PDF - Trauma

Question 1

Impact of diffuse and linear force on skull?

Answer 1

Diffuse force - typically produces linear skull fracture

Focal / localized force - depressed skull fracture

Question 2

What does leakage of CSF from ear / nose signal?

Answer 2

Greater risk of infection developing in CSF / brain

Question 3

What causes brain contusion?

Answer 3

Angular or rotational, not linear, acceleration of brain

- Explains why woodpecker survives without brain injury

Question 4

What is cerebral autoregulation?

Answer 4

Vasoconstriction or dilation to preserve optimal cerebral flow despite fluctuation in systemic blood pressure
over a range of 60 to 140

CPP = MAP - ICP

Question 5

What is cushing’s response?

Answer 5

1. Elevation of systemic blood pressure in response to increased ICP to preserve cerebral blood flow
2. Bradycardia
3. Slowed respiratory rate

Question 6

Cause fixed and dilated ipsilateral pupil?

Answer 6

Uncal herniation: medial temporal lobe compression against midbrain

Question 7

What causes respiratory failure?

Answer 7

Tonsillar herniation: shifting of lower brain stem and cerebellar tonsils down the foramen magnum

Question 8

Pathology subdural?

Answer 8

Focal laceration of bridging cortical veins, which empty into larger venous sinuses
- Clot forms beneath dura compressing cortex

Question 9

Rx subdural?

Answer 9

Surgical removal hematoma after imaging

Question 10

Who is at risk for subdural?

Answer 10

Elderly atrophic brain since cortical bridging veins are stretched over a larger subdural space
- Always consider in confused elderly patient

Question 11

Pathology epidural hematoma?

Answer 11

Rupture of a MMA orvein, rarely from a torn venous sinus

- Clot forms between skull and dura often after temporal bone fracture lacerating MMA

Question 12

Presentation epidural?

Answer 12

Initial LOC followed by a lucid interval, then neurological worsening

Question 13

How to treat increased ICP?

Answer 13

Hyperventilation: reduces arterial pCO2, causing cerebral arterial vasoconstriction, reducing intracranial blood volume ICP

Question 14

Definition concussion?

Answer 14

Trauma-induced AMS that may involve LOC, typically including a brief period of confusion and amnesia

Question 15

Rx concussion?

Answer 15

Removal from sport or combat, and period of rest and therapy

Question 16

Presentation post concussion syndrome?

Answer 16

1. HA or neck ache
2. Impaired concentration or memory
3. Positional dizziness or vertigo

Question 17

Presentation Spinal shock?

Answer 17

1. Expected UMN signs absent for weeks - months

2. Hypotonia and areflexia accompany paralysis

Question 18

Presentation high cervical lesion?

Answer 18

Quadriplegia w/ respiratory paralysis, since diaphragm innervated by C3, C4 C5

Question 19

What improves outcome in spinal cord injury?

Answer 19

High-dose IV corticosteroids (dexamethasone) begun within 8 hours