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Emergency Medicine
Head injuries
51
Science
Graduate
06/29/2015

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Cards

Term
head injuries aka
Definition
traumatic brain injury
Term
head injuries : primary injury
Definition

bullet, blunt trauma, ect

immediate brain damage

Term
head injuries : secondary injury
Definition

increased ICP from bleeding or swelling

ischemia, hypoxia from poor perfusion/oxygenation

Term
with head injuries the issues are primarily with the...
Definition
secondary injury (ie swelling)
Term
traumatic brain injury mild -->
Definition
GCS 14 and higher
Term
traumatic brain injury moderate
Definition
GCS 9-13
Term
traumatic brain injury severe
Definition
GCS < 9
Term
skull fracture - simple
Definition

non-depressed

non-open

Term
types of skull fractures
Definition

simple

depressed

basilar skull 

Term
basilar skull fracture
Definition

hemotypanum

CSF otorrhea or rhinorrhea

periorbital ecchymosis (raccoons eyes)

retroauricular ecchymosis (battle sign)

Term
fracture on the back of the skull
Definition
basilar
Term
occur at site of head impact
Definition
brain contusions
Term
can occur on opposite of head impact (contracoup)
Definition
brain contusions
Term
can lead to intra-cerebral edema/bleeding with a rise in the ICP
Definition
brain contusions
Term
as we age our brains shrink and they....
Definition
can move around more
Term
subarachnoid head bleed
Definition

common with severe TBI (GCS < 9)

between pia mater and under dura, covers the brain

Term
can have a lucid interval followed by rapidly decreasing LOC, ending with unilateral neurodecifics. can lead to herniation
Definition
epidural hematoma (usually arterial)
Term
pushes on brain but contained with suture lines so don't usually get very big and stays in one spot
Definition
epidural hematoma (usually arterial)
Term
can have delayed onset up to 2 weeks
Definition
subdural hematoma (usually venous)
Term
below the dura matera nd around the pia so can leak and fill in the different gyri and sulcuses
Definition
subdural hematoma (usually venous)
Term
brain contusions can lead to..
Definition
head bleeds
Term
occurs commonly in people of diffuse cerebral atrophy (older folks at risk)
Definition
subdural hematoma (SDH)
Term
often associated with acceleration/deceleration forces
Definition
subdural hematoma (SDH)
Term
can take up to 2 weeks before becoming symptomatic (may not have symptoms)
Definition
subdural hematoma (SDH)
Term
Subdural hematoma can become...
Definition
a chronic coniditon for the person
Term
as increased pressure occurs (bleeding or edema) the brain contents can be forced downward towards the brainstem
Definition
herniation
Term
Brainstem compression (herniation) leads to...
Definition

DLOC

hyperventilation to apnea

eventual death

Term
when we keep bleeding inside the brain - no place for blood to go (can't get outside of skull) -->
Definition
and if we get enough blood in there it wil push the brain contents down into the foramen magnum (herniation)
Term
must be maintained in order to support cerebral metabolism/function
Definition
cerebral circulation
Term
can be altered in states of hypotension or extreme HYPER-tension
Definition
cerebral circulation
Term
pressure exerted by the brain from gravity and vascular conditions
Definition
intracranial pressure
Term
intracranial pressure is normally between...
Definition
0-15 mmHg
Term
has normal small fluctuations with breathing, coughing, straining, ect
Definition
intracranial pressure
Term
the average pressure in the arteries
Definition
mean arterial pressure
Term
how do you calculate mean arterial pressure?
Definition
(CO x SVR) + CVP
Term
pressure that "perfuses" the brain
Definition
cerebral perfusion pressure
Term
how do you calculate cerebral perfusion pressure
Definition

CPP = MAP - ICP

 

Term
normal MAP
Definition
60-150
Term
normal ICP
Definition
0-15
Term
if the MAP drops below 60
Definition
there is not enough blood pressure to overcome the ICP and thus erebral blood flow is diminished
Term
if the ICP rises above 15 then...
Definition

structures that are non-compressible

(blood, CSF, semi-solid brain matter) push against soft brain material

Term
if the brain is damaged - it swells and results in a rise in...
Definition

ICP

 

Term
damage to the brain can be from....
Definition
blunt force, HYPOXIA, obstructed venous outflow, ect
Term
symptoms of increased ICP - Early -
Definition

headache

mental status change

abnormal reflexes

possible altered cranial nerve function

Term
Symptoms of increased ICP - Late -
Definition

changes in vital signs

 RR, depth

bradycardia

HTN (HR is too slow, PVR is through the roof)

Term
Cushings triad
Definition

HTN - brain tries to get more blood to flow to it

Bradycardia - body senses BP too high & tries to decrease CO

agonal respirations - occurs w/ brainstem compression (ICP)

Term
Often times you see cushing triad in ICU when the brain starts swelling -->
Definition
not necessarily in the ER
Term
Management of head injuries
Definition

safety net

ABC's - don't hyperventilate - cerebral ischemia

CT scan (w/out contrast)

urgent neuro-surgical intervential (intracranial catheter to monitor/relieve pressure)

consider mannitol infusion

evaluate C-spine

Term
_____ is used clinically in osmotherapy to reduce acutely raised intracranial pressure until more definitive treatment can be applied
Definition
mannitol
Term
it stays in the extracellular space and "draws" fluid from edematous tissue
Definition
mannitol
Term
you cannot bleed enough in your head to cause...
Definition

hypotensive shock

 

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