Head Trauma: Anatomy, Bleeding, ICP, and Cranial Nerves along with neck and and face trauma

What does LOC stand for in medical terminology?

Level of consciousness

What does MVC refer to?

Motor vehicle collision

What is the function of cerebrospinal fluid (CSF)?

CSF bathes and cushions the brain and spinal cord.

What is the outermost part of the head called?

Scalp

What are sutures in the context of head anatomy?

Interlocking joints in the skull that close around age 3.

What is the Foramen Magnum?

The passage between the brainstem and spinal cord.

What are the three layers of the meninges?

Dura mater, arachnoid membrane, pia mater.

What characterizes epidural bleeds?

Bleeding between the dura and skull, typically fast onset due to arterial involvement.

How do subdural bleeds differ from epidural bleeds?

Subdural bleeds occur between the dura and brain and have a slower onset due to venous involvement.

What is increased intracranial pressure (ICP)?

Pressure build-up on the brain due to infection, bleed, swelling, or cancer.

What are the signs of Cushing's Triad?

Increased BP, lower pulse, widening pulse pressure, projectile vomiting, irregular respirations.

What should be done if cerebrospinal fluid is leaking from the nose or ears after head trauma?

Treat it as coming from the brain; do not stop the flow of blood.

What is the Glasgow Coma Scale used for?

To assess neurological function, not level of consciousness.

What does a score of less than 8 on the Glasgow Coma Scale indicate?

Intubation is likely needed; the patient is at high risk of severe brain injury.

What is Cheyne-Stokes breathing?

A pattern of fast, slow, stop, deep, shallow, or no breathing.

What does decorticate posturing indicate?

A high brain stem injury with arms flexed.

What does decerebrate posturing indicate?

A high brain stem injury with arms extended.

What is a brain contusion?

Vessel rupture in the brain usually caused by shaking, leading to bleeding and structural changes.

What is a concussion?

A brief loss of consciousness due to 'shaking of the brain,' typically fully reversible.

What does coup and contrecoup refer to?

Injury to the brain on the opposite side of the impact.

What are the 12 cranial nerves responsible for?

They are peripheral nervous system nerves of the head.

What is the mnemonic to remember the 12 cranial nerves?

Oh, Oh, Oh, To touch and feel a girl's _______ soft, ah, heaven.

basilar skull fracture

a serious break in the bones at the base of the skull, usually caused by severe blunt force head trauma

meninges

Three protective membranes covering the brain and spinal cord

intervertebral disks

Cushions between vertebrae that absorb shock and allow movement in the spine.

Raccoon Eyes

Bruising around the eyes indicates basal skull fractures.

Battle’s sign

Bruising behind the ears, often indicative of a skull fracture.

Traumatic Brain Injury

A type of damage to the brain resulting from an external force, which can lead to cognitive, physical, and emotional impairments.

Primary (direct) injury

An injury to the brain caused by an external force

Secondary (indirect) injury

The “after-effects” of a primary injury

Coup-contrecoup injury

a type of traumatic brain injury where damage occurs both at the site of the impact (coup) and on the opposite side of the brain (contrecoup)

cerebral edema

swelling of the brain

inter-cranial pressure

pressure within the cranial vault

epidural hematoma

when bleeding occurs between the tough outer membrane covering the brain (dura mater) and the skull.

subdural hematoma

A type of bleeding in which a collection of blood, usually associated with a traumatic brain injury, gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain.

retrograde amnesia

inability to remember events leading up to an injury

anterograde (posttraumatic) amnesia

inability to remember events after an injury

An epidural hematoma is MOST accurately defined as:

bleeding between the skull and dura mater

Cerebral Concussion

A temporary loss or alteration of part or all of the brain’s abilities to function without physical damage to the brain

Cushing’s triad

a dangerous sign of high pressure inside the skull (increased intracranial pressure or ICP) that threatens the brainstem

Cushing’s =

pulse down and BP up

widening pulse pressure is a common sign and symptom of a serious what

head injury

widening pulse pressure

There is a large gap, typically greater than 50 to 60 mmHg, between your top (systolic) and bottom (diastolic) blood pressure numbers

T/F: it is more common for children to experience nausea and vomiting after head trauma than adults

true

T/F: pressure on the medulla causes vomiting

true

most reliable sign of a head injury

decreased/altered mental status

how does the body regulate temperature

hypothalamus

circle of willis

circular network of arteries at the base of the brain, provides connections/collateral circulation between the anterior and posterior blood supplies of the brain.

signs of a basilar skull fracture

raccoon eyes, Battle’s sign, CSF leakage and hemotympanum

Hemotympanum

blood behind the ears

Sellick maneuver/cricoid pressure

n airway management technique used during rapid sequence intubation (RSI) to prevent the regurgitation and aspiration of gastric contents

air embolism

An open wound can allow air to enter a large blood vessel.

how to prevent an air embolism

apply an occlusive dressing over a large open neck wound

if bleeding from external ear…

apply a sterile dressing

if suspected skull injury with fluid/blood from ear

do not plug/pack the ear

epistaxis

nose bleed

why would you load and go for a nosebleed

airway compromise, difficulty breathing, uncontrolled breathing, signs of shock, significant blood loss, serious trauma, and AMS

do you check an elderly patient’s BP before and after epistaxis

yes

blowout fracture

Fracture of the orbital wall, usually the floor, caused by blunt force to the eye/orbit.

how many eyes should be covered for a significant eye injury

both

what do you irrigate an eye with

sterile saline or clean water

how do you store a loose tooth

in milk

outermost meninge layer

dura mater

middle meninge layer

arachnoid mater

innermost meninge layer

pia mater

halo test

Test to see if cerebrospinal fluid (CSF) is mixed with blood draining from the nose or ears after a head injury

contusion

bruised brain tissue

coup

Brain injury occurs at the site of impact.

countercoup

Brain injury occurs on the opposite side from the impact.

decorticate posturing

Arms flexed toward chest

Wrists/fingers flexed

Legs extended

decerebrate posturing

Arms extended

Arms rotated inward

Legs extended

Toes may point downward

epidural hematoma

bleeding between the skull and dura mater

Subdural hematoma

bleeding between the dura mater and arachnoid mater

Subarachnoid hemorrhage

Bleeding between the arachnoid and pia mater, in the subarachnoid space.

Intracerebral/intraparenchymal hemorrhage

bleeding inside the brain itself

JVD

jugular veins in the neck are unusually swollen or prominent, sign of increased right-sided heart pressure