Low-velocity vs high-velocity bullet injuries. How does each cause intracranial trauma?
Low-velocity: direct mechanical trauma
High-velocity: direct injury but also shock waves and cavitation injury
What effect does propofol and thiopental have on CBF, ICP, and CRMO2?
Reduction in each
What do benzodiazepines do to CRMO2, CBF, and ICP?
Reduction in each
What effect does ketamine have on CRMO2, CBF, and ICP?
Unclear
Some studies say decrease
Others say increase
What effect do opioids have on ICP, MAP, and CPP?
May increase ICP
May decrease MAP and CPP
What is Kernohan’s notch (false localizing sign) phenomenon?
The contralateral cerebral peduncle is pushed against the tentorial edge creating the situation of ipsilateral hemiparesis
What is the action of dopamine at dose of 2-10 mcg/kg/min?
At > 10mcg/kg/min?
2-10 mcg/kg/min: beta inotrope
> 10 mcg/kg/min: increase alpha vasoconstriction
What is action of phenylephrine?
Pure alpha sympathomimetic
What is action of norepinephrine?
Alpha 1 and 2 > Betas 1 agonist for vasoconstriction
MOA of synthetic human angiotensin II?
Vasoconstriction and increased aldosterone release
MOA of esmolol?
Selective Beta 1 blocker
(Used for rapid heart rate arrhythmias)
For any penetrating trauma, what imaging should be done at both early and delayed phases?
Angiogram to rule out pseudo-aneurysm
What are the findings in the Cushing’s reflex for herniation?
Bradycardia, Hypertension, Irregular respirations
What are the findings for vitals with spinal/neurogenic shock?
Bradycardia, Hypotension
What components of physical exam must you clearly ask for in every spinal cord injury case?
Rectal exam
Perianal sensation
Bulbocavernosus reflex
What diagnosis needs to be entertained in the severe trauma patient with long-bone fracture and poor neurologic exam?
Fat emboli
Work with consultants to stabilize long-bone fracture
Remember, fat emboli can also lead to PE as well
What important consideration must be given to anesthesia in cases of unstable or severe cervical spinal cord injury?
Fiber optic intubation
What is an important intra-op maneuver to mention when managing unstable thoracic fractures which require reduction?
Temporary rod placement during bony work
While doing an ACDF for a traumatic injury the anesthesiologist tells you there is an air leak. What do you advise the anesthesiologist to do?
Deflate cuff and move it so that is proximal to the level of your ACDF (especially if doing a low-ACDF) but distal to vocal folds. Placing a retractor over the esophagus which was the cuff can compress and cause an air leak
If a patient has a unilateral facet jump with neurologic deficit, should you obtain MRI or reduce?
Some would argue to skip MRI and do an awake closed reduction to prevent worsening
CPP goal in TBI
60-70 mm Hg
What should always be given to patients with penetrating traumatic brain and spinal cord injuries?
Tetanus toxoid booster
