Term
| what does the glasgow coma scale consist of? |
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Definition
| best motor response, verbal response, and eye opening. (limitation includes problems like eyes being swollen). a glasgow score less than 8 is severe. the better the glasgow score in the beginning, the better the outcome should be. |
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Term
| what are the stages of injury? |
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Definition
| primary (initial trauma) and secondary (body's response). modulating the secondary response is where a lot of improvement can occur. |
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Term
| what % of head injury pts who come into the ER and are talking will die? |
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Definition
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Term
| what are two vessels in the scalp, which if lacerated could be fatal? |
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Definition
| occipital or superficial temporal artery |
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Term
| what needs to be tested in the case of a skull laceration? |
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Definition
| put a glove on and see if you can feel a jagged edge of the bone |
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Term
| what is a very important type of skull fracture? |
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Definition
| temporal bone fracture (longitudinal/transverse) - b/c can lacerate the middle meningeal artery = epidural hematoma |
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Term
| what is a cerebral concussion? how is the severity determined? |
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Definition
| functional (not structural) damage to the brain. severity of a concussion = duration of amnesia. it has been decided that if you are knocked in the head and do not lose consciousness but do experience amnesia that this is still considered a concussion. |
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Term
| what are the 2 kinds of amnesia? what should be the relationship between these? |
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Definition
| anterograde (memory damaged from injury on) and retrograde (don't remember the past before injury). the duration of both *should be approximately the same. document this the first time you see the pt. |
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Term
| what % of pts still have problems after a standard concussion? |
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Definition
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Term
| what is the most sensitive brain function in head trauma? |
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Definition
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Term
| what is the scientific basis for retrograde memory loss sustained during trauma? |
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Definition
| short term memory -> long term memory is a RNA synthetic process, and when you have a concussion: all cerebral metabolism stops. |
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Term
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Definition
| parenchymal brain damage (bruise) caused by contact between the surface of the brain and the bony protuberances of the base of the skull. characteristic distribution: frontal poles, orbital gyri, temporal poles, occasionally inferior surfaces of the cerebellum. they can blossom (spread) over time and thus require hospital monitoring. |
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Term
| where are most subarachnoid hemorrhages (SAH)? what characterizes SAH due to trauma? |
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Definition
| in the sulci or cortical surface (not usually the skull base). SAH due to trauma may look like an aneurysmal bleed, but may have more peripheral blood and are less associated w/vasospasm and rebleeding (but need to determine if SAH or trauma occurred first). |
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Term
| what characterizes diffuse axonal injury/shear injury? |
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Definition
| these are deceleration injuries, usually associated w/MVA+falls - have to do w/rotational and torsional injury of the brain. shearing of the junction between the gray and white matter = punctate hemorrhages in pons, corpus callosum, cerebellum. many pts who have this remain in a neurovegetative state. |
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Term
| what characterizes traumatic intracerebral hematoma? |
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Definition
| these are associated w/penetrating injury (but - if you see a pt in the ER w/head injury and hematoma, need remember that they could have had a hematoma first, and then fell down and had the head injury second). tx: if small, the pt will likely recover, if big - no sx either, mid-size: possible sx. |
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Term
| what characterizes traumatic subdural hematoma (SDH)? |
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Definition
| this is a rupture of the bridging veins by rapid acceleration/deceleration (can also be cortical vessel injury). this is the most common intracranial injury seen in child abuse (associated skeletal fx). acute: white on CT (tx: sx to remove clot/stop bleed), subacute: closer to intensity of brain (tx: usually wait until chronic), chronic: hypodense (tx: small hole to drain). as the blood in the hematoma metabolizes, it can become more anticoagulant-like = more pressure. younger people's brains can reexpand easier as the hematoma is metabolized - older people have more trouble w/this. |
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Term
| what characterizes traumatic epidural hematoma (EDH)? |
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Definition
| bleeding between dura and skull, less common, usually arterial bleed from middle meningeal artery (but can be tearing one of the venous sinuses – sigmoid sinus, transverse sinus or superior sagittal). almost always associated w/and near skull fracture. all EDHs can be nonfatal if early dx/tx. |
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Term
| what is the tx for GSW to the head? |
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Definition
| debridement of entrance and exit wound, remove any hematomas and leave everything else behind |
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Term
| what characterizes secondary brain injury to primary head trauma? what kind of trauma have the most association w/secondary injury? |
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Definition
| hematomas (mass lesion/shift/herniation), brain swelling, damage to brain from hypoxemia, pyrexia, hypotension, and many types of vascular injury (ischemia/vasospasm). SDH have the highest risk for all of these. |
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Term
| how do pts w/head injuries tend to present? |
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Definition
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Term
| what words should be avoided when documenting a neuro exam? |
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Definition
| lethargic, difficult to arouse, stuporous, somnolent - all too relative. consciousness is defined by 2 characteristics: content and arousal (ex: pt eyes open to voice, to painful stimulation, answers simple questions then goes back to sleep; etc) |
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Term
| what is the basic goal of craniovertebral trauma sx tx? |
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Definition
| decompress, debride, stabilize |
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Term
| how do you know if a pt w/a SDH is probably going to die? |
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Definition
| if they have a midline shift which is greater than the thickness of the SDH = intrinsic damage to the brain in addition to being compressed by the hematoma |
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Term
| are there many reasons to wait/watch pts w/sever head injury? |
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Definition
| no - stabilize with ABCs, get them to a CT scan and consult neurosurgeon |
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Term
| what characterizes spinal cord damage? |
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Definition
| almost always irreversible |
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Term
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Term
| what dermatone is the nipple line? |
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Definition
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Term
| what dermatone is the umbilicus? |
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Definition
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Term
| what dermatone is the inguinal region? |
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Definition
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Term
| what does imaging showing normal alignment of the spine in neutral position mean? |
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Definition
| nothing is guaranteed - can have unseen fractures or ligamentous disruption. always need to see the C7-T1 junction. MRI may also be necessary to see possible ligamentous damage. |
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Term
| what is the asia impairment scale? |
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Definition
| ASIA = american spinal cord injury assessment - used by drs to talk about spinal cord injury in a way similar to the Glasgow coma scale to talk about head injury. A: complete, no motor/sensory function in S4-5. B: incomplete, sensory, but not motor function is preserved in S4-5. C: incomplete, motor function is preserved below the neurological level and more than 1/2 the key muscles below have a muscle grade less than 3. D: incomplete, motor function is preserved w/muscle grade greater than 3. E: normal |
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Term
| what is spinal and neurogenic shock characterized by? |
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Definition
| initially a period of paralysis/hypotonia/areflexia, **hypotension/bradycardia** (due to a loss of sympathetic tone, causing relative hypovolemia from venous pooling - distinguished from hypovolemic shock by heart rate). conclusion of spinal shock is signified by a return of the bulbocavernousus reflex. after spinal shock concludes, not further neurologic improvement is likely. |
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Term
| what is the most common incomplete spinal cord injury? ***possible exam question**** |
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Definition
| central cord syndrome: usually occurs in pts who have already had *cervical spondylosis and *spinal stenosis and have a *hyperextension injury (or RA) = damage to central spinothalamic tracts, central corticospinal tracts = upper extremity symptoms [*upper extremity weakness, numbness and dysesthetic pain in arms and hands*]. the cervical fiber tracts for upper extremity motor/sensory are more medial than lower extremity. |
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Term
| what are the respiratory complications of central spinal cord injury? |
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Definition
| C1-3: absence of ability to breathe independently. C4: poor cough, diaphragmatic breathing, hypoventilation. C5-T6: decreased respiratory reserve. T6 or T7-L4: functional respiratory system w/adequate reserve. |
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Term
| what is the initial management of spinal cord injury? |
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Definition
| immobilize pts until you can prove that they can move, avoid hypotension, drugs: methylprednisone, naloxene, DMSO, lazaroid, and tirilazad mesylate. **the only thing steroids are really effective at reducing is peritumoral edema in the spinal cord or brain.** |
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