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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. 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
Mild TBI injury
Cerebral Blood Flow
AMPLE Acronym for HI hx
Concussion
2. GCS Motor (1-6)
1 - None 2 - To pain 3 - To command 4 - Spontaneous
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
Increased risk of brain injury
Epidural Hematoma
3. 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
Mild TBI
Subdural hematoma
1 - None 2 - To pain 3 - To command 4 - Spontaneous
Expanding lesions
4. Blunt trauma - Usually anterior temopral or posterior frontal lobe - CT may be initially normal - delayed bleed - Symptoms range from normal -> LOC
> 60 mm Hg
Basilar skull fracture
Mild TBI
Intraparenchymal Hemorrhage
5. An ICP level of _____ increases subsequent morbidity and mortality
Bilateral fixed and dilated pupils
Contra-coup Injury
ED steps to lower ICP
> 20 mm Hg
6. 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
ED steps to lower ICP
Mild TBI causes
Moderate TBI
7. Skull fracture causes - Immediate LOC with a 'lucid' period prior to deterioration (in 20%)
Intraparenchymal Hemorrhage
> 60 mm Hg
Epidural Hematoma
Subdural hematoma
8. Osmotic agent that can reduce ICP - Expands plasma volume (reduces hypotension) - Can improve oxygen-carrying capacity
Mannitol
Diffuse Axonal injury
Subarachnoid hemorrhage
Penetrating wounds
9. 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)
Uncal Herniation
Intracranial Pressure
Subdural hematoma
Post-Concussive syndrome
10. Occurs @ site of impact with an object
AMPLE Acronym for HI hx
Coup Injury
Intracranial Pressure
Subarachnoid hemorrhage
11. The pressure inside the skull and thus in the brain tissue and CSF
Contra-coup Injury
Intracranial Pressure
Mild TBI injury
Post-Concussive syndrome
12. Battle's sign (mastoid ecchymosis) - Raccoon eyes (periorbital ecchymosis) - CSF otorrhea / rhinorrhea - hemotympanum - vertigo - decreased hearing - 7th nerve palsy
Expanding lesions
Diffuse Axonal injury
Basilar skull fracture
Coup Injury
13. The most common site of brain herniation
Uncal Herniation
Cerebral Blood Flow
Expanding lesions
Mild TBI causes
14. 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
> 20 mm Hg
Diffuse Axonal injury
Uncal Herniation
Mild TBI injury
15. Occurs @ side opposite to the area that was impacted
> 20 mm Hg
Epidural Hematoma
Cerebral Blood Flow
Contra-coup Injury
16. The major caUse of brain herniations
Mild TBI
1 - None 2 - Incomprehensible 3 - Inappropriate words 4 - Confused speech 5 - Oriented
Expanding lesions
Mild TBI injury
17. Neurologic or neurophysiologic dysfunction w/o overt hemorrhages or other gross lesions
Mild TBI causes
Subarachnoid hemorrhage
> 60 mm Hg
Subdural hematoma
18. GCS score of 3-8
Severe TBI
Contra-coup Injury
Coup Injury
> 60 mm Hg
19. 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
Severe TBI
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
1 - None 2 - Incomprehensible 3 - Inappropriate words 4 - Confused speech 5 - Oriented
ED steps to lower ICP
20. Net pressure gradient causing blood flow to the brain - Too little -> Ischemia - Too much -> Raised ICP
ED steps to lower ICP
Cerebral Perfusion Pressure
Uncal Herniation
Single fixed and dilated pupil
21. The blood supply to the brain in a given time - Typically 15% of cardiac output - CBF = CPP / CVR
Cerebral Blood Flow
Moderate - Severe TBI Causes
Subdural hematoma
Concussion
22. Athletes at highest risk - Recurrent concussions more likely after 1st
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
Increased risk of brain injury
Expanding lesions
Moderate TBI
23. GCS - Verbal (1-5)
1 - None 2 - Incomprehensible 3 - Inappropriate words 4 - Confused speech 5 - Oriented
Contra-coup Injury
AMPLE Acronym for HI hx
Mild TBI
24. Uncal transtentorial herniation -> compression of parasympathetic fibers running with CN-III (Oculomotor) -> ________
Basilar skull fracture
Contra-coup Injury
Intracranial Pressure
Ipsilateral fixed and dilated pupil
25. A - Allergies M - Medications P - Past medical history L - time of Last meal E - Events leading up to injury
Epidural Hematoma
AMPLE Acronym for HI hx
Cerebral Blood Flow
Bilateral fixed and dilated pupils
26. CBF is maintained when the CPP is ______
Primary treatment/management priorities of TBIs
Penetrating wounds
> 60 mm Hg
1 - None 2 - To pain 3 - To command 4 - Spontaneous
27. GCS - Eye opening (1-4)
Mannitol
Moderate - Severe TBI Causes
1 - None 2 - To pain 3 - To command 4 - Spontaneous
Basilar skull fracture
28. 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
Primary treatment/management priorities of TBIs
Penetrating wounds
29. Intracranial hematoma with uncal herniation - requires rapid operative decompression
Primary treatment/management priorities of TBIs
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
Single fixed and dilated pupil
Mild TBI causes
30. The major caUse of Brian's herniations
Pharmacology
Ipsilateral fixed and dilated pupil
> 20 mm Hg
Moderate TBI
31. GCS score of 9-13
Severe TBI
Intraparenchymal Hemorrhage
Moderate TBI
Ipsilateral fixed and dilated pupil
32. 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
ED steps to lower ICP
Primary treatment/management priorities of TBIs
Subarachnoid hemorrhage
Pharmacology
33. GCS score of 14-15
Expanding lesions
Mannitol
Pharmacology
Mild TBI
34. Increased ICP -> Poor brain perfusion - Bilateral uncal herniation - drug effects - severe hypoxia
Ipsilateral fixed and dilated pupil
Concussion
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
Bilateral fixed and dilated pupils
35. Blunt trauma - shaken baby syndrome - CT normal -> puncuate hemorrhagic injury along grey-white junction of cerebral cortex
Concussion
ED steps to lower ICP
Diffuse Axonal injury
Contra-coup Injury
36. Patients with ______ should be given immediate antibiotics (ceftriaxone 2 gm IV)
Increased risk of brain injury
Contra-coup Injury
Penetrating wounds
Mannitol