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PAR2022 - Trauma > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Traumatic brain injuries affect quality of life in which 5 ways?

A
  • neurological impairment
  • medical complications
  • cognitive impairment
  • personality and behavioural change
  • lifestyle consequences
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2
Q

what are the main causes of TBI?

A

Transport accident #1

Falls # 2

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3
Q

what sex and age has highest rate of TBI?

A

Males 10-29

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4
Q

What area houses the frontal lobe?

A

anterior cranial fossa

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5
Q

What area sits inside the occipital bone housing the brain?

A

Posterior cranial fossa

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6
Q

What area sits in the temperal bone housing the brain?

A

middle cranial fossa

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7
Q

What is the name of the large hole in the base of the skull?

A

Foramen magnum

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8
Q

what is the name of the bone that seperates the nasal cavity?

A

Ethmoid bone

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9
Q

WHat is the name of the opening the optic nerve runs through?

A

Optic foramen

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10
Q

What are the layers of the skull?

A
  • dural sinus - where CSF is collected
  • Skull
  • Periosteum (attaches dura mater and skull)
  • Dura mater (tough fibrious layer)
  • Subdural space
  • Arachnoid mater
  • Subachronoid space
  • Vessels
  • Pia mater (attached to brain)
  • Brain
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11
Q

What are the arteries that connect to the circle of willis?

A
  • Middle cerebral artery
  • Internal carotid artery
  • Posterior cerebral artery
  • Basilar artery
  • Vertebral artery
  • Anterior cerebral artery
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12
Q

WHat is the formula for Cerebral Perfusion Pressure?

A

CPP = Mean arterial pressure - intracranial pressure

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13
Q

What is the normal value for intracranial pressure?

A

<20mmHg

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14
Q

How much of cardia output is received by the cerebral perfusion?

A

15%

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15
Q

How much of the body’s oxygen is used in cerebral perfusion?

A

20%

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16
Q

What happens if the blood supply stops to cerebral perfusion?

A

Unconscious is 10 mins

dead in 4-6

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17
Q

What is the formula for Mean arterial pressure?

A

MAP = (2x Diastolic) + systolic / 3

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18
Q

What level does MAP need to be to perfuse the brain?

A

at least 50mmHg

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19
Q

What happens with ICP compensation?

A

ICP increases = increased BP

When compensation occures the venous blood vessels compress, reduction is free CSF

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20
Q

What are some secondary injuries with TBI?

A
  • hypoxic
  • hypotension
  • hypovolaemia
  • hyperthermic
  • hypoglycaemic
  • hypercapnoic
  • acidotic
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21
Q

What happens when there is too much PaCO2 in the brain?

A

Causes blood vessel dilation, causing increase in ICP and increase in swelling

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22
Q

What happens when there is too little PaCO2 in the brain?

A

brain blood vessels shrink decreasing brain swelling leading to drop in ICP

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23
Q

What are the steps of the TBI death spiral

A
  • Cranial injury
  • tissue edema (swelling)
  • Increased ICP
  • Compression of arteries
  • Decreased cerebral blood flow
  • Decreased o2 with death of brain cells
  • Oedema around necrotic tissue
  • Increased ICP with compression of brain stem and resp
  • Co2 accumulates, causing vasodilation
  • Increased ICP due to increased blood volume
  • death
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24
Q

Define a head injury?

A

injury to the soft tissue, intracranial structures or skeletal structures of the head

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25
Q

Define a brain injury?

A

Head injury resulting in damage to the brain, either as a result of the primary or secondary injury

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26
Q

what are examples of significant head injuries?

A 
base of skull fracture
fractured mandible
middle third fractures
severe scalp wound
eye injuries
LOC
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27
Q

What are the main types of skull fractures?

A

Closed or Open are main two

other types:

  • linear
  • depressed
  • comminuted (depressed fracture with shards of skull into brain)
  • Basilar
  • Impaled object
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28
Q

What fractures are Battle signs - Retroauricular ecchymosis - associated with? (Bruising behoind the ear)

A

Auditory canal and lower skull fractures

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29
Q

What fractures are Racoon eyes - bilateral periorbital ecchymosis - associated with?

A

orbital fractures

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30
Q

what are some signs of base of skull fracture?

A

May tear dura mater

  • CSF comes out of nose and ears
  • perform halo test to see if CSF is present in blood
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31
Q

What is an extradural haematoma?

A

arterial bleed inside the skull

32
Q

What is a subdural haematoma?

A

usually venous bleed inside the skull

- usually slow onset

33
Q

Define primary brain injury

A

induced by a mechanical force and occurs at the moment of injury.

2 main mechanisms - something striking the head, or the head striking something

and acceleration-deceleration

34
Q

Define secondary brain injury

A

not mechanically induced may be delayed from moment of impact

35
Q

what is a focal injury

A

Occurs at specific location

36
Q

What is a diffuse injury?

A

concussion

axonal injury

37
Q

What is a diffuse axonal injury?

A

Disruption of axonal fibres in white matter and brainstem

eg. MVA/shaken baby

  • injury immediate and irreversible
  • immediate rise in ICP
38
Q

What are soem caused of secondary brain injury?

A
  • oedema
  • intracellular calcium OD
  • reduced protein synthesis
  • inflammation
  • heightened metabolism
39
Q

How does hypoxia double mortality in brain injury?

A

decreased PO2 leads to cerebral flow increase, increasing swelling and ICP, increasing ischaemia

40
Q

How does hypotension double mortality in brain injury?

A

decreased Cerebral Perfusion Pressure (CPP) leads to cerebral ischaemia, increasing swelling thus increasing ICP

41
Q

What is coup and contracoup?

A

coup is the brain hitting the skull from intial impact

contracoup is the brain hitting the skull from the rebound from the initial injury

42
Q

What is second impact syndrome?

A

Occurs when the brain swells rapidly, after a person suffers a second concussion before symptoms from the earlier one have subsided.

43
Q

How does GCS relate to severity of head injury?

A

Minor injury - GCS 13-15
Moderate - 9-12
Sever - <9

44
Q

Blood alcohol concentration of 0.20% relates to what loss of GCS points?

A

1

45
Q

What does hypercapnia do to Cerebral perfusion?

A

causes cerebral vasodilation

46
Q

What does hypocapnia do to Cerebral perfusion?

A

cerebral and carotid vasoconstriction

47
Q

What does hypoxia do to Cerebral perfusion?

A

leads to cerebral vasodilation

48
Q

What are early indications of increased ICP?

A
  • drowsiness, confusion, dystaxia
  • altered mental status
  • amnesia
  • blurred vision
  • headache/neckpain/stiffness
  • vomiting
  • paraesthesia
  • paralysis
49
Q

what is cushings triad?

A

Upper brainstem compression:

  • increased BP (due to baro receptors being compressed)
  • Bradycardia (vagus nerve being compressed)
  • Adventitious respirations
  • pupils become small and reactive
  • decorticate posturing
50
Q

What happens in the second stage of Cushings Triad?

A

Middle brainstem compression:

  • widening pulse pressure
  • increasing bradycardia
  • CNS hyperventilation: deep and rapid
  • Bilateral pupil sluggishness
  • Decerebrate posturing
51
Q

What happens with the third stage of Cushing triad?

A

Lower brainstem injury:

  • pupils dilated and unreactive
  • Ataxic respirations (erratic with no patterns)
  • Irregular and erratic pulse rate
  • ECG Changes
  • Hypotension
  • Loss of response to pain
52
Q

What are the types of Middle third facial fractures?

A

LeFort 1 - between maxillary floor and orbital floor

LeFort 2 - Maxilla, Zygomatic and Nasal fracture

LeFort 3 - most sever - full middle third

53
Q

What is a type of maxillo-facial fractures?

A

Nose
Zygoma
Jaw

54
Q

How do you manage a facial fracture?

A

Consider force

Posture

  • sit up
  • lateral if unconscious

Airway
- do not insert NPA

Analgesia

55
Q

How soon does a tooth need to be replaced by?

A

a few hours

  • clean tooth with saline
  • avoid touching root surface
  • can place in Milk
  • Saline used if milk unavailable
56
Q

Whats the ratio of spinal cord injuries for men and women.

A

Men have 5x more

57
Q

How long is the average spine?

A

70-72 cm in length

58
Q

How many curvatures does the spine has?

A

4 curvatures:

  • 2 concave anteriorly - cervical/lumbar (secondary curves)
  • 2 convex posteriorly - thoracic/sacral (primary curves)
59
Q

How is the spine divided into cervicle, thoracic, lumbar, sacra and coccygeal?

A 
7 cervical
12 thoracic
5 lumbar
5 sacral
4 coccygeal
60
Q

What supports the spinal column?

A

Cartilage discs

  • strong ligaments
  • rib cage and sternum
  • natural curvature
61
Q

How long is the spinal cord?

A

42-45cms

starts at C1 and ends at L1/2

62
Q

What are the nerves of the spine?

A

31 pairs in total:

  • 8 cervical
  • 12 thoracic
  • 5 lumbar
  • 5 sacral
  • 1 coccygeal
63
Q

What can happen in a c1/c2 fracture?

A

The dens from c2 can break off.

64
Q

What are the mechanisms of SCI?

A
  • Hyperextension
  • Hyperflexion
  • Compression
  • Flexion (rotation)
  • Direct / penetrating
65
Q

What are the classifications of SCI?

A

Quadriplegia/Tetraplegia - T1 and above

Paraplegia - T2 and below

Complete/incomplete:

  • central cord syndrome
  • brown sequard syndrome
  • anteriorcord syndrome
66
Q

what is central cord syndrome?

A

Lower limb function retained but loss of upper limb

67
Q

What is brown sequard syndrome?

A

motor loss on one side

can also have loss of pain and temperature on opposite side

68
Q

What is anterior artery syndrome?

A

Damage to anterior two thirds of cord due to arterial infarction

69
Q

What are the types of spinal cord injury?

A

Transient concussion

Contusion (secondary injury)

Laceration

Compression

Complete transection

70
Q

What is the pathophysiology of SCI?

A

Primary mechanisms:

Secondary mechanisms:

  • vascular insufficientcy
  • oedema
  • cell toxicity
  • apoptosis
71
Q

What do you look for in assessing SCI?

A

RESP:

  • Abdominal / Paradoxial breathing
  • chest injuries likely in thoracic fractures

CIRCULATION:-

  • hypotension with no associated tachycardia
  • no external signs of haemorrage
  • patient is pink warm and dry
72
Q

What is spinal shock?

A

the loss of sensorimotor function below the injury

73
Q

What is neurogenic shock?

A

Referds to haemodynamic instability that occurs in high spinal cord injury

74
Q

What are the things to remember with SCI and breathing?

A

Lesions above C5 can paralyse diaphargm

Any lesion above T12 may cause breathing compromise

Lesions below C5 will aloow diaphragm to work but intercostals and abdominals will be affected

75
Q

What IV therapy do you give for SCI?

A

90SBP mmHg

10.ml/kg

76
Q

What do you test in a neurological exam for SCI?

A

Motor function:
Arms - push/pull/grip
Legs - push/plantar flexion - pull/dorsiflexion and leg raise

Sensory function:
Arms - Palms and back of hands
Legs - Lateral aspect of calcaneus
Suprastenal notch

PAR2022 - Trauma (12 decks)

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