neurotrauma

Question 1

what is assessed in D

Answer 1

diability

- GCS, pupils

Question 2

3 parts of GCS and scores

Answer 2

1. eyes
2. verbal
3. motor
   score 3-15

Question 3

3 score levels of GCS

Answer 3

mild - 13-15
mod - 9-12
severe

Question 4

5 possible CT findings in TBI

Answer 4

1. normal
2. epidural (lens)
3. subdural (midline shift and squished vents)
4. intracerebral contusions
5. diffuse axonal injury ( shear forces)

Question 5

Sx and mgmt of mild

Answer 5

normal CT
- no Sx
can be discharged if get to 15, or obs. at 13-14

Question 6

what to do for moderate

Answer 6

CT head
admit for obs
- if deteriorate, CT again

Question 7

what to do for severe

Answer 7

ABC are critical

- hypoxemia and hypotension incr. mortality

Question 8

what is goal in severe TBI

Answer 8

prevent more injury

Question 9

4 main things to prevent in severe

Answer 9

1. maintain CPP = MAP-ICP
2. hyperthermia
3. seizures
4. hyprglycemia

Question 10

what is monroe kelly doctrine

Answer 10

skull is rigid, so more volume will incr. ICP

Question 11

why manage ICP

Answer 11

• leads to small A compression - brain ischemia

- assoc. with worse outcomes

Question 12

when to monitor ICP

Answer 12

GCS

Question 13

4 devices to monitor ICP

Answer 13

1. intraparncyhmal
2. external ventricular (most common)
3. epidural transducer
4. subdural bolt

Question 14

what levels to aim ICP and CPP

Answer 14

ICP

Question 15

4 main contents of skull and how to manage

Answer 15

1. hematoma - craniotomy
2. CSF - drain
3. ICF/ISF - hyperosmotics
4. blood (A and V)
   V - elevate
   A - hyperventilate

Question 16

3 other ICP management tools

Answer 16

1. barbituates
2. hypothermia
3. decompressive craniotomy

Question 17

how to maintain CPP

Answer 17

• generally by reducing ICP

- can also raise MAP with epi

Question 18

what is issue with Na

Answer 18

• hypo common in TBI
• causes movement into ISF
• swelling