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Elaina: Emergency > TBI, neck injury > Flashcards

TBI, neck injury Flashcards

1
Q

how many americans are living with TBI related disability?

A

2.5-6.5 million

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2
Q

what is the leading cause of TBI in the US?

A

MVA

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3
Q

what three types of responses make up the GCS? how many criteria in each category?

A 
eye responses (4)
verbal responses (5)
motor responses (6)
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4
Q

what are the three levels of TBI severity according to GCS score?

A

mild=GCS 13-15
moderate=GCS 9-12
severe=GCS less than 8

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5
Q

what are the three types of tissue deformation seen in TBI?

A

1) compression
2) tensile (tissue stretching)
3) shearing (tissue sliding over tissue)

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6
Q

what do we worry about occurring minutes to days after the initial primary insult in TBI?

A

secondary injury:

1) microscopic/cellular injury
2) cerebral arterial dilation
3) cerebral edema
4) ischemia/hypoxia
5) increased ICP

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7
Q

battle’s sign, raccoon eyes, CSF rhinorrhea, otorrhea, or hemotympanum should make you think of what?

A

basilar skull fracture

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8
Q

who should always get a CT scan following head injury, regardless of severity of symptoms?

A

those on oral anticoagulants

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9
Q

what is the diagnostic imaging of choice for head injury?

A

CT without contrast

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10
Q

a vacant stare, delayed verbal expression, inability to focus attention, gross incoordination, emotionality out of proportion to circumstances are signs of what?

A

concussion

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11
Q

where do we want to maintain mean arterial pressure (MAP) when dealing with TBI patients?

A

90 mmHG

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12
Q

what are the three first things you should set your patient with suspected TBI up with STAT when they present to the ED?

A

1) put patient on O2
2) cardiac monitoring
3) IVF w/ normal saline infusion

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13
Q

does a concussion reflect more of a functional or a structural injury?

A

functional

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14
Q

what will imaging of concussion show?

A

it will be grossly normal

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15
Q

what percentage of patients with a past concussion did not recognize it as such?

A

80 percent

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16
Q

having a seizure within the first week of injury puts you at risk for what?

A

post-traumatic epilepsy resistant to typical anticonvulsant RX

25 percent risk increase

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17
Q

your patient is a 12 year old boy with a very mild concussion. he lives with his demented grandmother because his mom can’t take care of him. should you send him home?

A

NOOooO

admit even if healthy patient has no responsible adult available to observe the patient

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18
Q

according to the cantu guidelines, if your patient had a loss of consciousness for more than 1 minute OR post traumatic amnesia for longer than 24 hours, when can they return to play?

A

1 month if asymptomatic at rest and on exertion for 7 days

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19
Q

most common cause of intracerebral hemorrhage?

A

HTN

ruptured vessel WITHIN the brain

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20
Q

what must you do if patient presents with intracerebral hemorrhage?

A

lower ICP!

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21
Q

what is normal ICP? what is pathologic ICP?

A

normal = 0-10 mmHG

pathologic is over 20 mmHG

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22
Q

at what mmHG is cerebral perfusion pressure considered critical?

A

50-70 mmHg

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23
Q

what are the two ways that we can bring down intracranial pressure?

A

1) increase MAP: IVF, pressors

2) decrease ICP: osmotic diuresis, HOB elevation, drain CSF (burr hole), hyperventilation

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24
Q

what is the mechanism of injury for a diffuse axonal injury?

A

acceleration/deceleration causes a shear force that injures the axons at the junction of the grey and white matter

25
Q

if you are in a coma between 6-24 hours due to a diffuse axonal injury, what does your prognosis look like?

A

recover without long term sequelae

26
Q

if you are in a moderate staged coma for over 24 hours following diffuse axonal injury, what does you prognosis look like?

A

you wake up, but will have long-term cognitive defecits

27
Q

what is the prognosis for a severe diffuse axonal injury (prolonged coma)?

A

persistent vegetative state in 90 percent

28
Q

if patient presents in collar and boarded, what should your highest suspicion be?

A

C-spine injury

evaluate immediately!

29
Q

patient presents on a board with suspected C-spine injury, what should your first priority be?

A

get the patient off the board as soon as possible..they are painful and can lead to necrosis

30
Q

where do the majority of spinal injuries occur?

A

cervical region in 55 percent

31
Q

what is the MOI of central cord syndrome?

A

forced hyperflexion of neck

32
Q

how will a patient with central cord syndrome present? what is their prognosis?

A

weakness in the UPPER extremities; sensation probably okay

probably will recover okay

33
Q

which type of cord syndrome is related to vascular injury, infarct or compression fractures?

A

anterior cord syndrome

34
Q

how will your patient with anterior cord syndrome present?

A

loss of sensation, temp, pain on BOTH sides

proprioception and vibration sense will be intact (dorsal unaffected)

probably not a great recovery

35
Q

a penetrating trauma (stabbing, gunshot) is most likely to cause which spinal cord syndrome?

A

brown-sequard syndrome

half the spinal cord is impacted

36
Q

how will someone with brown-sequard syndrome present?

A

loss of strength, proprioception, vibration on the same side as the injury

loss of pain and temperature on the other side

37
Q

what is the maneuver we use to maintain spinal immobilization when moving a patient from board to wherever we take them next?

A

log roll

38
Q

what will you lose with an injury to C4?

A

spontaneous breathing

39
Q

what will you lose with an injury to T1/T2?

A

loss of intercostal muscles and abdominal use

40
Q

you will be able to detect 70 percent of C-spine abnormalities of which x-ray view?

A

lateral neck view

41
Q

what imaging modality should you use for “low risk” patients with c-spine injury suspicion?

A

plain films

42
Q

what imaging modality for high risk patients with c-spine injury suspicion?

A

CT

43
Q

what are some examples of “high risk” patients in terms of C-spine injury evaluation?

A

true trauma, unreliable, demented, obese

44
Q

at what level of the spinal cord does a jefferson fracture occur? what is the MOI?

A

C1

axial loading (diving)

45
Q

how will a patient with a jefferson fracture present?

A

may have few symptoms although the fracture is very unstable

46
Q

what is the most common type of C2 fracture?

A

odontoid fracture

also may have few symptoms but is extremely unstable

47
Q

what type of fracture, and at what level, occurs with forced hyperextension of the neck?

A

hangman’s fracture – C2

48
Q

MOI of hangman’s fracture (C2)?

A

falls, motor vehicle fractures…hanging

49
Q

how may a patient with hangman’s (C2) fracture present? what is a major complication?

A

they might just walk in!

complication: central cord syndrome (more weakness in UE than LE)

50
Q

patient states they were gardening this morning and heard a “pop” followed by sudden pain between the shoulder blades. whats up?

A

clay shoveler’s fracture (STABLE fracture in spinal cord)

51
Q

how will someone with a clay shoveler’s (spinous process) fracture present?

A

pain but NOT neurologic symptoms

52
Q

which type of brain bleed is often missed on early CT (within 6 hours of injury)?

A

subarachnoid hemorrhage

53
Q

acute “thunderclap” headache should make you think of what type of brain bleed?

A

subarachnoid hemorrhage

54
Q

what pattern will you see on CT of a patient with a subdural hematoma?

A

crescent shaped concave hematoma

55
Q

who are we most likely to see subdural hematomas in? how do we manage them?

A

elderly with dementia/cerebral atrophy, alcoholics

they are slow venous bleeds so may only require observation

56
Q

which type of brain bleed is characterized by a brief LOC followed by a lucid period, and then often death?

A

epidural hematoma

57
Q

what will we see on CT of a patient with an epidural hematoma?

A

lens (biconvex or football shaped) bleed

58
Q

what physical findings will we note on PE of a patient with an epidural hematoma?

A

fixed dilated pupil on ipsilateral side with a contralateral hemiparesis (late finding)

59
Q

why does an epidural hematoma carry such a poor prognosis? how do we manage these patients?

A

as opposed to subdural hematoma (venous bleed), this is a high pressure arterial bleed

IMMEDIATE neurosurgical intervention for decompression to prevent brain herniation

Elaina: Emergency (6 decks)

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