Initial assessment - correct answer A-J, airway first unless massive hemorrhage
Open airway - manuever - correct answer Jaw thrust
GCS 40 - correct
... [Show More] answer E: spont, verbal, pressure, none
V: orient, confused, words, sounds, none
M: obeys, local, w/d, abnl flex, extension, none
Pupils unreactive to light: -2, -1, 0
Monroe-Kellie Doctrine and CPP - correct answer When one content in the skull increases, another must decrease to compensate and maintain normal ICP. MAP-ICP = CPP. Keep >60 in TBI, no hypotension
Normal ICP: adults, older children, young children, infants - correct answer Adults: 0-15
Older children: 10-15
Young children: 3-7
Infants: 2-6
Head and facial fractures, airway, G-tube, surgical airway, intubation med - correct answer No nasal intubation or NGT, cricothyroidotomy (needle if under 12), lidocaine to prevent increase in ICP
Succinylcholine risks - correct answer Avoid in DAI, risk of hyperkalemia (crush injury/burn), risk of malignant hyperthermia
Cushing's triad - correct answer Hypertension with wide PP, bradycardia, irregular respirations. Suspect SCI if similar s/s but hypotensive.
Basilar skull fracture, anterior and middle - correct answer Anterior: periorbital ecchymosis, rhinorrhea, anosmia
Middle: otorrhea, mastoid ecchymosis, hemotympanum (increased risk of infection)
Epidural hematoma - 4 points - correct answer a. Middle meningeal artery from temporal skull fx
b. Rapid onset w/ lucid interval
c. Uncal herniation: ipsilateral pupil, contralateral hemiparesis
d. Burr hole
Subdural hematoma - 4 points - correct answer a. Tearing of venous bridging veins
b. Slower decamp of mental status
c. Elderly on blood thinners, ETOH
d. Shaken impact syndrome: SDH, retinal hemorrhage, posterior rib fx
Concussion - 3 points - correct answer a. Cognitive rest
b. No ASA or NSAIDS - APAP only
c. Graduated return to play
Diffuse axonal injury - correct answer Prolonged coma, hyperthermia, HTN, profuse sweating, posturing
Pharmacological mgmt of increased ICP - correct answer Hypertonic saline if hypotensive
Mannitol - osmotic diuretic, 1 gm/kg, onset 1-5 min, peak 20-60 minutes. Monitor for pulmonary edema, K, Na, serum osmolality (300-320),
Treatment of increased ICP - correct answer SBP >100, no permissive hypotension
CO2 35-37
Elevate HOB 30-45, neutral alignment
Limit stimulation, treat anxiety and pain
Treat fevers aggressively [Show Less]