ATLS 10 NEWEST 2024/2025 TEST BANK WITH QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATION, Exams of Nursing

Download ATLS 10 NEWEST 2024/2025 TEST BANK WITH QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATION and more Exams Nursing in PDF only on Docsity! 1 In the elderly population, what is decreased physiological reserve? - ANSWER-aging is characterized by impaired adaptive and homeostatic mechanisms that caused an increased susceptibility to the stress of injury. Insults tolerated by the younger population can lead to devastating results in elderly patients. Pre-existing conditions that affect morbidity and mortality include: - ANSWER-cirrhosis, coagulopathy, COPD, ischemic heart disease, DM ATLS 10 NEWEST TEST BANK WITH QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ 2 True or false? Although the mechanism of injury may be similar to those for the younger population, data shows increased mortality with similar severity of injury in older adults. - ANSWER-True What is the most common mechanism of injury in the elderly? - ANSWER-Fall. Nonfatal falls are common in women and fractures are common in women who fall. Falls are the most common cause of TBI. In the elderly population, what are risk factors for falls? - ANSWER-advanced age, physical impairment, history of previous fall, medication use, dementia, unsteady gait, and visual, cognitive impairment Most of elderly traffic fatalities occur in the daytime and on weekends and typically involve other vehicles. Why? - ANSWER- Older people drive on more familiar roads and at lower speeds and tend to drive during the day. Older people have slower reaction time, a larger blind spot, limited cervical mobility, decreased hearing, and cognitive impairment. True or False? Mortality associated with small to moderate sized burns in older adults remains high - ANSWER-True 5 In elderly population, due to their changes in pulmonary system, placing a gauze between gums and cheek to achieve seal when using bag valve mask ventilation is okay. In addition, because aging causes a suppressed heart rate response to hypoxia...... - ANSWER-respiratory failure may present insidiously in older adults. Age related changes in the cardiovascular system place the elderly trauma patient at significant risk for being inaccurately categorized as hemodynamically stable. - ANSWER-Elderly patients have a fixed heart rate and fixed cardiac output, thus, their response to hypovolemia will involve increasing their systemic vascular resistance. Furthermore, since older patients have HTN, an acceptable BP may truly reflect a hypotensive state. A systolic BP of 110 is to be utilized as the threshold for identifying hypotension in patients 65 and older. Do no equate blood pressure with shock in older patients - ANSWER-BP in older patients may look normal due to the medications they are on. Use lactate and base deficit to evaluate for evidence of shock what 2 factors place elderly patients at risk for intracranial hemorrhage? - ANSWER-aging causes dura to become more adherent to the skull increasing risk of injury and older patients are on anticoagulant and antiplatelet medications. 6 Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place elderly patients as risk for hypothermia and complications for immobility. - ANSWER-Rapid evaluation and when possible early liberation from spine boards and cervical collars will minimize complications. True or False: Fall prevention is the mainstay of reducing the mortality associated with pelvic fractures. - ANSWER-true poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs, palms, soles, scalp, ear, nasal bridge and temple injury from being struck while wearing glasses, contact burns and scalds. These are all signs of.......? - ANSWER- Elder maltreatment. The presence of physical findings of maltreatment should prompt a detailed history. if history conflicts with findings, immediately report findings to authorities. True of false: early activation of the trauma team may be required for elderly patients who do not meet traditional criteria for activation - ANSWER-True. A simple injury such as an open tibia fracture in a frail elderly patient may become life threatening. Common mechanisms of injury include falls, MVC, burns, and penetrating injuries - ANSWER-common injuries in the elderly include rib fractures, TBI, pelvic fractures 7 The best initial treatment for the fetus is to provide optimal resuscitation of the mother. True or False? - ANSWER-True. Also if xray examination is indicated during the pregnant patient's treatment, it should not be withheld because of the pregnancy. What happens as the uterus enlarged and the bowel is pushed cephalad. - ANSWER-When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the upper abdomen. As a result, the bowel is somewhat protected from blunt abdominal trauma, whereas the uterus and its contents (fetus and placenta) become more vulnerable. Uterus remains intrapelvic until 12 weeks and then at 20 weeks it is at the umbilicus, and at 34-36 weeks it reaches the costal margin. Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation following trauma if fluid enters maternal intravascular space. True or False - ANSWER- True By the third trimester, what is the complication of trauma to the pelvis of the mother? - ANSWER-by the third trimester, the uterus is large and thin walled. In vertex presentation, fetal head is usually in the pelvis and the remainder of the fetus is exposed above the pelvic brim. Pelvic fractures in late gestation can result in skull fracture or intracranial injury to the fetus. Also we can have a placental abruption due to its little elasticity and vulnerability to sheer forces. 10 Anatomical alterations in the thoracic cavity seem to account for the decreased residual volume associated with diphragmatic elevation and chest x ray reveals increased lung marking and prominence of the pulmonary vessels. - ANSWER-oxygen consumption increases during pregnancy and its important when resuscitating injured pregnant patients to maintain adequate oxygenation above 95% In patients with advanced pregnancy, those that require a chest tube placement, where should the test tube be placed? - ANSWER-it should be positioned higher to avoid intra- abdominal placement given the elevation of the diaphragm. Urinary system: what happens to the GFR, serum creatinine and urea nitrogen levels? - ANSWER-GFR and renal blood increases during pregnancy, whereas levels of the serum creatinine and urea nitrogen fall to one half of the normal pre pregnancy levels. Glycosuria is common in pregnancy. When interpreting x ray films of the pelvis in a pregnant patient, the symphysis pubis widens 4-8 mm and the sacroiliac joint spaces increase by the 7th month - ANSWER-keep this in mind Eclampsia - ANSWER-Maintain a high index of suspicion for eclampsia when seizures are accompanied by HTN, proteinuria, 11 hyperreflexia, and peripheral edema in pregnant trauma patients. This can mimic head injury. External contusions and abrasions of the abdominal wall are signs of blunt uterine trauma. - ANSWER-true. Fetal injuries can occur when the abdominal wall strikes an object, such as the dashboard or steering wheel, or when a pregnant patient is struck by a blunt instrument. Using a shoulder restraints in conjunction with a lap belt reduces the likelihood of direct and indirect fetal injury, presumably because the shoulder belt dissipates deceleration forces over a great surface area and helps prevent the mother from flexing forward over the gravid uterus. - ANSWER-the deployment of air bags in vehicles does not appear to increase pregnancy specific risks. Using lap belt alone allows for forward flexion and uterine compression with possible uterine rupture or placental abruption. Lap belt worn too high over uterus may produce uterine rupture. Penetrating injury to pregnant women - ANSWER-As uterus grows larger, other viscera are protected from penetrating injury. Dense uterine musculature in early pregnancy can absorb significant amount of energy from penetrating objects decreasing their velocity and lowering risk of injury to other viscera. However, fetal outcome is generally poor with penetrating injury to uterus. 12 carefully observe pregnant patients with even minor injuries since occasionally minor injuries are associated with placental abruption and fetal loss. - ANSWER-True. AND to optimize outcomes for mother and baby, clinicians must assess and resuscitate the mother first and then assess the fetus before conducting second survey of the mother. Failure to displace the uterus to the left side in a hypotensive pregnant patient - ANSWER-logroll all patients appearing clinically pregnant (second and third trimester) to the left 15-30 degrees and elevate the right side 4-6 inches and support with a bolstering device to maintain spinal motion restriction and decompression of the vena cava. Due to increases intravascular volume, pregnant patients can lose a significant amount of blood before tachycardia, hypotension, and other signs of hypovolemia occur. Thus, what do stable vital signs in a pregnant patient indicate about the fetus? - ANSWER-The fetus may be in distress and the placenta deprived of vital perfusion while the mother's condition and vital signs appear stable. Administer crystalloid fluid resuscitation and blood to support the physiological hypervolemia of pregnancy. vasopressers should be an absolute last resort in restoring maternal blood pressure as they further reduce uterine blood flow, resulting in fetal hypoxia. What does a normal fibrinogen level indicate in a pregnant patient? - ANSWER-Fibrinogen level may double in late 15 Admission to hospital for pregnant patients: - ANSWER- vaginal bleeding, uterine irritability, abdominal tenderness, pain or cramping, evidence of hypovolemia, changes in or absence of fetal heart tones and or leakage of amniotic fluid With extensive placental separation or amniotic fluid embolization, widespread consumptive coagulopathy can emerge rapidly causing depletion of fibrinogen, other clotting factors, and platelets. - ANSWER-immediately perform uterine evacuation and replace platelets, fibrinogen, and other clotting factors. As little as 0.01mL of RH+ blood will sensitize 70% of Rh- women. - ANSWER-All pregnany RH negative trauma patients should receive RH immunoglobulin therapy unless injury is remote from the uterus (isolated distal extremity injury) Intimate partner violence in pregnant patient: - ANSWER- injuries inconsistent with history, diminished self image, depression or suicide attempts, self abuse, frequent ED visits, symptoms suggestive of substance abuse, isolated injuries to the gravid abdomen, parter insists on being present for the interview and exam and monopolizes discussion What is the difference between burns and other injuries? - ANSWER-The biggest difference is that the consequences of burn injury are directly linked to the extent of the inflammatory response to the injury. The larger and deeper the burn, the 16 worse the inflammation. 17 Flame injury is more evident than most chemical injuries. - ANSWER-Monitor IV lines closely to ensure they do not become dislodged as the patient becomes more edematous. Regularly check ties securing ET or NG to ensure they are not too tight. Factors that increase the risk of upper airway obstruction are: - ANSWER-increasing burn size and depth, burns to the head and face, inhalation injury, associated trauma, and burns inside the mouth. Airway can become obstructed form direct injury such as inhalation injury, but also from massive edema resulting from burn injury. How do you decontaminate burn areas? - ANSWER-Completely remove the patient's clothing to stop burning process, but do not peel off adherent clothing. Synthetic fabrics can ignite, burn rapidly at high temps and melt into hot residue that continues to burn the patient. brush any dry chemical powder from wound. rinse with copious amounts of warm saline irrigation or rinsing in a warm shower. once the burning process has been stopped, cover the patient with warm, clean, dry linens to prevent hypothermia. hoarseness, stridor, accessory respiratory muscle use, sternal retraction are signs of what? - ANSWER-airway obstruction. Clinical manifestations of inhalation injury may be subtle and may not show up within the first 24 hours. do not wait for the xray to show evidence of pulmonary injury or changes in 20 confusion (30-40%), coma (40-60%) and death (>60%). Cherry red skin color in patients may only be seen in moribund patients. Measurements of arterial PaO2 do not reliably predict CO poisoning b/c a partial pressure of only 1 mm Hg results in an HbCO level of 40% or greater. Pulse ox cannot be relied on to rule out carbon monoxide poisoning b/c we cant distinguish oxyhemoglobin from carboxyhemoglobin. A discrepancy between pulse ox and arterial blood gas may be explained by presence of carboxyhemoglobin. Cyanide inhalation poisoning can occur in confined spaces and sign of potential toxicity is persistent profound unexplained metabolic acidosis. - ANSWER-THERE IS NO ROLE for hyperbaric oxygen therapy in the primary resuscitation of a patient with critical burn injury. American Burn Association states 2 requirements for diagnosis of smoke inhalation injury: - ANSWER-1. exposure to combustible agent 2. signs of exposure to smoke in the lower airway, below the vocal cords, seen on bronchoscopy. A chest Xray and arterial blood gases should be ordered to evaluate the pulmonary status of a patient with smoke inhalation injury, but normal values on admission DO NOT exclude an inhalation injury. 21 The treatment of smoke inhalation injury is supportive. - ANSWER-Any patient with smoke inhalation injury and significant burns greater than 20% TBSA should be intubated. IF the patient's hemodynamic condition permits and spinal injury has been excluded, elevate the patient's head and chest 30 degrees to help reduce neck and chest wall edema. True or false: Clinicians should provide burn resuscitation fluids for deep partial and full thickness burns larger than 20% TBSA - ANSWER-True. urine output monitoring is 0.5mL/kg/hr in adults and should be maintained at 30-50cc/hr to minimize over resuscitation in a burn patient, cardiac dysrhytmias may be the first sign of hypoxia and electrolyte or acid base abnormalities. - ANSWER- therefore an ECG should be performed for cardiac rhythm disturbances. Persistent acidemia in patients with burn injuries may be due to under resuscitation or infusion of large volumes of saline. Tachycardia is a poor indication for resuscitation in the burn patient. - ANSWER-Adjust the fluid rate up or down based on the urine output and recognize that factors such as inhalation injury, age of patient, renal failure, diuretics, and alcohol can affect the volume of resuscitation and urine output. 22 True of false: Burn patients should get tetanus. - ANSWER-true Partial thickness burns - ANSWER-are characterized as either superficial partial thickness (moist, painfully hypersensitive, , potentially blistered, homogenously pink, and blanch to touch) or deep partial thickness ( drier, less painful, potentially blistered, red or mottled in appearance, and do not blanch to touch) Full thickness burns - ANSWER-appear leathery and skin may be white or translucent or waxy white. surface area is painless to light touch or pinprick and generally dry Compartment syndrome in burn patients: - ANSWER- Compartment syndrome can result from an increase in pressure inside the compartment that interferes with perfusion to the structures within that compartment. In burns, this condition results from a combination of decreased skin elasticity and increased edema in the soft tissue. A pressure > 30 mm Hg within the compartment can lead to muscle necrosis and once the pulse is gone it may be TOO LATE to save the muscle. so recognize the signs early: pain greater than expected and out of proportion to the injury pain on passive stretch of the affected muscle tense swelling of the affected compartment paresthesias or altered sensation distal to the affected compartment 25 to examine patient for skeletal and muscular damage, especially for fractures of the spine and rhabdomyolysis How do you dissolve a tar burn? - ANSWER-Use mineral oil Abuse and burns - ANSWER-circular burns and burns with clear edges and unique patterns may reflect cigarette burns or iron. Burns on the sole of the feet usually suggest child was placed in hot water. A burn on the posterior aspect of the LE and buttocks Patient with electrical burn can develop for acute renal failure - ANSWER-remember these burns can cause serious muscle damage without showing signs outright. Test urine for hemochromogen and administer proper volume. Assess for compartment syndrome and attach EKG leads as electrical injury can cause arrhythmias. Frostbite is due to freezing of tissue with intracellular ice crystal formation, microvascular occlusion, and subsequent tissue anoxia. - ANSWER-first degree: hyperemia and edema are present w/o skin necrosis second degree: large clear vesicles accompany the hyperemia and edema with partial thickness skin necrosis. third degree frostbite: full thickness skin necrosis including muscle and bone with later necrosis 26 treatment is circulating water at constant 40 degrees C or 104F until pink color and perfusion return in 20-30 minutes. In frostbite injury, warming large areas can result in reperfusion syndrome, with acidosis, hyperK and local swelling. - ANSWER- therefore monitor the patient's cardiac status and peripheral perfusion during rewarming. Sympathetic blockade agents and vasodilating agents have shown to be effective in altering the progression of acute cold injury - ANSWER-false hypothermia is a core temp below 36C or 96.8F - ANSWER- hypothermia can worsen coagulopathy and affect organ function. Rhabdomyolysis can lead to metabolic acidosis, hyperK, hypoC, and DIC. - ANSWER-Myoglobin induced renal failure can be prevented with intravascular fluid expansion, alkalinization of the urine by IV administration of Bicarbonate and osmotic diuresis. For MSK trauma, loss of sensation in a stocking or glove distribution is an early sign of.... - ANSWER-early sign of vascular impairment Knee dislocations can reduce spontaneously and may not 27 present with any gross external or radiographic anomalies until 30 cold significantly contaminated 31 ischemic tissue or denervated wounds True or false? on page 162. To exclude occult dislocation and concomitant injury, x ray films must include the joints above and below the suspected fracture site - ANSWER-true. unless life threatening, splinting of extremity injuries should be done during the secondary survey. do not apply traction to patients with an ipsilateral tibia shaft fracture. - ANSWER-true Laryngeal Trauma presents as hoarseness, subcutaneous emphysema, and palpable fracture - ANSWER-true. sounds of airway obstruction and include snoring, gurgling, stridor, hoarseness, cyanosis, agitation LEMON assessment for difficult airway - ANSWER-Look, evaluate 3-3-2 rule, mallampati, obstruction, neck mobility Do not give a nasopharyngeal airway to someone suspected of having a cribriform plate fracture. - ANSWER-also do not give nasotracheal intubation to patients with basillar skull fracture A tube placed in the trachea with the cuff inflated below the vocal cords and the tube connected to oxygen enriched assisted 32 ventilation and airway secured in place. - ANSWER-definitive airway patients use the gum elastic bougie when vocal cords cannot be visualized on direct laryngoscopy. - ANSWER-using the GEB has allowed for rapid intubation of nearly 80% of prehospital patients in whom laryngoscopy was difficult. A GEB inserted into the esophagus will pass its full length without resistance Reliable ways to detect proper intubation - ANSWER-proper placement of the tube is suggested but not confirmed: 1. hearing equal breath sounds bilaterally 2. detecting no borborygmi (rumbling or gurgling noises) in the epigastrium. the presence of this with inspiration suggestion esophageal intubation and warrants removal of tube 3. A CO2 detector ideally capnograph or colorimetric CO2 monitoring device. If CO2 is not detected in exhaled air, then esophageal intubation has occurred. 4. Proper position of the tube is best confirmed via chest xray definitive control of hemorrhage and restoration of adequate circulating volume are the goals of treating hemorrhagic shock. - ANSWER-never give vasopressors as the first line treatment as they worsen tissue perfusion. most injured patients who are in hemorrhagic shock require early surgical intervention or angioembolization to reverse the shock state. The presence of 35 31-40% blood loss. heart rate increase, respiratory rate increase, blood pressure decrease, pulse pressure decrease, urine output and GCS decrease - ANSWER-class III and this is the least amount of blood loss that consistently causes a drop in systolic blood pressure. blood products needed and base deficit is -6 to - 10 > 40% blood loss. heart rate increase, RR increase, BP decrease, pulse pressure decrease, urine output and GCS decrease - ANSWER-MTP and base deficit is -10 or less A chest xray must be obtained after attempts at inserting a subclavian or IJ to document position of line and evaluate for pneumo or hemothorax. - ANSWER-do not use sodium bicarb to treat metabolic acidosis from hypovolemic shock Hypothermia can be prevented and reversed by storing crystalloids in a warmer or infusing them through intravenous fluid warmers. - ANSWER-blood products cannot be store in a warmer, but they can be heated by passage through intravenous fluid warmers. Fluids should be warmed to 39C or 102.2F before infusing them. Massive fluid resuscitation with the resultant dilution of platelets and clotting factors (severe hemorrhage and injury results in consumption of coagulation factors and early coagulopathy) 36 contributes to coagulopathy in injured patients. - ANSWER-The response of elderly patients, athletes, pregnant patients, patients on medications, hypothermic patients, and patients with pacemakers or implantable devices may have different set of vitals in response to shock. Older patients are unable to increase their HR when stressed by blood volume loss. A systolic BP of 100 may represent shock in an elderly patient. Due to medications, HR may not increase in the elderly population when in shock. - ANSWER- Blood volumes may increase 15-20% in athletes, cardiac output can increase 6 fold and the rest HR can be 50. Trained athletes have a remarkable ability to compensate for blood loss and they may not manifest the usual way to hypovolemia, even with significant blood loss. Patients suffering from hypothermia and hemorrhagic shock do not respond as expected to the administration of blood products and fluid resuscitation. IN hypothermia, coagulopathy may develop and worsen. - ANSWER-When a patient fails to respond to fluid therapy one or more of these causes may be: tension pneumothorax, cardiac tamponade, undiagnosed bleeding, unrecognized fluid loss, acute gastric distention, MI, diabetic acidosis, neurogenic shock Tracheobronchial injury will present with hemoptysis, cervical subcutaenous emphysema, tension pneumothorax, and/or cyanosis. - ANSWER-A bronchoscopy can confirm the diagnosis, but these patients require immediate surgical consultation. 37 intubation of these patients may be difficult, so they may need fiber optic assisted ET what are these signs and symptoms describing? chest pain, air hunger, tachypnea, respiratory distress, tachycardia, hypotension, tracheal deviation away from side of injury, unilateral absence of breath sounds, neck vein distention, cyanosis (late manifestation), hyperresonance on percussion - ANSWER-tension pneumothorax. initially, you can do a needle decompression or finger thoracostomy. place tube in afterwards pain, difficulty breathing, tachypnea, decreased breath sounds on affected side, and noisy movement of air through chest wall injury - ANSWER-these are signs and symptoms of an open pneumothorax. sterile occlusive dressing large enough to overlap the wound's edges and tap it securely on 3 sides Causes of Pulseless Electrical Activity - ANSWER-hypovolemia, hypokalemia, hyperkalemia, hypoglycemia, hypothermia, toxins, cardiac tamponade, tension pneumothorax, thrombosis Massive hemothorax is suggested when a patient is in shock and has decreased breath sounds or dullness to percussion on one side of the chest with collapsed neck veins - ANSWER-chest tube at the fifth intercostal space at the midaxillary line and you get a return of 1500mL or 1/3 or more of the patient's blood in the chest, that indicated the need for urgent thoracotomy. persistent 40 sinus tachycardia, AFib, bundle branch block, elevated central venous pressure without any obvious cause may indicate right ventricular dysfunction secondary to contusion. - ANSWER- cardiac troponins can be diagnostic in an MI but have little role in diagnosing blunt cardiac injury. patients with a blunt injury to the heart diagnosed by conduction abnormalities are at increased risk for sudden dysrhythmias and need to be monitored for 24 hours. Traumatic aortic disruption- most survive if they have an incomplete laceration near the ligmentum arteriosum. commonly caused by vehicle collision or fall from a great height. have a high index of suspicion if history has decelerating force. - ANSWER-Look for widened mediastinum on chest xray, obliteration of the aortic knob, deviation of the trachea to the right, depression of the L mainstem bronchus, elevation of R mainstem bronchus, deviation of the esophagus to the right, left hemothorax, presence of the pleural or apical cap, fractures of the first or second rib or scapula, widened paraspinal interface, widened paratracheal stripe. In a traumatic aortic rupture, heart rate and blood pressure control can decrease the likelihood of rupture. - ANSWER- definitive treatment is surgery. Diaphragmatic injury-displaced bowel, stomach, and nasogastric tube on left side. - ANSWER-The appearance of peritoneal lavage fluid in the chest tube also confirms diagnosis 41 esophageal injury- clinical picture is a patient with a left pneumothorax or hemothorax without a rib fracture who has received a severe blow to the lower sternum or epigastrum and is in pain or shock out of proportion to the apparent injury - ANSWER-presence of mediastinal air also suggests diagnosis and definitive treatment is direct repair of the injury. injuries to the retroperitoneal structures are difficult to recognize because they occur deep within the abdomen and may not initially present with signs or symptoms of peritonitis. - ANSWER-the retroperitoneal space is NOT sampled by DPL or FAST physical exam findings suggestive of a pelvic fracture include: - ANSWER-ruptured urethra, scrotal hematoma or blood at the urethral meatus, discrepancy in limb length and rotational deformity of a leg w/o obvious fracture. use pelvic binder that is centered at the greater trochanters rather than over the iliac crests. signs of urethral injury include: - ANSWER-blood at the uretheral meatus, ecchymosis or hematoma of the scrotum and perineum. Palpation of the prostate gland is NOT a reliable sign of urethral injury. 42 a retrograde urethorgram is mandatory when the patient is unable to void, requires a pelvic binder, or has blood at the meatus, scrotal hematoma, or perineal ecchymosis. confirm an intact urethra before inserting a urinary catheter. DPL: Aspiration of gastrointestinal contents, vegetable fibers, or bile through the lavage mandate laparotomy. Aspiration of 10cc or more of blood in hemodynamically abnormal patients requires laporotomy. - ANSWER-performed rapidly, invasive procedure sensitive for detecting intraperitoneal hemorrhage low specificity requires gastric and urinary decompression not repeatable a positive DPL is an indication for laparotomy contraindications include previous abdominal operations, morbid obesity, advanced cirrhosis, pre-existing coagulopathy. FAST - ANSWER-noninvas and can be done rapidly repeatable does not assess retroperitoneal structures. obesity can degrade images obtained by FAST 45 uncal herination - ANSWER-ipsilateral pupillary dilation associated w/contralateral hemiparesis and loss of pupillary response to light ICP - ANSWER-normal is 10. > 22 has poor outcomes. increased ICP decreases cerebral perfusion pressure. monroe kellie doctrine states that total volume of intracranial contents must remain constant because cranium is a rigid container incapable of expanding. CPP= MAP -ICP - ANSWER-a MAP of 50-150 is autoregulated to maintain a constant cerebral blood flow. GCS of 8 or less= severe brain injury GCS of 9-12= moderate GCS of 13-15= mild Indications for CT scanning - ANSWER-GCS < 15 at 2 hours after injury suspected open or depressed skull fracture any sign of basilar skull fracture emesis more than 2 episodes age > 65 anticoagulant use 46 LOC > 5 minutes amnesia before impact Goals of treatment of brain injury - ANSWER-systolic BP > 100 temp 36-38 Glucose 80-180 Hgb > 7 PaCO2 35-45 ICP 5-15 pulse ox > 95 NA 135- 145 TBI treatment - ANSWER-IV fluids & hypertonic saline (do not give hypotonic fluids or glucose containing fluids because this can harm the injured brain) Avoid hyponatremia reversal of anticoagulants 47 Hyperventilation to keep PaCO2 at 35-temporizing measure Mannitol-do not give to patients with hypotension