TNCC Notes for Written Exam LATEST
2024-2025 LATEST A+
TNCC Notes for Written Exam
What is Cushing's phenomenon or Cushing's Reflex? -
✅ Triad of progressive HTN, bradycardia and diminished respiratory effort.
What are the two types of herniation that occurs with ICP? -
✅ 1. Uncal herniation
2. Central or transtentorial herniation
Why does herniation occur? What are the symptoms? -
✅ Because of uncontrolled increases in ICP.
S/E's
- Unilateral or bilateral pupillary dilation
- AsyDimmetric pupillary reactivity
- Abnormal motor posturing
- Other evidence of neurologic deterioration
Define uncal herniation. -
✅ The uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior
fossa. This herniation is the more common of the two types of herniation syndromes.
Define central or transtentorial herniation. -
✅ A downward movement of the cerebral hemispheres with herniation of the diencephalon and
midbrain through the elongated gap of the tentorium.
Disruptions of the bony structures of the skull can result in what? -
✅ Displaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a
passage for CSF.
CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading
bacteria.
Also: meningitis or encephalitis or brain abscess
Define Minor Head Trauma. -
✅ GCS 13-15
Define Moderate Head Trauma -
✅Postresuscitative state with GCS 9-13.
Define Severe Head Trauma. -
✅Postresuscitative state with GCS score of 8 or less.
What is a concussion and its signs and symptoms? -
✅ A temporary change in neurologic function that may occur as a result of minor head trauma.
S/S:
- Transient LOC
- H/A
- Confusion and disorientation
- Dizziness
- N/V
- Loss of memory
- Difficulty with concentration
- Irritability
- Fatigue
What are the signs and symptoms of postconcussive syndrome? -
,TNCC Notes for Written Exam LATEST
2024-2025 LATEST A+
✅ - Persistent H/A
- Dizziness
- Nausea
- Memory impairment
- Attention deficit
- Irritability
- Insomnia
- Impaired judgement
- Loss of libido
- Anxiety
- Depression
What is diffuse axonal injury and its signs and symptoms? -
✅ (DAI) is widespread, rather than localized, through the brain. Diffuse shearing, tearing and
compressive stresses from rotational or accerleration/deceleration forces resulting in microscopic
damage primarily to axons within the brain.
S/S:
- Immediate unconsciousness
- mild DAI, coma = 6-24 hrs
- severe DAI, coma = weeks/months or persistent vegetative state
- Elevated ICP
- Abnormal posturing
- HTN
- Hyperthermia
- Excessive sweating because of autonomic dysfunction
- Mild to severe memory impairment, cognitive, behavioral, and intellectual deficits
What is a cerebral contusion and its S/S? -
✅ A common focal brain injury in which brain tissue is bruised and damaged in a local area. Mainly
located in frontal and temporal lobes. May cause hemorrhage, infarction, necrosis and edema. Max
effects of bleeding &edema peak 18-36 post injury.
S/S:
- Alteration in LOC
- Behavior, motor or speech deficits
- Abnormal motor posturing
- Signs of increased ICP
What is an epidural hematoma and its S/S? -
✅ Results when a collection of blood forms between the skull and the dura mater. Bleeding is
arterial=blood accumulates rapidly:
- Compression of underlying brain
- rapid increase in ICP
- Decreased CBF
- Secondary brain injury
* Usually requires surgical intervention
S/S:
- Transient LOC
- Lucid period lasting a few minutes to several hours
- Rapid deterioration in neurologic status
- Severe H/A
- Sleepiness
- Dizziness
- N/V
- Hemiparesis or hemiplegia on opposite side of hematoma
- Unilateral fixed and dilated pupil on same side of hematoma
What is a subdural hematoma and its S/S? -
✅ A focal brain injury beneath the dura mater that results from acceleration/deceleration. Usually
venous, and not necessarily from a fx. Formation may be acute or chronic.
, TNCC Notes for Written Exam LATEST
2024-2025 LATEST A+
Acute pt's hematoma manifest 48 hrs post injury
S/S:
- Altered LOC or steady decline in LOC
- S/S of increased ICP
- Hemiparesis or hemiplegia on opposite side of hematoma
- Unilateral fixed and dilated pupil on same side of hematoma
Chronic pt's " " up to 2 wks post injury
- H/A
- Progressive decrease in LOC
- Ataxia
- Incontinence
- Sz's
What are intracerebral hematoma's and its S/S? -
✅ Occur deep within brain tissue, may be single or multiple and commonly associated with
contusions (frontal & temporal lobes). They result in significant mass effect, leading to increased ICP
and neurologic deterioration.
S/S:
- Progressive and often rapid decline in LOC
- H/A
- Signs of increasing ICP
- Pupil abnormalities
- Contralateral hemiplegia
What are the S/S of a linear skull fx? -
✅ - H/A
- Possible decreased LOC
What are the S/S of a depressed skull fx? -
✅ - H/A
- Possible decreased LOC
- Possible open fx
- Palpable depression of skull over the fx site
What are the S/S of a basilar skull fx? -
✅ - H/A
- Altered LOC
- Periorbital ecchymosis (raccoon eyes), mastoid ecchymosis (Battle's sign), or blood behind tympanic
membrane (hemotympanum)
- Facial nerve (VII) palsy
- CSF rhinorrhea or otorrhea
How would you assess a pt with a cranial injury? -
✅ (Initial assessment)
INSPECTION:
- Assess airway
- RR, pattern and effort
- Assess pupil size and response to light
- Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation
syndrome
- Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates
- Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome
- Widely dilated pupil occasionally occurs w/direct trauma to globe of eye
- Determine if pt uses eye meds
- Abnormal posturing?
- Inspect craniofacial area for ecchymosis/contusions
- Periorbital ecchymosis
2024-2025 LATEST A+
TNCC Notes for Written Exam
What is Cushing's phenomenon or Cushing's Reflex? -
✅ Triad of progressive HTN, bradycardia and diminished respiratory effort.
What are the two types of herniation that occurs with ICP? -
✅ 1. Uncal herniation
2. Central or transtentorial herniation
Why does herniation occur? What are the symptoms? -
✅ Because of uncontrolled increases in ICP.
S/E's
- Unilateral or bilateral pupillary dilation
- AsyDimmetric pupillary reactivity
- Abnormal motor posturing
- Other evidence of neurologic deterioration
Define uncal herniation. -
✅ The uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior
fossa. This herniation is the more common of the two types of herniation syndromes.
Define central or transtentorial herniation. -
✅ A downward movement of the cerebral hemispheres with herniation of the diencephalon and
midbrain through the elongated gap of the tentorium.
Disruptions of the bony structures of the skull can result in what? -
✅ Displaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a
passage for CSF.
CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading
bacteria.
Also: meningitis or encephalitis or brain abscess
Define Minor Head Trauma. -
✅ GCS 13-15
Define Moderate Head Trauma -
✅Postresuscitative state with GCS 9-13.
Define Severe Head Trauma. -
✅Postresuscitative state with GCS score of 8 or less.
What is a concussion and its signs and symptoms? -
✅ A temporary change in neurologic function that may occur as a result of minor head trauma.
S/S:
- Transient LOC
- H/A
- Confusion and disorientation
- Dizziness
- N/V
- Loss of memory
- Difficulty with concentration
- Irritability
- Fatigue
What are the signs and symptoms of postconcussive syndrome? -
,TNCC Notes for Written Exam LATEST
2024-2025 LATEST A+
✅ - Persistent H/A
- Dizziness
- Nausea
- Memory impairment
- Attention deficit
- Irritability
- Insomnia
- Impaired judgement
- Loss of libido
- Anxiety
- Depression
What is diffuse axonal injury and its signs and symptoms? -
✅ (DAI) is widespread, rather than localized, through the brain. Diffuse shearing, tearing and
compressive stresses from rotational or accerleration/deceleration forces resulting in microscopic
damage primarily to axons within the brain.
S/S:
- Immediate unconsciousness
- mild DAI, coma = 6-24 hrs
- severe DAI, coma = weeks/months or persistent vegetative state
- Elevated ICP
- Abnormal posturing
- HTN
- Hyperthermia
- Excessive sweating because of autonomic dysfunction
- Mild to severe memory impairment, cognitive, behavioral, and intellectual deficits
What is a cerebral contusion and its S/S? -
✅ A common focal brain injury in which brain tissue is bruised and damaged in a local area. Mainly
located in frontal and temporal lobes. May cause hemorrhage, infarction, necrosis and edema. Max
effects of bleeding &edema peak 18-36 post injury.
S/S:
- Alteration in LOC
- Behavior, motor or speech deficits
- Abnormal motor posturing
- Signs of increased ICP
What is an epidural hematoma and its S/S? -
✅ Results when a collection of blood forms between the skull and the dura mater. Bleeding is
arterial=blood accumulates rapidly:
- Compression of underlying brain
- rapid increase in ICP
- Decreased CBF
- Secondary brain injury
* Usually requires surgical intervention
S/S:
- Transient LOC
- Lucid period lasting a few minutes to several hours
- Rapid deterioration in neurologic status
- Severe H/A
- Sleepiness
- Dizziness
- N/V
- Hemiparesis or hemiplegia on opposite side of hematoma
- Unilateral fixed and dilated pupil on same side of hematoma
What is a subdural hematoma and its S/S? -
✅ A focal brain injury beneath the dura mater that results from acceleration/deceleration. Usually
venous, and not necessarily from a fx. Formation may be acute or chronic.
, TNCC Notes for Written Exam LATEST
2024-2025 LATEST A+
Acute pt's hematoma manifest 48 hrs post injury
S/S:
- Altered LOC or steady decline in LOC
- S/S of increased ICP
- Hemiparesis or hemiplegia on opposite side of hematoma
- Unilateral fixed and dilated pupil on same side of hematoma
Chronic pt's " " up to 2 wks post injury
- H/A
- Progressive decrease in LOC
- Ataxia
- Incontinence
- Sz's
What are intracerebral hematoma's and its S/S? -
✅ Occur deep within brain tissue, may be single or multiple and commonly associated with
contusions (frontal & temporal lobes). They result in significant mass effect, leading to increased ICP
and neurologic deterioration.
S/S:
- Progressive and often rapid decline in LOC
- H/A
- Signs of increasing ICP
- Pupil abnormalities
- Contralateral hemiplegia
What are the S/S of a linear skull fx? -
✅ - H/A
- Possible decreased LOC
What are the S/S of a depressed skull fx? -
✅ - H/A
- Possible decreased LOC
- Possible open fx
- Palpable depression of skull over the fx site
What are the S/S of a basilar skull fx? -
✅ - H/A
- Altered LOC
- Periorbital ecchymosis (raccoon eyes), mastoid ecchymosis (Battle's sign), or blood behind tympanic
membrane (hemotympanum)
- Facial nerve (VII) palsy
- CSF rhinorrhea or otorrhea
How would you assess a pt with a cranial injury? -
✅ (Initial assessment)
INSPECTION:
- Assess airway
- RR, pattern and effort
- Assess pupil size and response to light
- Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation
syndrome
- Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates
- Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome
- Widely dilated pupil occasionally occurs w/direct trauma to globe of eye
- Determine if pt uses eye meds
- Abnormal posturing?
- Inspect craniofacial area for ecchymosis/contusions
- Periorbital ecchymosis
