Trauma Certified Registered Nurse (TCRN) – Head and Neck Trauma Review – Neurological, Maxillofacial, and Neck Injuries Study Guide

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TCRN Review - Head and Neck
(Neurological Trauma and
Maxillofacial and Neck Trauma)



What are the three main constituents in the brain? - Correct
answer- CSF, Brain Tissue (mostly water), Blood


The brain makes up approximately _____% of the volume of the
skull and is _____% water. - Correct answer- 80%
75%


CSF makes up about _____% of the volume of the skull. - Correct
answer- 10%


There is approximately _____ mL of CSF. - Correct answer- 125-
150 mL


Blood makes up about _____% of the volume of the skull and
_____% of the blood is venous. - Correct answer- 10%
80%


The pressure of water, CSF and blood against the skull is known as
_____. - Correct answer- ICP - Intracranial pressure

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What are the normal ICPs for children and adults? - Correct answer-
Child - 0-5 mmHg
Adult - 5-12 mmHg


ICP pressures above _____ mmHg in any age group is considered
elevated. - Correct answer- 20 mmHg


ICP pressures above 20 mmHg do what? - Correct answer-
Compromise blood flow into the skull and contribute to cerebral
hypoxia and hypoglycemia.


What can happen if ICP pressures climb too high? - Correct answer-
The brain may be forced out of the skull through any opening (such
as skull fractures, tentorial plate or foramen magnum).


ICP above _____ mmHg is severe and life-threatening. - Correct
answer- 40 mmHg


ICP between _____ and _____ mmHg is termed "moderate
intracranial hypertension". - Correct answer- 20 and 40 mmHg


ICP above 20 mmHg is abnormally high and is known as _____. -
Correct answer- Early increased ICP


What should resting ICP be? - Correct answer- Less than 10 mmHg

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When ICP increases, pressure is exerted downwards on brain tissue,
affecting the cerebral cortices _____ and _____. - Correct answer-
Reticular Activating System (RAS) and Cranial Nerves


List 6 things caused by pressure on the RAS (Reticular Activating
System). - Correct answer- 1. Progressive restlessness
2. Confusion
3. Disorientation
4. Lethargy or combativeness
5. Changes in speech
6. Loss of judgement


List 4 motor functions caused by increased ICP. - Correct answer- 1.
Monoplegia
2. Hemiplegia
3. Over-pronation or supination of the wrists
4. Pronator drift


List 5 eye changes caused by increased ICP. - Correct answer-
Diplopia
Blurred Vision
Visual field defects (loss of sight in part of one visual field)
Conjugate deviation of eyes or gaze palsies
Oval pupils with hippus

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Increased ICP causes _____ losses. - Correct answer- Sensory


List 3 things caused by pressure on the hypothalamus. - Correct
answer- Nuchal rigidity
Temperature changes
Vomiting (usually without nausea)


Describe how to test for pronator drift. - Correct answer- Ask the
patient to hold both arms straight forward with the palms up for at
least 30 seconds. Have the patient close his or her eyes. Monitor for
unilateral downward drift of one hand (known as pronator drift).


Describe "conjugate deviation of the eyes". - Correct answer- Both
eyes move in the same direction.


What is a gaze palsy? - Correct answer- Inability to move both eyes
in one direction.


What is a hippus? - Correct answer- Pupil rapidly dilates and
constricts when stimulated with light so it looks as though it is
jiggling up and down.


List 6 late signs of increased ICP. - Correct answer- 1. Further
reduction in LOC and responsiveness
2. Wide fluctuations in core body temperature

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