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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. 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
Expanding lesions
Cerebral Perfusion Pressure
> 20 mm Hg
Mild TBI injury
2. Skull fracture causes - Immediate LOC with a 'lucid' period prior to deterioration (in 20%)
Severe TBI
Coup Injury
Cerebral Blood Flow
Epidural Hematoma
3. CBF is maintained when the CPP is ______
> 60 mm Hg
Intracranial Pressure
Mild TBI injury
Cerebral Perfusion Pressure
4. Athletes at highest risk - Recurrent concussions more likely after 1st
AMPLE Acronym for HI hx
Increased risk of brain injury
Diffuse Axonal injury
Basilar skull fracture
5. Occurs @ side opposite to the area that was impacted
Moderate TBI
Contra-coup Injury
Moderate - Severe TBI Causes
Concussion
6. The major caUse of Brian's herniations
Pharmacology
Ipsilateral fixed and dilated pupil
Subarachnoid hemorrhage
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
7. GCS score of 9-13
1 - None 2 - Incomprehensible 3 - Inappropriate words 4 - Confused speech 5 - Oriented
Post-Concussive syndrome
Moderate TBI
Concussion
8. The pressure inside the skull and thus in the brain tissue and CSF
Severe TBI
Increased risk of brain injury
Intraparenchymal Hemorrhage
Intracranial Pressure
9. 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
Subarachnoid hemorrhage
> 60 mm Hg
Single fixed and dilated pupil
Diffuse Axonal injury
10. 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
Cerebral Perfusion Pressure
1 - None 2 - Incomprehensible 3 - Inappropriate words 4 - Confused speech 5 - Oriented
Moderate - Severe TBI Causes
Cerebral Blood Flow
11. GCS Motor (1-6)
Post-Concussive syndrome
Ipsilateral fixed and dilated pupil
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
Subdural hematoma
12. An ICP level of _____ increases subsequent morbidity and mortality
> 20 mm Hg
Coup Injury
Moderate - Severe TBI Causes
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
13. The major caUse of brain herniations
Epidural Hematoma
Cerebral Blood Flow
Increased risk of brain injury
Expanding lesions
14. GCS - Verbal (1-5)
1 - None 2 - Incomprehensible 3 - Inappropriate words 4 - Confused speech 5 - Oriented
Intracranial Pressure
Contra-coup Injury
Basilar skull fracture
15. Blunt trauma - shaken baby syndrome - CT normal -> puncuate hemorrhagic injury along grey-white junction of cerebral cortex
Mild TBI injury
Diffuse Axonal injury
Concussion
Single fixed and dilated pupil
16. Neurologic or neurophysiologic dysfunction w/o overt hemorrhages or other gross lesions
Pharmacology
Moderate - Severe TBI Causes
Subdural hematoma
Mild TBI causes
17. Occurs @ site of impact with an object
Subdural hematoma
Bilateral fixed and dilated pupils
Severe TBI
Coup Injury
18. Uncal transtentorial herniation -> compression of parasympathetic fibers running with CN-III (Oculomotor) -> ________
> 60 mm Hg
Subarachnoid hemorrhage
Ipsilateral fixed and dilated pupil
AMPLE Acronym for HI hx
19. A - Allergies M - Medications P - Past medical history L - time of Last meal E - Events leading up to injury
Subarachnoid hemorrhage
AMPLE Acronym for HI hx
Intraparenchymal Hemorrhage
Moderate TBI
20. 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
1 - None 2 - To pain 3 - To command 4 - Spontaneous
Expanding lesions
Mild TBI injury
Concussion
21. The blood supply to the brain in a given time - Typically 15% of cardiac output - CBF = CPP / CVR
Intracranial Pressure
Bilateral fixed and dilated pupils
Ipsilateral fixed and dilated pupil
Cerebral Blood Flow
22. Battle's sign (mastoid ecchymosis) - Raccoon eyes (periorbital ecchymosis) - CSF otorrhea / rhinorrhea - hemotympanum - vertigo - decreased hearing - 7th nerve palsy
Primary treatment/management priorities of TBIs
Contra-coup Injury
Intraparenchymal Hemorrhage
Basilar skull fracture
23. Osmotic agent that can reduce ICP - Expands plasma volume (reduces hypotension) - Can improve oxygen-carrying capacity
Cerebral Perfusion Pressure
Contra-coup Injury
Epidural Hematoma
Mannitol
24. Net pressure gradient causing blood flow to the brain - Too little -> Ischemia - Too much -> Raised ICP
Diffuse Axonal injury
Mild TBI injury
Severe TBI
Cerebral Perfusion Pressure
25. 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
Increased risk of brain injury
ED steps to lower ICP
Primary treatment/management priorities of TBIs
Expanding lesions
26. Patients with ______ should be given immediate antibiotics (ceftriaxone 2 gm IV)
AMPLE Acronym for HI hx
Moderate - Severe TBI Causes
Penetrating wounds
Mild TBI injury
27. GCS - Eye opening (1-4)
Pharmacology
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
Cerebral Perfusion Pressure
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
Intraparenchymal Hemorrhage
Ipsilateral fixed and dilated pupil
Coup Injury
29. Intracranial hematoma with uncal herniation - requires rapid operative decompression
Single fixed and dilated pupil
Contra-coup Injury
Expanding lesions
ED steps to lower ICP
30. The most common site of brain herniation
Uncal Herniation
Diffuse Axonal injury
Severe TBI
Subarachnoid hemorrhage
31. 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)
Ipsilateral fixed and dilated pupil
Post-Concussive syndrome
Intracranial Pressure
Basilar skull fracture
32. Blunt trauma - Usually anterior temopral or posterior frontal lobe - CT may be initially normal - delayed bleed - Symptoms range from normal -> LOC
Intraparenchymal Hemorrhage
Concussion
Mild TBI causes
Mild TBI
33. 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
Moderate TBI
> 20 mm Hg
AMPLE Acronym for HI hx
34. GCS score of 14-15
Coup Injury
Mild TBI
Moderate - Severe TBI Causes
Diffuse Axonal injury
35. GCS score of 3-8
Coup Injury
Severe TBI
Mild TBI injury
Epidural Hematoma
36. Increased ICP -> Poor brain perfusion - Bilateral uncal herniation - drug effects - severe hypoxia
Primary treatment/management priorities of TBIs
AMPLE Acronym for HI hx
1 - None 2 - Incomprehensible 3 - Inappropriate words 4 - Confused speech 5 - Oriented
Bilateral fixed and dilated pupils