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1. What is the primary goal of treating TBI? How is this done?: preventing secondary brain injury. This
... [Show More] is done by maintaining blood pressure and providing adequate profusion.
2. After managing ABCDEs of TBI what MUST be identified if present? How is this done?: 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.
3. Which brain lobes do the following hold:
1. anterior fossa:
2. middle fossa:
3. posterior fossa:: 1. anterior fossa: frontal lobes 2. middle fossa: temporal lobes
3. posterior fossa: lower brainstem and cerebellum
4. What are the 3 layers of the meninges?: dura mater, arachnoid mater, pia mater
5. What does the dura mater adhere firmly to?: the skull. it is tough and fibrous
6. What layer of the meninges splits into two leaves as specific sites to enclose large venous sinuses? What do these sinuses do?: dura mater.
these sinuses provide major venous drainage from the brain.
7. 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?: 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.
8. What are the arteries that lie between the skull and the dura mater (epidural space)?: meningeal arteries.
9. What is the most commonly injured meningeal artery and where is it located?: middle meningeal artery. Located over the temporal fossa
10. T/F: the arachnoid mater is fused to the dura mater?: FALSE: not attached. This produces a potential space for a subdural hematoma
11. In a subdural hematoma, what is the cause?: injury to bridging veins that extend from brain surface to the sinuses within the dura.
12. fills the space between the arachnoid and pia mater?: CSF. this cushions the brain and spinal cord.
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13. What location of brain hemorrhage is frequently seen in brain contusion or injury to major blood vessels at base of brain?: subarachnoid.
14. The and contain the reticular activating system which is responsible for .: midbrain and upper pons state of alertness
15. What important function resides in the medulla?: cardiorespiratory cen- ters.
16. What important functions are in the following brain segments:
1. left hemisphere:
2. frontal lobe:
3. parietal lobe:
4. temporal:: 1. left hemisphere: language center
2. frontal lobe: executive function, emotions, motor
3. parietal lobe: sensory function/spatial orientation
4. temporal: memory functions
17. What divides the brain into supratentorial and infratentorial compart- ments?: tentorium cerebelli. (tent over cerebellum)
18. What is the physiology behind a blown pupil?: blown pupil: dilation of pupil -CN III runs along the tentorium cerebelli. parasympathetic fibers that constrict the pupil run along CN III (oculomotor). When temporal lobe is herniated, it can compress these fibers. Unapposed sympathetic activity causes pupillary dilation.
19. What is the tentorial notch/hiatus: this is where the midbrain passes through into the infratentorial compartment.
20. what part of the brain most commonly herniates through the tentorial notch?: Uncus (medial part of temporal lobe)
21. does weakness occur on the same or opposite side of the uncal hernia- tion?: OPPOSITE. the corticospinal tract of the midbrain is compressed and then crosses at the foramen magnum.
22. state: Ipsilateral/contralateral
pupillary dilation associated with hemiparesis is the classic sign of uncial herniation.: ipsi
contra
23. average ICP is mmHg.: 10
24. The monro-kellie doctrine states that the total volume of intracranial contents must remain constant, because the cranium is : a rigid, non expandable container.
25. The monro-kellie doctrine states that and may be com-
pressed out of the skull providing a degree of buffering.: CSF and venous blood.
Once the CSF and venous blood reach a certain level of displacement the ICP rapidly increases.
26. What is the equation for CPP (cerebral perfusion pressure)?: - CPP=MAP-ICP
27. in TBI, Every effort should be made to reduce , while normalizing
, , and .: ICP
MAP, oxygenation, intravascular volume
28. What GCS ranges for the following classes:
1. Minor
2. Moderate
3. Severe: 1. 13-15
2. 9-12
3. 3-8
29. What nerve palsy may occur with basilar skull fracture?: seventh nerve.
30. A GCS of is accepted definition of coma?: 8 or less
31. How do you assess a GCS of someone with asymmetric responses?: Use the best possible because this will be the best predictor of outcome
32. Basilar fractures of the skull usually require what type of imaging?: this requires CT with bone-window setting.
33. What are the t [Show Less]