Anatomy
What are the two main denominations of the nervous system and what are their components?
Central: brain and spinal cord
Peripheral: peripheral nerves
What's the difference between a diffuse and focal brain injury?
Diffuse is spread out (concussion or diffuse axonal injury)
Focal is focused (contusion, intercranial hemorrhage)
Why is a blood pressure reading important when it comes to head injuries?
Prevent shock as well as ensure cerebral perfusion pressure
The Monroe-Kellie Doctrine applies to what?
Intercranial pressure
Early signs of increased ICP include..
Vomiting (with or without nausea)
Headache
Dizziness
Amnesia
Visual disturbances
Altered LOC
Seizures
Name on controlled trait for each lobe of the brain.
Frontal: personality, behavior, judgement, attention, emotional expression
Temporal: speech, understanding, language, memory, organization
Parietal: intelligence, reasoning, academic skills, reading, writing
Occipital: visual perception and visual recognition
When the brain begins to swell, the overall ____ within the brain DECREASES, causing the overall _____ within the skull to INCREASE.
Volume, intercranial pressure
What are the 3 H bombs we are trying to avoid?
Hypoxia, hypotension, hyperventilation
What are the three symptoms comprising Cushing's Triad?
1. Hypertension (with widening pulse pressure)
2. Bradycardia (bounding and slow)
3. Erratic respirations
Decerebrate posturing and dilated/fixed pupils are a common indicator of what?
Brain hemorrhage
What are ALL of the protective mechanisms of the brain?
Scalp, skull, dura mater, arachnoid mater, CSF, pia mater
Decorticate and decerebrate posturing can help indicate the location of brain lesions. Decorticate means the lesion is on the ____ brain, decerebrate means it is on the ____ brain.
Higher, lower
What is the GCS and what does every score mean?
Eyes- 4 A, 3 V, 2 P, 1 U
Verbal- 5 normal, 4 confused, 3 wrong words, 2 sounds, 1 no talking
Motor- 6 follows commands, 5 moves towards pain, 4 moves away from pain, 3 decorticate, 2 decerebrate, 1 no movement
How can we tell the difference between an epidural and subdural hematoma?
Epidural is sudden onset, subdural is a prolonged onset
What is Battle's Sign and what does it indicate?
Bruising behind the ears, indicates a basal skull fracture
A basal skull fracture may damage which specific bones?
Sphenoid, ethmoid, frontal, temporal and occipital
We can compress many portions of the brain. Which of the following 3 segments is the WORST section of the brainstem to compress and why?
Upper, lower or middle
Lower, because it controls autonomic functions
We are bringing a head trauma patient to the ER. What vital MUST we have upon arrival for every patient with altered LOC?
BGL
Brain contusions often present at the site of impact ____ or the opposite site of impact, _____.
Coup, contrecoup
A subarachnoid hemorrhage will present with...
Global neurological deficiencies
Name 1 type of glial cell and what it does
Satellite cell: monitors food, waste and CO2
Schwann cell: myelinates nerves in PNS
Oligodendrocytes: myelinate nerves in CNS
Astrocytes: maintain BBB
Microglia: phagocytic cells
Ependymal: aid and help maintain CSF
What is a diffuse axonal injury and what is the general prognosis?
A significant TBI caused by rapid deceleration, prognosis is usually poor with a vegetative state
Other than SPO2, what is the most important vital sign to monitor and take care of?
BP, namely systolic over 90 mmHg
CPP=MAP-ICP
If our intercranial pressure rises, how does that affect our cerebral perfusion pressure and why?
It lowers it because we are increasing pressure which increases pressure on vessels, decreasing perfusion
Altered respirations (Cheyne-Stoke, Boit's, ataxic, etc.) are strong indications of damage to what portion of the brain?
The brainstem