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Flashcards in neck emergencies Deck (56)
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1

AVPU

a. Alert, or responsive to
b. Verbal stimuli, or to
c. Painful stimuli, or
d. Unresponsive

2

head injury GCS ranges

1. GCS 13-15: Mild Head Injury
2. GCS 9-12: Moderate Head Injury
3. GCS 3-8: Severe Head Injury

3

Standardized evaluation of neurological status

The Glasgow Coma Scale

Predictive of morbidity/mortality

4

AMPLE history

A -> Allergies

M -> Medications (especially anticoagulants/anti-platelets V IMPORTANT)

P -> Past medical history

L -> Last meal (especially if surgery is indicated emergently)

E -> Events (what happened just before..?)

5

Cushing's Triad what is it and what is it used for


Increased ICP and impending Herniation – pt’s will die

Bradycardia

hypertensioN

irregular respiration

6

pupillary response to light mydriasis would indicate

Mydriasis ipsilateral to site of 3rd nerve injury in herniation events

7

Motor deficits usually ipsilateral or contralateral to the sight of injury?

Motor deficits usually contralateral to the sight of injury

8

typical sxs in head exam of injury (3)

1. Battle sign, Racoon eyes, hematotympanum

9

labs

cbc, electrolytes, stat glucose, coags, tox screen, ETOH level

10

threshold for intubation

very low threshold

GCS<8), hypoxia, hypoventilation, need to sedate for trip to the scanner

11

treat presumptively for ICP if

seizure and ICP **

(GCS<8), fixed and dilated pupil(s), decorticate or decerebrate posturing, bradycardia, hypertension or respiratory depression
b. Initial treatment is HOB up 30degrees and Manitol 1g/kg iv

12

leakage of blood from the MMA creates


Dura --> glued on the inside of the cranium
b. When you have bleeding from the middle meningeal artery, it starts to tear that membrane but it’s a tough membrane so the dura bulges in towards the brain (epidural hematoma)

Arterial bleed so each beat of the heart squeezes more blood in, causing more of a bulge

13

lens shaped bleed

subdural hematoma

from venous source and accumulates MORE SLOWLY spreading out in a crescent shape

not always the case but this is what we see

most reliable way to distinguish is how quickly are there symptoms occurring

14

Associated with skull fracture in 40-85%

Laceration of dural vessels from skull fracture (91%), usually the middle meningeal artery

epidural hematoma

15

common sxs associated with epidural hematoma

Transient loss of consciousness; lucent interval

3rd nerve palsy (sign of cerebral herniation)

Somnolence 24-96 hrs after accident

16

course of EDH

Hematoma expands

Increased ICP, decreased CBF

Herniation, ipsilateral CN-3 dysfunction and contralateral paralysis or posturing

17

who get's SDH

infants, elderly, drunk

Underlying brain injury (50%)
Worse long term prognosis than epidural hematoma

18

stages of SDH

Hyperdense (<1 week);

isodense (1-3 weeks);

hypodense (3-4 weeks)

19

course of acute SDH

1. May be acute, like epidural hematoma

2. May have delayed course, days to weeks

3. Increased ICP, edema, herniation

4. ETOH increases cerebral edema by increasing the permeability of the blood brain barrier

20

cause of SDH

Cause: damage to subdural veins ("bridging veins")

21


Most common acute finding in child abuse (whiplash injury)

1. Usually posterior

Interhemispheric Subdural Hematoma:

22

Chronic Subdural Hematoma MC seen in what population

1. Following minor injury, rarely parenchymal injury, alcohol makes it more likely to occur
2. Convex configuration

23

Bleeding from small vessels at site of coup or contrecoup injury

Sub-Arachnoid Hemorrhage

24

if CT is negative and you suspect SAH

traumatic SAH should be ruled out from CT alone

for trivial trauma--> treat like atraumatic get a LP

25

Separation of suture between temporal and occipital bones

Seldom fatal (except for race car drivers)

SAH

26

battle sign

bruising from behind the ear

basal skull fracture

27

basal skull fracture sxs

CSF otorrhea
, CSF rhinorrhea
(danger of meningitis!)

if you get two rings on the coffee filter paper then suspect CSF

28

how do you get basal skull fractures

a. Caused by deceleration injury or occipital trauma

29

other PE in basal skull fractures

h. Battle’s sign
i. Racoon eyes
j. Hematotympanum

30

Hematotympanum

A collection of blood in the tympanic cavity behind the tympanic membrane. Visible on otoscopy as a blue, intact eardrum. Occurs secondary to head trauma (e.g. basilar skull fracture).