Flashcards in Head Trauma Deck (43)
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1
who are at high risk of head injuries
young men and elderly
previous head injuries
residents of inner cities
alcohol and drug abuse
low income
2
what do over half of head injuries involve
alcohol
3
when do most deaths occur after head injury
within first hour
then peak at 7 hours- secondary effects
3rd peak later due to medical complications- high risk of pneumonia, DVT, PE
4
what are the components of the glasgow coma scale
eye opening (4-1)
- spontaneously
-to speech
-to pain
-none
verbal (5-1)
-orientated
-confused
-inappropriate
-incomprehensible
-no verbal
motor (6-1)
-obeying
-moves to localised pain
-flexion withdrawal from pain
-abnormal flexing (decorticate)
-abnormal extension (decerebrate)
-no motor response
5
which part of glasgow coma scale carries most significance
motor
6
what are the best and worst GCS scores
best 15
worst 3
7
when is a patient comatosed on GCS
8 or less
8
what are the parameters for head injury severity on GCS score
14/15, brief LOC= mild
9-13 = moderate
3-8= severe
9
patients with what risk factors should have a CT scan done within 1 hour of being identified
GCS< 13 on initial assessment
GCS< 15 2 hours after injury
suspected open/ depressed skull fracture
any sign of basal skull fracture
post traumatic seizure
focal neurological deficit
more than one episode of vomiting
suspicion of NAI
10
who should get a CT if they experienced some LOC or amnesia since the injury
>65
coagulopathy (medically induced or thrombophilia)
dangerous mechanism of injury
11
what does lacunar eyes mean
basilar skull fracture
12
what is battles sign
bruising over the mastoid - basilar skull fracture
13
what does any blood in CSF suggest
basilar skull #
14
what is DAI (found in CT in diffuse head injury)
diffuse axonal injury
15
what are the possible CT findings in a focal head injury
traumatic haemorrhage- extradural, subdural, intracerebral
contusion
16
what are the features of an extradural haematoma
blood cant cross suture lines - fills space
lens shape/ biconvex shape
more common in younger patients
17
what is the usual presentation of an extradural haematoma
injury with LOC
has lucid interval in recovery
rapid progression of neurological symptoms
-deteriorating GCS
-possible hemiparesis/ wekaness
-unilateral fixed and dilated pupil
-apnoea and death
18
what are the features of an acute subdural haematoma
more common in elderly
brain atrophy
bridging veins disrupted
will be hyPERdense
19
what will a chronic subdural haematoma look like on imaging
hyPOdense
20
what is an intracerebral haemoatoma
blood clot within the brain
21
what is coup and contra-coup
coup- brain hits side of head that is impacted
contra coup- brian hits opposite side
22
what causes a diffuse axonal injury
large shearing forces
23
what is the neurosurgical role in head injury
prevent secondary insults
-hypoxia
-hypotension
-mass lesions
-controlling ICP and CPP (cerebral perfusion pressure)
24
what formula calculated cerebral perfusion pressure
MAP - ICP
25
what maintains good cerebral perfusion pressure
maintained MAP (up) and ICP (down) at right levels
26
what are the basal cisterns
compartments within the subarachnoid space where the pia mater and arachnoid membrane are not in close approximation and cerebrospinal fluid (CSF) forms pools or cisterns
mass have vessels/ nerves running through them
27
what does closure of the basal cisterns do
increases ICP
28
how is ICP monitored
wire inserted into head
29
what is the medical management for raised ICP
sedation- propofol, benzodiazepines, barbiturates
maximise venous drainage of brain - head tilt of bed (30 degrees), cervical collars, ET tube ties
co2 control
osmotic diuretics - mannitol, hypertonic saline
CSF release- external ventricular drain
30
