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Closed Head Trauma

Clinical Medicine II

How do we fix a head lac, and what must we do prior to this fix in layers, often staple, must palpate inside the lac for bony crepitus or stepoffs
Fxn of the tentorium cerebelli and falx cerebri tentorium divides cerebral hemispheres from cerebellum/ brainstem and falx: divides R and L cerebral hemispheres
Fxn of CSF cushions brain and spinal cord against trauma
What makes CSF? How much 150cc, made in choroid plexus in ventricles
What % of cardiac output does the cerebrum get 15% and only 2% mass of body
What is Cerebral Blood flow influenced by? How does it respond CO2 and some O2, Hypercapnia: vasodilation, Hypocapnia: vasoconstriction Hypoxia: vasodilation
What can we do with ↑ICP hyperventilate them to ↓CBF
What is CPP Cerebral perfusion pressure: mean arterial BP-Intracranial pressure MAP-ICP
The ability of the brain to maintain constant cerebral BF despite changes in CPP Autoregulation Range: 45-160mmHg
How does the brain autoregulate vasodilation and vasoconstriction of cerebral vessels
What does ICP depend on Brain+Blood+CSF <15mmHg (-FB)\
What happens when the brain begins to swell CSF leaves cavity to cords, then blood, the results in brain herniation’s
What are causes of ↑ICP mass lesion, hematoma, cerebral edema (anything ↓ the space in the skull)
What is a transtentorial herniation epidural hematoma, can medial force the temporal lobe (uncus) through tentorium opening
What are the two main structures compressed d/t an uncal herniation compressed CN III and corticospinal tract
Clinical findings of an uncal herniation Ipsilateral fixed, dilated pupil, contralateral weakness of arm/leg, ↓ LOC
Two types of closed head injuries Diffuse and focal
What are Diffuse lesions? Focal? concussion, diffuse axonal injury Focal: skull fx, cerebral contusion, intracerbral hemorrhage, epidural hematoma, subdural hematoma
What is a concussion transient LOC or alteration following blunt impact to dead : sec-mins (maybe hrs)
What is residual of a concussion post-concussive syndrome: HA, memory problems, anxiety, insomnia, dizziness last weeks to months
Tearing/shearing of n. fibers at time of impact diffuse axonal injury
Clinical signs of diffuse axonal injury CT may be nl, but profound neurological deficits, comas and 33% death d/t cerebral edema
Tx of isolated skull frx conservative follow up, no tx needed
Tx of a depressed skull frx palpate to identify, require surgery to elevate fragment, Abx if open
Fracture across base of temporal bone basilar skull fracture
4 signs of a basilar skull fracture hemotypanum, raccoon’s eyes, battle’s sign, CFS rhinorrhea/otorrhea
How do we dx a basilar skull frx usually clinically, CT hard to pick up this
Focal hemorrhagic area on brain: CT, often surrounded by edema cerebral contusion
What is a contrecoup lesion cerebral contusion on opposite side of the injury
What does a cerebral contusion look like an intracerebral hemorrhage or brain bleed
Parenchymal hemorrhage d/t torn BV’s, onset? intracerebral Hemorrhage (can be delayed for days)
Bleeding b/w skull and dura, characteristics epidural hematoma, “lenticular” on CT, no damage to actual brain, rapid deterioration
MOI of epidural hematoma d/t (temporal) skull fx. Which tears the middle meningeal artery
What is a subdural hematoma and chracteristics bw dura and arachnoid/brain Sickle-shaped, d/t veins
Where are subdural hematomas normally seen elderly and alcoholics d/t brain atrophy: veins span greater distance and more easily torn
What does a subacute and chronic subdural hematoma look like S: gray (still can see brain shifting) C: black still some shifting and disappearance of the lateral ventricles
What are assessment steps for head injury maintain O2/ventilation, Cushing’s reflex, neuro exam, films,
What Is the mechanism of the Cushing reflex ↑ICP takes ↑MAP to perfuse brain, baroreceptors notice ↑ BP→↓HR
Do we get plain skull XR’s no CT will show both.
What calls for a CT prolonged LOC >1m, persistant ↓ mental status, clinical suspicion of skull frx, persistent vomiting (>x1), sz, focalneuro defici
When wouldn’t we get a CT mild MOI, nl neuro, glascow of 15, someone to monitor them
Management of severe head injury ABC’s, c-spine immob. Intubate/hyperventilate to ↓CO2, elevate head to 30 degrees, correct hypotension, give IV diuretic to ↓ ICP, rapid neuro surgery evacuation
When would you admit a person w/ head injury persistent ↓ LOC, focal nneuro deficit, Sz, unreliable pt with hx of LOC
When can we discharge pt minor injury, neuro intact, reliable fam member to observe
When do sz’s occur post-traumatic immediate, early, late ↑ incidence of epilepsy. Aggressively treat!
Created by: becker15
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