEM
What is Cushing’s reflex?
P723

Physiologic response to increased ICP:
1. Hypertension
2. Bradycardia
3. Decreased RR

19

HEAD TRAUMA
GCS SCORING SYSTEM
What are the three general
indications to monitor ICP
after trauma?
P723

1. GCS 9
2. Altered level of consciousness or
unconsciousness with multiple system
trauma
3. Decreased consciousness with focal
neurologic examination abnormality

20

HEAD TRAUMA
GCS SCORING SYSTEM
What is Kocher’s point?
P723 (picture)

Landmark for placement of ICP monitor
bolt:

21

HEAD TRAUMA
GCS SCORING SYSTEM
What nonoperative
techniques are used to
decrease ICP?
P724

1. Elevate head of bed (HOB) 30
(if spine cleared)
2. Diuresis-mannitol (osmotic diuretic),
Lasix®, limit fluids
3. Intubation (PCO2 control)
4. Sedation
5. Pharmacologic paralysis
6. Ventriculostomy (CSF drainage)

22

HEAD TRAUMA
GCS SCORING SYSTEM
What is the acronym for the
treatment of elevated ICP?
P724

“ICP HEAD”:
INTUBATE
CALM (sedate)
PLACE DRAIN (ventriculostomy)/
PARALYSIS

HYPERVENTILATE TO PCO2 35
ELEVATE head
ADEQUATE BLOOD PRESSURE
(CPP 70)
DIURETIC (e.g., mannitol)

23

HEAD TRAUMA
GCS SCORING SYSTEM
Can a tight c-collar increase
the ICP?
P724

Yes (it blocks venous drainage from
brain!)

24

HEAD TRAUMA
GCS SCORING SYSTEM
Why is prolonged
hyperventilation dangerous?
P724

It may result in severe vasoconstriction
and ischemic brain necrosis!
Use only for very brief periods

25

HEAD TRAUMA
GCS SCORING SYSTEM
What is a Kjellberg?
(pronounced “shellberg”)
P724

Decompressive bifrontal craniectomy
with removal of frontal bone frozen for
possible later replacement

26

HEAD TRAUMA
GCS SCORING SYSTEM
How does cranial nerve
examination localize the
injury in a comatose patient?
P724

CNs proceed caudally in the brain stem
as numbered: Presence of corneal reflex
(CN 5 + 7) indicates intact pons; intact
gag reflex (CN 9 + 10) shows functioning
upper medulla (Note: CN 6 palsy is often
a false localizing sign)

27

HEAD TRAUMA
GCS SCORING SYSTEM
What is acute treatment of
seizures after head trauma?
P724

Benzodiazepines (Ativan®)

28

HEAD TRAUMA
GCS SCORING SYSTEM
What is seizure prophylaxis
after severe head injury?
P724

Give phenytoin for 7 days

29

HEAD TRAUMA
GCS SCORING SYSTEM
What is the significance of
hyponatremia (low sodium
level) after head injury?
P725

SIADH must be ruled out; remember,
SIADH = Sodium Is Always Down Here

30

HEAD TRAUMA
EPIDURAL HEMATOMA
What is an epidural
hematoma?
P725

Collection of blood between the skull and
dura