TCAR CORE MAIN QUESTIONS AND ANSWERS
SET A+
✔✔airway & facial truma - ✔✔nothin into nose b/c risk of getting tubes into the sterile
brain. nothng into their nose of pt with facial trauma until the surgeon clears the patient
✔✔raccoon eyes - ✔✔periorbital ecchymosis
✔✔when does a patient get periorbital ecchymosis - ✔✔anterior fossa fracture
✔✔bruises - ✔✔all bruises blossom over time so might not be present at the first time pt
comes
✔✔delayed findings characteristic of middle fossa fracture - ✔✔Battle's sign/postaurical
hematoma
CSF otorrhea
✔✔indication of raccoon eyes - ✔✔periorbital ecchymosis
consider anterior fossa fracture
✔✔indication of Battle's sign - ✔✔middle fossa skull fractur
✔✔aka Battle's sign - ✔✔postauricular hematoma
middle fossa skull fracture
✔✔bruise behind the ear - ✔✔Battle's sign. postauricular hematoma
✔✔CSF from ear - ✔✔otorrhea
✔✔s/s of middle fossa basilar skull fracture - ✔✔CN 7 = facial eakness
CN 8 = hearing loss
otorrhea CSF
Battle's sign
,✔✔complicaton of posterior fossa fracture - ✔✔often leads to herniation/death
- as little as 5-10ml of blood in the posterior fossa is all it takes to cause herniation
✔✔layers of CNS - ✔✔meninges = dura, arachnoid, pia
✔✔epidural space - ✔✔NO natural epidural space. space only exists if the space is
sheared away
✔✔where do epidural hematomas form - ✔✔anywhere b/c the dura mater is everywhere
*most common site is under the temporal bone at the site of hte middle meningeal
artery
✔✔head injury associated w/middle meningeal artery - ✔✔epidural hematoma
✔✔frequent cause of epidural hematoma - ✔✔temporal bone breaks. arterial pulsaitons
dissect the dura away from the inner skull. hematoma is formed but the bleeding is
tightly contained. relatively thin bone and vulnerable location and major arter
*dura is normally tightly adhered to the inner surface of hte crandium. it takes sufficient
arterial prssure to dissect the dura away from the skull
✔✔classic presentation of epidural hematoma - ✔✔temporal bone. middle meningeal
artery
immediate LOC - lucid- progressive deterioration b/c it "blossoms"
✔✔how do you LOC - ✔✔remember = only two ways to LOC
-shut down reticular activating system or knock out both hemispheres
✔✔what type of brain injury is a concussion - ✔✔diffuse brain injury
✔✔pathology of epidural hematoma - ✔✔first concussion - diffuse injury - lucid but GCS
doesn't have to be 15- hematoma formation (focal injury) so shifts brain and affects both
hemispheres
✔✔CT that indicates epidural hematoma - ✔✔characteristic convex appearance from
peeled dura mater holding back clotted blood (hematoma)
✔✔when do you get LOC in epidural hematoma - ✔✔once the brain shifts, both
cerebral hemispheres are affected so LOC
✔✔A&P of the skull - ✔✔remember = it is an enclosed box
✔✔where do cranial contents go when a hematoma expands - ✔✔natural opening =
foramen magnum "drain to the brain"
, ✔✔% of skull contents - ✔✔80% brian, blood 10%, CSF 10%
*CSF is displaced first, blood next (not good when blood leaves the brain --patient is in
trouble)
✔✔uncal herniation - ✔✔
✔✔patterns of brain herniation - ✔✔cingulate aka subfalcine
downward shift = central/transtentorial/uncal
✔✔what happens to the cranial nerves during a herniation - ✔✔all cranial nerves are
compressd
✔✔pupils in herniation - ✔✔compression = dilation
late finding = fixed pupil
how to tell which side has the herniation = larger fixed pupil
✔✔what type of nerves are cranial nerves - ✔✔cranial nerves are peripheral nerves so
they dont' cross midline (ipsilateral)
✔✔same side - ✔✔ipsilateral
✔✔opposite side - ✔✔contralateral
✔✔ipsilateral/contralateral in herniation - ✔✔ipsilateral = pupils b/c cranial nerves do not
cross the peripehray
contralateral = extremity weakness b/c axons from motor do cross
✔✔interventions for expanding epidural hematoma - ✔✔emergent evaculation due to
herniation risk
monitor pupils (fixed/dilated ipsilateral is a late finding) and motor weakness
(contralateral)
✔✔late finding in herniation - ✔✔ipsilateral fixed and dilated pupils
✔✔what type of surgery is epidural hematoma - ✔✔not really brain surgery b/c brain
isn't touched. you flip back the skull and interact with the dura
✔✔where is the subdural hematoma - ✔✔blood accumulation under the dura layer
✔✔blood accumulation under the dura layer - ✔✔subdural hematoma
✔✔what type of bleeding is subdural hematoma - ✔✔venous bleed
SET A+
✔✔airway & facial truma - ✔✔nothin into nose b/c risk of getting tubes into the sterile
brain. nothng into their nose of pt with facial trauma until the surgeon clears the patient
✔✔raccoon eyes - ✔✔periorbital ecchymosis
✔✔when does a patient get periorbital ecchymosis - ✔✔anterior fossa fracture
✔✔bruises - ✔✔all bruises blossom over time so might not be present at the first time pt
comes
✔✔delayed findings characteristic of middle fossa fracture - ✔✔Battle's sign/postaurical
hematoma
CSF otorrhea
✔✔indication of raccoon eyes - ✔✔periorbital ecchymosis
consider anterior fossa fracture
✔✔indication of Battle's sign - ✔✔middle fossa skull fractur
✔✔aka Battle's sign - ✔✔postauricular hematoma
middle fossa skull fracture
✔✔bruise behind the ear - ✔✔Battle's sign. postauricular hematoma
✔✔CSF from ear - ✔✔otorrhea
✔✔s/s of middle fossa basilar skull fracture - ✔✔CN 7 = facial eakness
CN 8 = hearing loss
otorrhea CSF
Battle's sign
,✔✔complicaton of posterior fossa fracture - ✔✔often leads to herniation/death
- as little as 5-10ml of blood in the posterior fossa is all it takes to cause herniation
✔✔layers of CNS - ✔✔meninges = dura, arachnoid, pia
✔✔epidural space - ✔✔NO natural epidural space. space only exists if the space is
sheared away
✔✔where do epidural hematomas form - ✔✔anywhere b/c the dura mater is everywhere
*most common site is under the temporal bone at the site of hte middle meningeal
artery
✔✔head injury associated w/middle meningeal artery - ✔✔epidural hematoma
✔✔frequent cause of epidural hematoma - ✔✔temporal bone breaks. arterial pulsaitons
dissect the dura away from the inner skull. hematoma is formed but the bleeding is
tightly contained. relatively thin bone and vulnerable location and major arter
*dura is normally tightly adhered to the inner surface of hte crandium. it takes sufficient
arterial prssure to dissect the dura away from the skull
✔✔classic presentation of epidural hematoma - ✔✔temporal bone. middle meningeal
artery
immediate LOC - lucid- progressive deterioration b/c it "blossoms"
✔✔how do you LOC - ✔✔remember = only two ways to LOC
-shut down reticular activating system or knock out both hemispheres
✔✔what type of brain injury is a concussion - ✔✔diffuse brain injury
✔✔pathology of epidural hematoma - ✔✔first concussion - diffuse injury - lucid but GCS
doesn't have to be 15- hematoma formation (focal injury) so shifts brain and affects both
hemispheres
✔✔CT that indicates epidural hematoma - ✔✔characteristic convex appearance from
peeled dura mater holding back clotted blood (hematoma)
✔✔when do you get LOC in epidural hematoma - ✔✔once the brain shifts, both
cerebral hemispheres are affected so LOC
✔✔A&P of the skull - ✔✔remember = it is an enclosed box
✔✔where do cranial contents go when a hematoma expands - ✔✔natural opening =
foramen magnum "drain to the brain"
, ✔✔% of skull contents - ✔✔80% brian, blood 10%, CSF 10%
*CSF is displaced first, blood next (not good when blood leaves the brain --patient is in
trouble)
✔✔uncal herniation - ✔✔
✔✔patterns of brain herniation - ✔✔cingulate aka subfalcine
downward shift = central/transtentorial/uncal
✔✔what happens to the cranial nerves during a herniation - ✔✔all cranial nerves are
compressd
✔✔pupils in herniation - ✔✔compression = dilation
late finding = fixed pupil
how to tell which side has the herniation = larger fixed pupil
✔✔what type of nerves are cranial nerves - ✔✔cranial nerves are peripheral nerves so
they dont' cross midline (ipsilateral)
✔✔same side - ✔✔ipsilateral
✔✔opposite side - ✔✔contralateral
✔✔ipsilateral/contralateral in herniation - ✔✔ipsilateral = pupils b/c cranial nerves do not
cross the peripehray
contralateral = extremity weakness b/c axons from motor do cross
✔✔interventions for expanding epidural hematoma - ✔✔emergent evaculation due to
herniation risk
monitor pupils (fixed/dilated ipsilateral is a late finding) and motor weakness
(contralateral)
✔✔late finding in herniation - ✔✔ipsilateral fixed and dilated pupils
✔✔what type of surgery is epidural hematoma - ✔✔not really brain surgery b/c brain
isn't touched. you flip back the skull and interact with the dura
✔✔where is the subdural hematoma - ✔✔blood accumulation under the dura layer
✔✔blood accumulation under the dura layer - ✔✔subdural hematoma
✔✔what type of bleeding is subdural hematoma - ✔✔venous bleed
