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Flashcards in CNS and Musculoskeletal Trauma Deck (114)
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1

Age 15-24 yrs old are more apt to be involved in what types of trauma

MVC and violence often involving ETOH

2

Age >75 yrs old are more apt to be involved in what types of trauma

Falls

3

How many head injuries in the US per yr

1.6 million

4

How many permanent neurologic injuries in the US per yr

70,000-90,000

5

Types of primary traumatic brain injuries

Skull fx, vascular injuries, subdural and epidural hemorrhage, brain parenchyma injuries such as contusions and axonal injuries

6

Types of secondary traumatic brain injuries

Occur after the initial event and potentially preventable

7

Types of preventable secondary injuries are

Hypoxia, hypercapnia, hyperthermia

8

Secondary injuries may involve

Reperfusion, superoxide production, exciotoxic amnion acid release, necrosis and apoptosis

9

What types of skull fractures require early surgery to decrease the incidents of meningitis

Open skull fx, deep scalp lacs and fractures extending into sinuses

10

Are all skull Fx assoc with intarcrainal lesions

NO, but it should alert the CRNA to a potential underlying brain injury

11

What is the most common focal intracranial injury

Subdrual hematomato, yes tomato, LOL

12

What percentage of TBI have hematomatos

24%

13

What TBI has the highest mortality rate

Subdural Hematomatos (squishy tomato's)

14

How do you fix a subdural hematomato

surgical decompression

15

What percentage of TBI have eipdural tomatoes

6%

16

Classic presentation of an epidural hematomato

period of lucidity followed by neurologic decompensation and coma

17

Do all epidural hemotomatos need surgical intervention

NO small ones can be observed

18

Where is a cerebral contusion/hemotomato located

In the brain parenchyma

19

Determinants of outcomes for cerebral contusion/hemotomato are

GCS, presence of hypoxia, hematomato volume

20

Interventions may include

Surgical evacuation, with or without craniotomy if elevated Intercarranial hypertension is present

21

Diffuse injuries are caused by

acceleration deceleration or rotational injuries

22

The best diagnostic tool for diffuse injuries is

MRI

23

Diffuse injuries are classified as

Mild- coma 6-24 hr, Moderate- >24 hrs without decerbrate posturing, Sever- > 24 hrs with decerbrate posturing or faccidity

24

CRNA goals are to prevent further ________ injuries

secondary

25

Contribution cerebral factors to secondary TBIs

Increased ICP, expanding mass leasions, hypercapnia, hypoxia, venous obstruction with positioning and C collar, hypotension causing compensatory cerebral vasodilation, hyperventilation, SZ, and vasospasm.

26

Contribution systemic factors to secondary TBIs

hypotension, hypoxia, anemia, hypoventilation, hyperglycemia, hyponatremia, hyperosmolar state, coagulapathy

27

Preferred method of intubation? nasal or oral

Oral

28

Drugs to facilitate Intubation

Propofol, Etomidate, Lidocaine 1.5 mg/kg, Sucs vs Roc (Roc you buy till you get a twitch) Keep FIO2 at 100%, PaCO2 low normal range

29

Goals for TBI ICP is a CPP of

60-70

30

Goals for MAP without ICP monitoring

MAP 70-80