NRNP Finals 6560 Comprehensive
Questions (Frequently Tested) with
Verified Answers Graded A+
coup-contrecoup injury - Answer: Dual impacting of the brain into the skull; coup injury occurs
at the point of impact; contrecoup injury occurs on the opposite side of impact, as the brain
rebounds.
Scalp laceration: what, effect, management - Answer: Primary head injury
profuse bleeding - signs of hypovolemia
Apply direct pressure
Suture/ staple laceration
Lidocaine 1% with epi to control bleeding, not close to nose/ ears
Skull fracture: types, effect, management - Answer: Primary head injury
Simple: no displacement of bone. Observe and protect spine
Depressed: bone fragment depressing thickness of scull
Surgery for debridement. Give tetanus and seizure precautions
Basilar: fracture at floor of skull
Raccoon eye - periorbital bruising
,battle's sign: mastoid bruising
otorrhea/ rhinorrhea - halo sign: do not obstruct flow
Give Ab's
Oral intubation and oral gastric instead of nasal
Brain injury: types, effect, management - Answer: Primary head injury
Concussion: reversible change in brain functioning
loss of consciousness, amnesia
Do not give opioids, admit for unconsciousness greater than 2min
Contusion: bruising to surface of brain with edema
Frontal and temporal region
Brainstem contusion: posturing, variable temp, variable vital signs
N/V, dizziness, visual changes
seizure precautions
Hematoma - neuro: types, effect, management - Answer: Epidural hematoma: commonly
temporal/ parietal region with skull fracture, causing bleeding into epidural space
Loss of consciousness
Rapid deterioration: obtunded, contralateral hemiparesis, ipsilateral pupil dilation
CT scan (non contrast)
Treatment based on Brain trauma foundation. Surgical if greater than 30cm
Subdural hematoma
most common type of intracranial bleed
,Acute (hours): drowsy, agitated, confused, headache, pupil dilation,
CT scan (noncontrast)
surgery for 10mm thickness or 5mm midline shift or for worsening GCS
Chronic (days): headache, memory loss, incontinence
CT scan (noncontrast)
Surgery: burr holes/ crani
Cerebral edema/ ICP elevated/ herniation: symptoms, management - Answer: decreased level
of consciousness
Blown pupil
Cushing triad: HTN (widening pulse pressure), decreased resp rate, bradycardia (means
increased intracranial pressure)
Neuro exam components - Answer: AVPU: awake, response to verbal stimuli, painful stimuli,
unresponsive
GCS: 8 or below is comatose
Posturing:
decorticate = arms, legs in
decerebrate = arms, legs out
Electrolyte imbalances in brain injury - Answer: Hyponatremia: SIADH and cerebral salt wasting
Hypernatremia: DI (give mannitol)
Management of traumatic brain injury - Answer: - Consult neurosurgery
- Limit secondary injury
, - Prevent hypotension (syst 90) and hypoxemia (PaO2 60). May give blood to improve tissue
perfusion.
- Treat cerebral edema: elevate bed, sedate, paralyse, mannitol, hyperventilation (PaCO2 25-30),
during first 24hrs.
- sedation and analgesia: opioids to reduce ICP (Fentanyl) with propofol. Could give Nimbex or
Vec. to help oxygenate/ ventilate
- steroids: avoid
- Give mannitol or hypertonic saline for herniation: bolus then gtt. monitor serum osmolality,
sodium, and bp.
- Seizure precautions: give phenytoin or keppra
- DVT prophylaxis: stockings, LMWH
- head injury means spine injury until proven otherwise
- hypothermia: can control ICP (89 - 91F)
- decompressive crani: ICP refractory to tx
- brain O2 monitoring (jugular vein O2 sats)
ICP monitoring - Answer: For: GCS 3-8 with abnormal CT and comatose pt's with normal CT and
older than 40, posturing, hypotension.
Normal value: 5-10 mmHg
Recommend initiating treatment if ICP > 20 mmHG.
Can calculate CPP (CPP = MAP - ICP). Should be 60
Brain death criteria - Answer: Must have all:
No spontaneous movement
Questions (Frequently Tested) with
Verified Answers Graded A+
coup-contrecoup injury - Answer: Dual impacting of the brain into the skull; coup injury occurs
at the point of impact; contrecoup injury occurs on the opposite side of impact, as the brain
rebounds.
Scalp laceration: what, effect, management - Answer: Primary head injury
profuse bleeding - signs of hypovolemia
Apply direct pressure
Suture/ staple laceration
Lidocaine 1% with epi to control bleeding, not close to nose/ ears
Skull fracture: types, effect, management - Answer: Primary head injury
Simple: no displacement of bone. Observe and protect spine
Depressed: bone fragment depressing thickness of scull
Surgery for debridement. Give tetanus and seizure precautions
Basilar: fracture at floor of skull
Raccoon eye - periorbital bruising
,battle's sign: mastoid bruising
otorrhea/ rhinorrhea - halo sign: do not obstruct flow
Give Ab's
Oral intubation and oral gastric instead of nasal
Brain injury: types, effect, management - Answer: Primary head injury
Concussion: reversible change in brain functioning
loss of consciousness, amnesia
Do not give opioids, admit for unconsciousness greater than 2min
Contusion: bruising to surface of brain with edema
Frontal and temporal region
Brainstem contusion: posturing, variable temp, variable vital signs
N/V, dizziness, visual changes
seizure precautions
Hematoma - neuro: types, effect, management - Answer: Epidural hematoma: commonly
temporal/ parietal region with skull fracture, causing bleeding into epidural space
Loss of consciousness
Rapid deterioration: obtunded, contralateral hemiparesis, ipsilateral pupil dilation
CT scan (non contrast)
Treatment based on Brain trauma foundation. Surgical if greater than 30cm
Subdural hematoma
most common type of intracranial bleed
,Acute (hours): drowsy, agitated, confused, headache, pupil dilation,
CT scan (noncontrast)
surgery for 10mm thickness or 5mm midline shift or for worsening GCS
Chronic (days): headache, memory loss, incontinence
CT scan (noncontrast)
Surgery: burr holes/ crani
Cerebral edema/ ICP elevated/ herniation: symptoms, management - Answer: decreased level
of consciousness
Blown pupil
Cushing triad: HTN (widening pulse pressure), decreased resp rate, bradycardia (means
increased intracranial pressure)
Neuro exam components - Answer: AVPU: awake, response to verbal stimuli, painful stimuli,
unresponsive
GCS: 8 or below is comatose
Posturing:
decorticate = arms, legs in
decerebrate = arms, legs out
Electrolyte imbalances in brain injury - Answer: Hyponatremia: SIADH and cerebral salt wasting
Hypernatremia: DI (give mannitol)
Management of traumatic brain injury - Answer: - Consult neurosurgery
- Limit secondary injury
, - Prevent hypotension (syst 90) and hypoxemia (PaO2 60). May give blood to improve tissue
perfusion.
- Treat cerebral edema: elevate bed, sedate, paralyse, mannitol, hyperventilation (PaCO2 25-30),
during first 24hrs.
- sedation and analgesia: opioids to reduce ICP (Fentanyl) with propofol. Could give Nimbex or
Vec. to help oxygenate/ ventilate
- steroids: avoid
- Give mannitol or hypertonic saline for herniation: bolus then gtt. monitor serum osmolality,
sodium, and bp.
- Seizure precautions: give phenytoin or keppra
- DVT prophylaxis: stockings, LMWH
- head injury means spine injury until proven otherwise
- hypothermia: can control ICP (89 - 91F)
- decompressive crani: ICP refractory to tx
- brain O2 monitoring (jugular vein O2 sats)
ICP monitoring - Answer: For: GCS 3-8 with abnormal CT and comatose pt's with normal CT and
older than 40, posturing, hypotension.
Normal value: 5-10 mmHg
Recommend initiating treatment if ICP > 20 mmHG.
Can calculate CPP (CPP = MAP - ICP). Should be 60
Brain death criteria - Answer: Must have all:
No spontaneous movement
