ATLS Written Review: Brain and Spinal Injuries, Exams of Health sciences

Download ATLS Written Review: Brain and Spinal Injuries and more Exams Health sciences in PDF only on Docsity! ATS Graded(A+)Written Review 2024 Latest 202L1 What is the primary goal of treating TBI? How is this done? - Correct answer preventing secondary brain injury. This is done by maintaining blood pressure and providing adequate profusion. After managing ABCDEs of TBI what MUST be identified if present? How is this done? - Correct answer mass lesion that requires surgical evacuation is critical! this is done with CT. NOTE: obtaining a CT should not delay patient transfer to trauma center. Which brain lobes do the following hold: 1. anterior fossa: 2. middle fossa: 3. posterior fossa: - Correct answer 1. anterior fossa: frontal lobes 2. middle fossa: temporal lobes 3. posterior fossa: lower brainstem and cerebellum What are the 3 layers of the meninges? - Correct answer dura mater, arachnoid mater, pia mater What does the dura mater adhere firmly to? - Correct answer the skull. it is tough and fibrous What layer of the meninges splits into two leaves as specific sites to enclose large venous sinuses? What do these sinuses do? - Correct answer dura mater. these sinuses provide major venous drainage from the brain. What is the midline sinus of of the brain that splits into two sinuses: bilateral transverse and sigmoid sinus? What side are these bigger on? - Correct answer The main sinus enclosed by the dura major is the midline superior sagital sinus. This splits into the sigmoid and bilateral transverse sinuses which are larger on the right side. What are the arteries that lie between the skull and the dura mater (epidural space)? - Correct answer meningeal arteries. ATLS Written Review Latest 2021 Graded A What is the most commonly injured meningeal artery and where is it located? - Correct answer middle meningeal artery. Located over the temporal fossa T/F: the arachnoid mater is fused to the dura mater? - Correct answer FALSE: not attached. This produces a potential space for a subdural hematoma In a subdural hematoma, what is the cause? - Correct answer injury to bridging veins that extend from brain surface to the sinuses within the dura. _______ fills the space between the arachnoid and pia mater? - Correct answer CSF. this cushions the brain and spinal cord. What location of brain hemorrhage is frequently seen in brain contusion or injury to major blood vessels at base of brain? - Correct answer subarachnoid. The ____ and _____ contain the reticular activating system which is responsible for ____. - Correct answer midbrain and upper pons state of alertness What important function resides in the medulla? - Correct answer cardiorespiratory centers. What important functions are in the following brain segments: 1. left hemisphere: 2. frontal lobe: 3. parietal lobe: 4. temporal: - Correct answer 1. left hemisphere: language center 2. frontal lobe: executive function, emotions, motor 3. parietal lobe: sensory function/spatial orientation 4. temporal: memory functions What divides the brain into supratentorial and infratentorial compartments? - Correct answer tentorium cerebelli. (tent over cerebellum) What is the physiology behind a blown pupil? - Correct answer blown pupil: dilation of pupil ATLS Written Review Latest 2021 Graded A What is the classic presentation of a epidural hematoma? - Correct answer a lucid interval between time of injury and neurologic a deterioration. What are more common brain injury: epidural or subdural? - Correct answer subdural 30% epidural 0.5% Subdural hematoma occur from tear of _________. - Correct answer bridging vessels of the cerebral cortex Contusion occur in ___% of TBI. They often occur in _____ or ______ lobes of brain. They may coalesce to form ______ in as many as 20$%. - Correct answer 20-30% frontal or temporal intracerebral hematoma. What is the imaging protocol for a patient with cerebral contusion? - Correct answer get CT at presentation. then get another within 24 hours to assess for coalesced hematoma. What factors would require a CT in minor brain injury? - Correct answer 1. suspected open skull frac 2. basilar frac 3. >2 episode vomitting 4. pt older than 65 5. LOC >5 min 6. amnesia before impact of >30 min How long after discharge should patient with mild brain injury be observed by friend? - Correct answer 24 hours What type of brain injury requires serial GCS? - Correct answer ALL. minor. moderate. major What imaging is done in all patient with moderate brain injury? - Correct answer CT ATLS Written Review Latest 2021 Graded A What factor of ABCDE must be monitored closely in moderate brain injury? - Correct answer Airway and breathing. rapid deterioration may occur. hypoventilation and hypercapnia may ensue requiring intubation. close monitoring in ICU is required. What should immediately follow the secondary survey in major/severe brain injury? - Correct answer CT. REMEMBER: CT should never delay patient transfer When assessing ABCDE of severe brain injury, when does DPL or FAST come before neuro exam? - Correct answer if the systolic blood pressure cannot be brought above 100, DPL or FAST is done first as to assess source of hypotension Spinal cord injury has what result in blood pressure? - Correct answer hypotension. This may also occur in terminal brain injury with medullary failure What needs to be cleared before Doll's eye testing is conducted? - Correct answer cervical spine must cleared. What tests should be performed before sedation? - Correct answer GCS and pupillary rxn A midline shift of _____mm or greater on the CT is indicative of need for neurosurgery to evacuate the clot or contusion causing the shift - Correct answer 5mm What type of fluids should be used? - Correct answer hypertonic (ringers lactate or normal saline). NO GLUCOSE. What electrolyte abnormality is associated with brain edema and must be monitored? - Correct answer hyponatremia What are the physiologic consequences of PaCO2 >45? PaCO2 <30? - Correct answer f PaCO2 >45 = vasodilation = inc ICP PaCO2 <30 (hyperventilation) = constriction = ischemia What is the preferred PaCO2 in brain injury? - Correct answer 35 mm Hg ATLS Written Review Latest 2021 Graded A If ICP is rapidly increasing, what can be done while preparing for craniotomy? - Correct answer hyperventilation. NOTE: this must be monitored closely and is only done very short periods at a time Does hypertonic saline lower ICP in hypovolemia? Does mannitol lower ICP in hypovolemia? - Correct answer No NO After administration of mannitol what should be monitored closely? - Correct answer ICP! mannitol has a substantial rebound effect on ICP What is the role of muscle relaxants (vecuronium or succinylcholine) in seizures with TBI? - Correct answer NONE. these may mask tonic-clonic seizures and prevent anticonvulsant intervention (30-60 min of seizure = secondary brain injury) What meningeal tear would a CSF leakage of a head laceration indicate? - Correct answer dural tear What is the treatment of any intracranial mass lesion? - Correct answer Must be evacuated by neurosurgeon. transfer if not available. for a penetrating object such as an arrow or screw driver into the skull, test should be performed and what should be done with the object? - Correct answer need CT, Xray for trajectory, and angiography. leave the object in place. Removing the object lead to fatal vascular injury. What clinical signs are the criteria for brain death? - Correct answer GCS of 3, nonreactive pupil, absent brainstem reflexes, no spontaneous ventilatory effort Which vertebrae is most susceptible to injury? - Correct answer Cervical. NOTE: in peds this accounts for only 1% of vertebral injury What nerve and cervical spine level would cause apnea and results in death in 1/3 of patient with upper cervical spine injury - Correct answer phrenic nerve C1 ATLS Written Review Latest 2021 Graded A Fluid resuscitation of an infant begins with _______(amount and type). And then progresses to ______. (amount and type) - Correct answer 20mL/kg Ringers lactate. (may give up to three of these boluses initially) For the third bolus consider PRBCs at 10mL/kg For a patient who is not breathing what intervention is indicated? - Correct answer orotracheal intubation What should be used when vocal chords cannot be visualized on direct laryngoscopy? - Correct answer gum elastic bougie. in place when you feel clicks. can be inserted blindly beyond epiglottis What is the acronym BURP? - Correct answer backward, upward and rightward pressure used in external laryngeal manipulation with orotracheal intubation what is the most common life threatening injury in children? - Correct answer tension pneumothorax What is the most common acid-base disturbance in the injury child and what is it caused by? - Correct answer Respiratory acidosis caused by hypoventilation. What are the options to establish an airway when bag-mask ventilation and attempts at orotracheal intubation fail for a child? - Correct answer LMA, or intubating LMA, or needle cricothyroidotomy. -needle-jet insufflation is an appropriate temporizing technique for oxygenation but does not provide adequate ventilation. NOTE: surgical cric is RARELY indicated for infants an small children. usually it is an adoption when the cricothyroid membrane is easily palpable around the age of 12. A local area of frost bite should be rewarmed with what temperature and in what waY? - Correct answer 40C (104F) should be done in whirlpool. not dry heat. What is the main utility of ECG during resuscitation? - Correct answer detecting rhythm abnormalities ATLS Written Review Latest 2021 Graded A What does PaCO2 of 35-40 mmHg indicate in late pregnancy? - Correct answer impending respiratory failure. hypocapnia (around 30) is typical in late pregnancy due to inc tidal volume. Other than maternal death, what is the leading cause of fetal death? Symptoms? - Correct answer abruptio placentae (70%) suggested by vaginal bleeding, uterine tenderness, uterine contractions, uterine tetany, and irritability of uterus (contracts when touched) What type of monitoring should be initiated in fetus of gestation age >20 wks - Correct answer continuous monitoring with tocodynamometer. monitor should be done for 6 hours with no symptoms, and 24 with abruptio symptoms. What are the two extra precautions during primary survey of pregnant woman? - Correct answer 1. uterus should be displaced manually to the left to relive pressure not he inferior vena cava. 2. early initiation of crystalloid fluids due to moms compensatory mechanisms masking fetal distress associated with hypovolemia T/F? Diaphragmatic breathing in a patient who is unconscious is not a sign of C-Spine injury - Correct answer FALSE. diaphragmatic breathing=c- spine injury What is used to evaluate a suspected urethral injury? What is used to evaluate a bladder rupture? - Correct answer retrograde urethrogram cystogram What are the abdominal structures that may not be detected on DPL? - Correct answer duodenum, ascending/descending colon, rectum, biliary tract, and pancreas In a severe trauma where facial anatomy is distorted and an ETT cannot be placed, what is the next step to provide ventilation? - Correct answer Next would be a transchricothyroid needle-jet insufflation. this is attached to high pressure oxygen, but can only be provided for around 30-45min due to CO2 accumulation. -the definitive after this would be a surgical chricothyroidotomy or an emergent tracheotomy. (emergent tracheotomy is not preferred because complication and time consuming) ATLS Written Review Latest 2021 Graded A What hold urine output be maintained at after a crush injury to prevent kidney injury? - Correct answer 100 mL/hr Is operation ever indicated in first hour after injury of multiple injured patient? - Correct answer yes. especially if class 3 or 4 hemorrhagic shock is present What class of shock are there NO clinical signs of inadequate organ perfusion? - Correct answer Class I. <14% blood volume loss. (<750mL) What is suggested if chest tube placement for suspected pneumothorax results in incomplete lung expansion and air leak with bubbling? What imaging confirms? - Correct answer This suggests tracheobronchial injury such as ruptured bronchus. -a second chest tube may need to be placed -this is confirmed with broncoscopy Why do chest injuries have a high priority in the multiply injured person? - Correct answer they often result in hypoxia What is the physiology behind neurogenic shock? - Correct answer loss of vascular tone What is another name for Central Venous Pressure? When is it elevated? - Correct answer Basically the same as Right atrial pressure. -Elevated in cardiac failure, tamponade, tension pneumo, disrupted thoracic aorta. What would be expected on ABG abnormalities for pulmonary contusion? - Correct answer PaO2 <65 mm Hg (sat <90) would suggest need for intubation and in the presence of flail chest is more suggestive t/f vomitus in the posterior oropharynx suggests esophageal intubation. - Correct answer false. signs include: epigastric fullness, absent end title CO2, absent breath sounds, audible borborygmi sounds over abdomen t/f: major head injury rarely causes shock by itself - Correct answer true ATLS Written Review Latest 2021 Graded A