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Test your basic knowledge |
Emergency Medicine: Head Trauma
Start Test
Study First
Subjects
:
health-sciences
,
emergency-medicine
Instructions:
Answer 36 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. CBF is maintained when the CPP is ______
Primary treatment/management priorities of TBIs
> 60 mm Hg
Increased risk of brain injury
Mild TBI
2. The most common site of brain herniation
Mild TBI causes
Uncal Herniation
ED steps to lower ICP
Concussion
3. GCS score of 14-15
Mild TBI
Mild TBI injury
ED steps to lower ICP
Epidural Hematoma
4. GCS score of 9-13
Mild TBI causes
Increased risk of brain injury
Moderate TBI
Bilateral fixed and dilated pupils
5. A - Allergies M - Medications P - Past medical history L - time of Last meal E - Events leading up to injury
Primary treatment/management priorities of TBIs
AMPLE Acronym for HI hx
Coup Injury
1 - None 2 - Incomprehensible 3 - Inappropriate words 4 - Confused speech 5 - Oriented
6. GCS score of 3-8
Single fixed and dilated pupil
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
> 20 mm Hg
Severe TBI
7. The major caUse of brain herniations
Diffuse Axonal injury
Uncal Herniation
Contra-coup Injury
Expanding lesions
8. Caused by contusions - hematomas - diffuse axonal injury - direct cellular damage - tearing/shearing of tissues - loss of BBB - disruption of neurochemical homeostasis - loss of electrochemical function
Intracranial Pressure
Moderate - Severe TBI Causes
Expanding lesions
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
9. Battle's sign (mastoid ecchymosis) - Raccoon eyes (periorbital ecchymosis) - CSF otorrhea / rhinorrhea - hemotympanum - vertigo - decreased hearing - 7th nerve palsy
Increased risk of brain injury
Basilar skull fracture
Concussion
Ipsilateral fixed and dilated pupil
10. Blunt trauma - acceleration-decelleration injury - Traumatic disruption parenchyma and ____ vessels - blood in CSF - Symptoms of HA - photophobia - meningeal signs - Traumatic ____ common in moderate-severe TBI - Early signs = higher mortality rate
Mild TBI
Single fixed and dilated pupil
Subarachnoid hemorrhage
Pharmacology
11. GCS - Eye opening (1-4)
Cerebral Perfusion Pressure
1 - None 2 - To pain 3 - To command 4 - Spontaneous
Subarachnoid hemorrhage
1 - None 2 - Incomprehensible 3 - Inappropriate words 4 - Confused speech 5 - Oriented
12. Blunt trauma - Usually anterior temopral or posterior frontal lobe - CT may be initially normal - delayed bleed - Symptoms range from normal -> LOC
Basilar skull fracture
Intraparenchymal Hemorrhage
Bilateral fixed and dilated pupils
Uncal Herniation
13. Skull fracture causes - Immediate LOC with a 'lucid' period prior to deterioration (in 20%)
Cerebral Perfusion Pressure
Subarachnoid hemorrhage
Increased risk of brain injury
Epidural Hematoma
14. An ICP level of _____ increases subsequent morbidity and mortality
> 60 mm Hg
> 20 mm Hg
Subdural hematoma
Epidural Hematoma
15. Occurs @ site of impact with an object
Moderate - Severe TBI Causes
Coup Injury
Intraparenchymal Hemorrhage
Cerebral Perfusion Pressure
16. Any alteration in the mental state at the time of the event or subsequent to the event - 'Getting your bell rung' or 'Seeing stars' - Subtle impairment of cognitive function
Intracranial Pressure
Basilar skull fracture
Mild TBI injury
Penetrating wounds
17. GCS - Verbal (1-5)
Intraparenchymal Hemorrhage
1 - None 2 - Incomprehensible 3 - Inappropriate words 4 - Confused speech 5 - Oriented
Mild TBI injury
Subdural hematoma
18. Neurologic or neurophysiologic dysfunction w/o overt hemorrhages or other gross lesions
Single fixed and dilated pupil
AMPLE Acronym for HI hx
Mild TBI causes
Ipsilateral fixed and dilated pupil
19. Most common type of brain injury - Head injury with a temporary loss of brain function - aka: mild brain injury - mild traumatic brain injury (MTBI) - mild head injury (MHI) - and minor head trauma
Pharmacology
Concussion
Bilateral fixed and dilated pupils
Ipsilateral fixed and dilated pupil
20. The blood supply to the brain in a given time - Typically 15% of cardiac output - CBF = CPP / CVR
Pharmacology
Cerebral Blood Flow
Primary treatment/management priorities of TBIs
Diffuse Axonal injury
21. Uncal transtentorial herniation -> compression of parasympathetic fibers running with CN-III (Oculomotor) -> ________
> 20 mm Hg
Ipsilateral fixed and dilated pupil
Contra-coup Injury
Single fixed and dilated pupil
22. Occurs @ side opposite to the area that was impacted
Ipsilateral fixed and dilated pupil
Expanding lesions
Mild TBI causes
Contra-coup Injury
23. The major caUse of Brian's herniations
Bilateral fixed and dilated pupils
Pharmacology
Contra-coup Injury
Epidural Hematoma
24. Set of symptoms a patient may experience for up to a year or more after a concussion - Causes: HA - difficulty concentrating - emotional/behavioral problems (irritability)
Severe TBI
Intraparenchymal Hemorrhage
Post-Concussive syndrome
Single fixed and dilated pupil
25. Osmotic agent that can reduce ICP - Expands plasma volume (reduces hypotension) - Can improve oxygen-carrying capacity
Coup Injury
Mannitol
Moderate TBI
Intracranial Pressure
26. Blunt trauma - acceleration- deceleration - Brains with extensive atrophy (elderly and alcoholics) more susceptible to this - Acute: rapid LOC - lucid period possible - Chronic: Behavioral / AMS - gradual LOC
Subdural hematoma
Primary treatment/management priorities of TBIs
Concussion
Mild TBI
27. GCS Motor (1-6)
Cerebral Perfusion Pressure
Epidural Hematoma
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
1 - None 2 - To pain 3 - To command 4 - Spontaneous
28. 1. Prevent further secondary injury (managing hypoxemia - hypotension - anemia - hyperglycemia - hyperthermia - evacuating intracranial masses) 2. Identify treatable mass lesions 3. Identify other life-threatening injuries
Primary treatment/management priorities of TBIs
1 - None 2 - To pain 3 - To command 4 - Spontaneous
Concussion
Contra-coup Injury
29. Carefully ventilated to maintain PaCO2 levels 35-40 mm Hg - Adequate sedation -> keeps patients relaxed & inhibits gag reflex - Elevate head of bed to 30 degrees -> increases outflow of CSF from skull base - Give mannitol
> 20 mm Hg
Intraparenchymal Hemorrhage
Mannitol
ED steps to lower ICP
30. Intracranial hematoma with uncal herniation - requires rapid operative decompression
Single fixed and dilated pupil
Primary treatment/management priorities of TBIs
Penetrating wounds
> 60 mm Hg
31. Increased ICP -> Poor brain perfusion - Bilateral uncal herniation - drug effects - severe hypoxia
Post-Concussive syndrome
Ipsilateral fixed and dilated pupil
Bilateral fixed and dilated pupils
Cerebral Blood Flow
32. Athletes at highest risk - Recurrent concussions more likely after 1st
Increased risk of brain injury
Uncal Herniation
1 - None 2 - To pain 3 - To command 4 - Spontaneous
Post-Concussive syndrome
33. The pressure inside the skull and thus in the brain tissue and CSF
Intracranial Pressure
Ipsilateral fixed and dilated pupil
> 20 mm Hg
Mannitol
34. Blunt trauma - shaken baby syndrome - CT normal -> puncuate hemorrhagic injury along grey-white junction of cerebral cortex
Diffuse Axonal injury
ED steps to lower ICP
Penetrating wounds
Contra-coup Injury
35. Patients with ______ should be given immediate antibiotics (ceftriaxone 2 gm IV)
Subarachnoid hemorrhage
Subdural hematoma
> 20 mm Hg
Penetrating wounds
36. Net pressure gradient causing blood flow to the brain - Too little -> Ischemia - Too much -> Raised ICP
Subdural hematoma
Penetrating wounds
> 60 mm Hg
Cerebral Perfusion Pressure