Traumatic Brain Injury Management Quiz

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Questions and Answers

What causes subdural hematomas to expand?

Arterial bleeding

Aneurysmal rupture

Venous bleeding (correct)

Capillary bleeding

How long after a head injury can symptoms of subdural hematomas begin to appear?

From 48 hours to 2 weeks (correct)

Immediately

After 1 month

Within 24 hours

What does a compromised blood flow to the brain primarily affect?

Nerve signal transmission

Brain weight

Oxygen and nutrient delivery (correct)

Cerebrospinal fluid production

What is a late sign of severe cerebral ischemia?

Cushing response Signup and view all the answers

What happens if the rising intracranial pressure (ICP) is not treated?

The brainstem herniates Signup and view all the answers

What is paramount in managing complications caused by traumatic brain injury (TBI)?

Understanding intracranial perfusion principles Signup and view all the answers

What is the primary purpose of the Cushing response?

To attempt to reduce cerebral ischemia Signup and view all the answers

Which of the following occurs if death is the outcome due to rising ICP?

Cessation of cardiopulmonary function Signup and view all the answers

What is the primary goal during the acute phase of brain injury management?

Keep the patient's environment quiet Signup and view all the answers

Which cranial nerve is assessed when checking for symmetric smiles?

Facial nerve Signup and view all the answers

What is the initial dose range for Mannitol in treating increased intracranial pressure?

1.0 to 2.0 g/kg IV Signup and view all the answers

Why is it important to assess the symmetry of the soft palate during a neurological examination?

It evaluates the integrity of the vagus nerve. Signup and view all the answers

What is one effect of osmotic diuretics like Mannitol on intracranial pressure?

Draws water off the brain Signup and view all the answers

When assessing shoulder muscle resistance, which cranial nerve function is being evaluated?

Accessory nerve Signup and view all the answers

What is the primary purpose of the ABC algorithm in trauma care?

To simplify actions during high-pressure situations Signup and view all the answers

Which parameters are affected due to secondary brain injuries in patients with TBI?

Mean arterial pressure, cerebral blood flow, intracranial pressure, and cerebral perfusion pressure Signup and view all the answers

What assessment is used to evaluate auditory function and balance?

Auditory assessment Signup and view all the answers

What is the recommended GCS score threshold for initiating rapid sequence intubation (RSI)?

GCS less than 8 Signup and view all the answers

In increased intracranial pressure, where will the pupil changes typically manifest?

Same side as brain injury Signup and view all the answers

Why is it important to adhere to cervical spine precautions in TBI patients?

Because cervical spine fractures occur four to six times more often in these patients Signup and view all the answers

What formula is used to estimate the volume of an intracerebral hematoma?

$A imes B imes C$ Signup and view all the answers

What is a potential consequence of omitting crucial resuscitative steps in trauma care?

Patient distraction leading to worsening outcomes Signup and view all the answers

How is the estimated volume of a spheroid correlated in medical imaging?

It correlates well with planimetric CT analysis Signup and view all the answers

What is the first and most important step in trauma care according to the principles outlined?

Airway evaluation Signup and view all the answers

What is the first step to be taken when cardiac tamponade is suggested?

Administer oxygen Signup and view all the answers

Why is monitoring crucial for patients with suspected self-harm?

To identify potential further attempts at self-harm Signup and view all the answers

What condition can increase the risk of arrhythmias during pericardiocentesis?

Hypokalemia Signup and view all the answers

What is essential to identify when assessing a patient with a potential drug overdose?

Whether the overdose was intentional Signup and view all the answers

Which of the following should be included in the initial evaluation of a potential drug overdose?

Complete and reliable history Signup and view all the answers

What physical examination finding might indicate a history of drug use?

Fresh needle marks Signup and view all the answers

Which cathartic agent is noted for being the fastest and most potent?

Sorbitol Signup and view all the answers

What critical assessment should be made for older adults at risk of medication issues?

Mental acuity and eyesight Signup and view all the answers

What is a major limitation of the cathartics listed?

They can complicate drug removal procedures. Signup and view all the answers

What is the ideal first step in the management of a critical patient with a drug overdose?

Obtain a complete medical history Signup and view all the answers

Which of the following is not considered a true antidote?

Activated charcoal Signup and view all the answers

In which scenario is forced diuresis typically used?

When no antidote is available. Signup and view all the answers

Why should disodium phosphate be used cautiously in children?

Anatomical and physiological factors differ. Signup and view all the answers

Study Notes

Subdural Hematomas

Subdural hematomas expand slowly as a result of venous bleeding.
Symptoms can take up to two weeks to develop after a head injury.

Secondary Brain Injury

Damage to brain tissue that occurs after the initial injury.
Often affects Mean Arterial Pressure (MAP), Cerebral Blood Flow (CBF), Intracranial Pressure (ICP), and Cerebral Perfusion Pressure (CPP).

Managing Cerebral Ischemia

Cerebral ischemia occurs when blood flow to the brain is compromised.
This leads to a lack of oxygen and essential nutrients, causing further brain damage.
The Cushing response, a feedback mechanism, attempts to reduce ischemia by increasing CBF.
If rising ICP is not treated, brain herniation through the foramen magnum can occur, leading to brain death.

ABC Algorithm – Trauma Management

Airway: The first and most crucial step in TBI management is securing the airway.
Breathing: Ensure adequate ventilation and oxygenation.
Circulation: Maintain hemodynamic stability, including blood pressure and heart rate.

Assessing Cranial Nerve Function

Oculomotor: Pupil changes are ipsilateral to the brain injury.
Trochlear: Assess eye movement for upward, downward, and inward gaze.
Abducens: Assess lateral eye movement.
Facial: Assess facial symmetry and smile.
Auditory: Assess hearing and balance.
Glossopharyngeal: Assess gag reflex and ability to feel ears.
Vagus: Observe the soft palate for symmetry (the "aahh" test).
Accessory: Assess shoulder muscle resistance as the patient shrugs shoulders.
Hypoglossal: Assess tongue position.

Estimating Intracranial Hematoma Volume

Calculate using the formula: A x B x C / 2
- A = longest axis (cm)
- B = longest axis perpendicular to A (cm)
- C = number of slices x slice thickness (cm)

Initial Treatment for Cardiac Tamponade:

Provide oxygen.
Notify physician immediately.
Obtain chest x-ray, 12-lead ECG, and echocardiogram.
Start an IV if not already in place.
Draw blood for type and cross match and potassium level assessment.

Management of Drug Overdose:

Obtain a comprehensive medical and psychiatric history.
Conduct a thorough physical examination.
Identify the drug(s) ingested, amount, and ingestion time.
Consider the use of cathartics for drug removal from the gastrointestinal tract.
Administer antidotes as appropriate.

Cathartics for Drug Overdose:

Sorbitol: Fastest and most potent cathartic.
Magnesium sulfate: Slower acting.
Magnesium citrate: Slower acting.
Hypertonic saline: Slower acting.

Enhancing Drug Excretion:

Forced diuresis.
Alteration of urine pH.
Hemodialysis.
Hemoperfusion.

Drug Overdose in Older Adults:

Higher risk of unintentionally overdosing or underdosing medications due to diminished eyesight.

Administration of Morphine Sulfate:

Adults: 4 to 10 mg IV, with appropriate dose titration.

Fluid Reduction with Mannitol (Osmitrol):

Adults: Initially, 1.0 to 2.0 g/kg IV, followed by 0.25 to 1.00 g/kg IV every 4 hours.

Assessment and Reassessment:

Obtain radiographic studies (e.g., CT, x-ray, MRI).
Monitor baseline blood work, including ABG, hemoglobin, hematocrit, and other relevant parameters.

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Description

Test your knowledge on the management of traumatic brain injuries, including the effects of subdural hematomas, secondary brain injury, and cerebral ischemia. This quiz covers critical concepts such as airway management and the ABC algorithm in trauma care.