trigger - trauma

Question 1

HTN, Bradycardia and decreased respiratory drive is indicative of what

Answer 1

cushings reflex, indicates increased ICP

Question 2

observation only treatment as long as s/s are not severe

Answer 2

• concussion (obs in ER 2 hrs + 24 @ home)
• linear skull fracture (obs 4-6 in ED, 24 at home)

Question 3

seizures, bleeding/anticoags, or recurrent vomiting are all indications of what in concussions

Answer 3

INDICATIONS FOR ADMISSION!!

also GCS <15 @ 2 hours, abnormal CT, no people to obs for 24 hrs

Question 4

presents with short term mem loss, early dementia, impulsive behavior and depression

Answer 4

chronic traumatic encephalopathy
3+ concussions

Question 5

vague neuropsych s/s starting 7-10 days after injury

Answer 5

post concussive syndrome

Question 6

treat with tetnus shot, rocephin and vanc

Answer 6

depressed skull fracture

if the depression is greater than skull thickness than consult surg

Question 7

MC bone affected here is temporal bone

Answer 7

basilar skull fx

Question 8

Admit ALL patients with this

Answer 8

basilar skull fx

Question 9

halo sign CSF leaking, battle sign, racoon eyes

Answer 9

hallmarks of a basilar skull fx

also see: haemotympanum and bump on head

Question 10

haemotympanum and bump on head

Answer 10

hallmarks of a basilar skull fx

also see: racoon eyes, halo sign, battle sign

Question 11

tx with ancef/cefazolin

Answer 11

open fractures

Question 12

when should you order a pan-scan and what does this include

Answer 12

order for a skull fracture
order also for sig trauma

includes noncontrast CT brain and c spine with a CONTRAST CT chest, abdomen and pelvis

Question 13

never place a nasal airway in these patients

Answer 13

basilar skull fx

Question 14

between dura and arachnoid

Answer 14

subdrual hemorrhage

Question 15

usually d/t vein tearing

Answer 15

subdural hematoma

MC tramatic intracranial lesion

Question 16

what does it mean if hematoma on CT is darker

Answer 16

older subdural hematoma

Question 17

classified by acute (<2 d), subacute (3-21 d), or chronic (>21 d)

Answer 17

Subdural hematoma

subDURal is labeled by DURation

Question 18

MC in men

Answer 18

subdural hematoma

Question 19

90% of these present with HA that is worse with straining (cough, sneezing, lifting). but this does NOT present with seizures!

Answer 19

subdural hematoma

Question 20

presents MC with ipsilateral fixed dilated pupil

Answer 20

brain herniation

Question 21

accumulation of blood dura mater and skull

Answer 21

epidural hematoma

Question 22

trauma to temporal area

Answer 22

epidural hematoma

also associated with middle meningeal artery rupture

Question 23

middle meningeal artery rupture

Answer 23

epidural hematoma

assocaited with blow to temporal area

Question 25

lens shaped lesion on CT

Answer 25

epidural hematoma

Question 26

presents with LOC followed by lucid interval where patients neuro exam is normal

Answer 26

epidural hematoma | this is followed by quick decompensation w sig worsening of s/s

Question 27

blood in space between pia and arachnoid mater

Answer 27

subarachnoid hemorrhage

Question 28

thunderclap HA

Answer 28

associated with SAH

Question 29

sudden LOC in 45% pts and seizures in 25% patients | back pain and leg pain too

Answer 29

SAH s/s | also presents with thunderclap HA, back pain and BIL leg pain

Question 30

xanthochromic (yellow) CSF

Answer 30

SAH | also see incerased opening pressure and increased RBC in CSF

Question 31

gold standard is CTA of brain

Answer 31

SAH

Question 32

what is the use of esmolol and labetalol in SAH

Answer 32

reducing MAP<130

Question 33

What is the NEXUS criteria?

Answer 33

Midline posterior Spinal tenderness present Painful distracting injury present Intoxication present Focal Neurological Deficits present Encephalopathy (or ALOC) present All must be negative to clear a patient without imaging.

Question 34

restrict motion w SOFT collar

Answer 34

torticollis (C1 rotary subluxation)

Question 35

odontoid fx and posterior element fracture are what level

Answer 35

C2

Question 36

TLSO brace and pain meds

Answer 36

management of anterior wedge/compression fx of thoracic spine

Question 37

Lower back pain, difficulty walking, saddle anesthesia

Answer 37

cauda equina syndrome | urinary retention, poor rectal tone, change in bowel/bladder

Question 38

urinary retention, poor rectal tone, change in bowel/bladder

Answer 38

cauda equina syndrome | saddle anethesia, difficulty walking, LBP