Trauma-Morgan

Question 1

How do you classify head injuries?

Answer 1

by mechanism (closed, penetrating)
severity
morphology: skull fractures, intracranial lesions

Question 2

What are some examples of closed head injuries?

Answer 2

high velocity: auto accidents

low velocity: assault

Question 3

What are some examples of penetrating head injuries?

Answer 3

gun shot wounds

Question 4

What is the lowest & highest possible glascow coma score?

Answer 4

lowest: 3
highest: 15

Question 5

What is considered a mild, moderate, severe head injury?

Answer 5

Mild: 14-15. Talking & confused
Moderate: 9-13. Maybe not talking.
Severe: 8 or less. Comatose, intubated, paralyzed

Question 6

What type of CT do you want with a head injury patient?

Answer 6

non contrast

want to see blood as white

Question 7

Glasgow coma scale + ____ gives you a neurological baseline.

Answer 7

eye/pupil exam

Question 8

When should the GCS be taken for a patient?

Answer 8

after BP & O2 normal

before sedative meds

Question 9

What can a low BP & low O2 do to the GCS?

Answer 9

cause a decreased level of consciousness

Question 10

Why don’t we hyperventilate the brain anymore?

Answer 10

used to do it so that the vessels would constrict & intracranial pressure would go down.
but the damaged areas of the brain don’t get good bloodflow & become hypoxic

Question 11

What are the 3 components of GCS?

Answer 11

EMV
Eye opening (1-4)
Motor response (1-6)
Verbal Response (1-5)
Total: 3-15

Question 12

What earns each score for eye opening? 1-4.

Answer 12

4: spontaneous
3: response to speech
2: response to pain
1: nil

Question 13

What earns each score for the motor response? 1-6

Answer 13

6: obeys motor commands
5: localizes
4: withdraws
3: abnormal flexor response
2: extensor response
1: nil

Question 14

What earns each score for the verbal response? 1-5

Answer 14

5: oriented
4: confused conversation
3: inappropriate words
2: scream, groan, moan
1: no response

Question 15

What would earn a score of 3 on GCS?

Answer 15

doesn’t open eyes
flaccid
doesn’t talk or make sounds

Question 16

What else should you check with eyes?

Answer 16

pupil response: bad if dilated & unresponsive to light

corneal reflex

Question 17

What is dolls eye?

Answer 17

you turn the head sharply to one side & the eyes remained centered
tests brain stem function

Question 18

What is the oculovestibular reflex?

Answer 18

ice water in ear, bad if eyes don’t move.

Question 19

What types of skull fractures might you see?

Answer 19

vault: linear or stellate, depressed or not. OVER THE BRAIN.
basilar: w/ CSF leak maybe, w/ cranial nerve palsy maybeUNDER THE BRAIN

Question 20

What types of intracranial lesions might you see?

Answer 20

focal: subdural, epidural
diffuse: concussions, diffuse axonal injury

Question 21

What can hematomas look like?

Answer 21

can seem like a depressed skull fracture b/c of hard edges & a soft center
need a CT to find out

Question 22

Basilar skull fractures make up ___% of head injuries. How can you best visualize them?

Answer 22

25% head injuries

visualized w/ CT

Question 23

Where do basilar skull fractures usu happen?

Answer 23

petrous bone
anterior cranial fossa & cribriform plate
clival fractures
**can get longitudinal, transverse, anterior fossa fractures

Question 24

What are some common evidences of a basilar skull fracture?

Answer 24

bruise on the mastoid (battle's sign)
blood behind the ear drum (hemotympanum)
raccoon eyes-bruised eyelids
CSF leak
pneumocephalis
**need to watch them

Question 25

What is pneumocephalus?

Answer 25

gas in the brain

Question 26

Should you give antibiotics to patients w/ a basilar skull fracture?

Answer 26

probably not unless they develop meningitis

Question 27

What do you test the CSF fluid for w/ a basilar fracture?

Answer 27

glucose | beta-2-transferrin

Question 28

What usu causes an epidural hematoma?

Answer 28

arterial bleed, middle meningeal artery w/ temporal fracture | talk & die

Question 29

What usu causes a subdural hematoma?

Answer 29

tearing of veins, brain lacerations present w/ headache, neuro deficits focal, decreased concentration can be weeks or months later

Question 30

What is a cerebral contusion?

Answer 30

focal injury coupe-contra coupe pattern can become surgical hematomas usu in frontal & temporal lobes

Question 31

What do cerebral contusions look like on CT?

Answer 31

salt & pepper lesions

Question 32

What are intracerebral hematomas?

Answer 32

hematoma w/i brain | need to monitor

Question 33

What is a diffuse axonal injury?

Answer 33

loss of consciousness past 6 hours | can be in a coma for months

Question 34

What is second impact syndrome?

Answer 34

head injury during post-concussive symptoms | loss of auto regulation, dilated blood vessels, diffuse cerebral swelling, increased ICP, brain herniation & death

Question 35

Where do we try to keep ICP? CPP?

Answer 35

ICP: less than 20 CPP: greater than 70

Question 36

What is a possible treatment for increased ICP?

Answer 36

craniectomy, make it large. brain herniates safely out.

Question 37

Should you use steroids or anti-seizure meds to treat high ICP?

Answer 37

no. | no, unless they have a condition.

Question 38

T/F Mannitol is given w/ TBI.

Answer 38

True.

Question 39

What is the ASIA impairment scale?

Answer 39

A: complete, no motor, sensory, sacral sparing B: incomplete, only sensory C: incomplete, motor function preserved, w/ some key muscles <3 motor grade D: incomplete, more than half key muscles, more than 3 motor grade E: sensory & motor normal.

Question 40

What are some reflexes you look for w/ severe spinal cord injuries?

Answer 40

``` beevor's sign cremateric reflex anal cutaneous reflex bulbocavernosus reflex priapism, could be spinal cord injury from loss of sympathetics ```

Question 41

What are some incomplete spinal cord injuries?

Answer 41

brown-sequard | anterior, posterior, central cord

Question 42

What should you look for w/ central cord syndrome?

Answer 42

disproportionately greater weakness in upper extremities, look at the hands burning pain in the hands

Question 43

What happens w/ brown sequard?

Answer 43

spinal cord hemisection

Question 44

What is the treatment of spinal injuries?

Answer 44

``` ABC stabilize examine maintain BP, O2, Na No steroids! ```