ATLS TEST 1 LATEST EXAM 2024 ADVANCED TRAUMA LIFE SUPPORT TEST 1 LATEST, Exams of Nursing

Download ATLS TEST 1 LATEST EXAM 2024 ADVANCED TRAUMA LIFE SUPPORT TEST 1 LATEST and more Exams Nursing in PDF only on Docsity! ATLS Study Cards Questions with Correct and Verified Answers 2024. Glasgow Coma Scale - What is a Chance fracture? – Transverse fracture through vertebra. In children usually associated with enterc disruption. Seen in motor vehicle accidents involving only lap belt. May be associated with retroperitoneal and Abdominal visceral injuries. Anterior hip dislocation Position? – Flexed, abducted, externally rotated. ABE-Anterior, aBducted, Externally Rotated PID: Posterior, aDducted, Internally Rotated Burst fracture a/w with? – Associated with vertebral-axial compression injuries Posterior hip dislocation position? – Flexed, aDDucted, internally rotated Anterior shoulder dislocation appearance – Squared off appearance Posterior shoulder dislocation appearance – Lock in internal rotation. Ankle dislocation MC direction – Most are Externally rotated, with a prominent medial malleolus. FULL thickness (3rd degree) burn – Dark or white and leathery. Translucent white as well. Painless and generally "dry" Does not blanch with pressure. Very little swelling of burned tissue. Principle Life saving measures for patients with burn injuries include – -Establishing airway control -Stopping the burning. process -Intravenous access Factors that increase the risk for upper AIRWAY OBSTRUCTION in burns include: - -Burns to the head and face -Burn size and depth -Burns inside the mouth Partial thickness burn – Red remodeled appearance with associated swelling and blister formation. May have weeping or wet appearance and is painfully hypersensitive even to air current. Signs and symptoms and history that suggest INHALATION INJURY include: - These patients should be intubated. Inhalation injury is an indication for transfer to a burn center. Rule of nines – adult - The palm represents 1% of the body total surface area. Symptoms of carbon monoxide poisoning and respective levels – PaO2 does not reliably predict carbon monoxide poisoning because a CO partial pressure of only 1 mmm Hg results in a hemoglobin CO level of 40% or greater. Carbon monoxide has how many times greater affinity for hemoglobin than oxygen – 240 times. It displaces the oxyhemoglobin desaturated curve to the LEFT. Two criteria required for the diagnosis of smoke inhalation injury – -Exposure to a combustible agent -Signs of exposure to smoke in the lower airway, below the vocal cords, by bronchoscopy. Performing this action will help reduce neck and chest wall edema in patients with burn and inhalation injury. – Elevation of the head and chest by 30 degrees. IV fluid administration formula for burn victims – Indicated in burns involving over 20% of the body surface area. *(2-4 mL/kg of LR/NS) (weight in kg) (% area of burn); give 1/2 of this volume in first 8 hours. Remainder in over 16 hours. Large caliber, at least 15 gauge intravenous line should be introduced. Pitfalls for IV fluid requirements for burn victims. – These patients require greater fluid requirements: ~immolation injury ~pediatric burn victims ~concomitant blunt or crush Infant: 80 ml/kg Child: 70 ml/kg IO needle size: Infant Child – 18 gauge-Infant 15 gauge-Child What is the Packed red blood cell volume transfusion for a child? – 10 mL/ kilogram Pediatric verbal score - Impacted fractures demonstrates what? Non-impacted Fractures – Demonstrate no false motion of the humorous when the shoulder is rotated gently from a flexed elbow. Non-impacted Fractures: -Generally experience pain on movement of the arm. – Generally require hospitalization for orthopedic consultation and often operation Fundal height in pregnancy – The amniotic fluid may cause amniotic fluid EMBOLISM and DIC following trauma if the fluid gains access to maternal intravascular space. Physiologic changes in pregnancy – 1.Physiologic changes in pregnancy small increase in volume resulting in a decrease in hematocrit. 2. Elevation and WBC as high as 25,000. 3. Mild elevation in clotting factors. Bleeding and clotting times are unchanged, however. 4. Arterial pH 7.40-7.45 5. PaCO2: 25-30mmHg 6. Bicarbonate space 17-22 (Compensatory metabolic Acidosis). A resting PaCO2 of 35 to 40 mm in the setting of pregnancy – May represent impending respiratory failure. Normal PaCO2 for a pregnant woman is between 25 to 30 mmHg Kleinhauer-Betke test – Maternal blood smear test which allows detection of fetal RBCs in the maternal circulation, indicates fetomaternal hemorrhage. Indication for Rh immunoglobulin therapy. Drugs to avoid in hypovolemia, head injured and intoxicated patients. - Benzodiazepines, fentanyl propofol, ketamine Initial Assessment components of seriously injured patient - Primary survey – 1. Airway maintenance with cervical spine protection 2. Breathing and ventilation 3. Circulation & hemorrhage control 4. Disability: neurological status 5. Environment/Exposure: completely undress the patient but prevent hypothermia Assume a CERVICAL SPINE injury in patients with BLUNT multisystem trauma, especially those with an altered level of consciousness's or a blunt injury about the clavicles. - IV fluid warming temperature in shock? – 37 to 40°C Associated with aberrant conduction, premature beats, bradycardia. (3 conditions) - hypoxemia, hypothermia hypokalemia. AMPLE history. – Allergies Medications Past illness/Pregnancy, Last meal Environment/events related to injury Injuries a/w: Frontal impact automobile collision: Bent steering wheel, Knee imprint dashboard Bulls eye fracture windshield - Cervical spine fracture Anterior flail chest Myocardial contusion Pneumothorax Traumatic aortic disruption Fractured spleen or liver Posterior fracture/dislocation of hip and/or knee Injuries a/w: Side impact automobile collision - Contralateral next sprain Cervical spine fracture Lateral flail chest Pneumothorax Traumatic aortic disruption Diaphragmatic rupture Fractured spleen/liver and/or Fracture of kidney, pelvis or acetabulum Rear impact automobile collision - Cervical spine injury Soft tissue neck injury Ejection from automobile - Ejection from the vehicle precludes meaningful prediction of injury patterns. Patient at greater risk from virtually all injury mechanisms. Motor vehicle impact with pedestrian. - Head injury Traumatic aortic disruption Blunt force to the neck or Normal urinary output for children *greater* than 1 year of age - 1 milliliter per kilogram per hour Normal urine output for child less than 1 year of age - 2 milliliters per kilogram per hour Responses to initial fluid resuscitation in shock - What needs to happen when there is failure to respond to crystalloid and blood administration in the emergency room in the setting of a motor vehicle accident or trauma resulting in shock. - Depends, but some intervention such as operation or angioembolization to control exsanguinate hemorrhage Three other causes of failure to respond to IV fluids that are not HEMORRHAGIC in origin. - 1.Tension pneumothorax 2. Blunt cardiac injury 3.Pericardial tamponade Type-specific blood is indicated in what type of responder? - Indicated in the setting of TRANSIENT responders. *T*ype specific blood in *T*ransient responders What type of blood should be transfused for minimal or no response trauma patients after crystalloid fluid resuscitation? - Typed only packed red blood cells. (pRBCs) Rh neg (O negative) preferred for females of childbearing age. Definition of massive transfusion of pRBC: - Transfusion of >10 units of packed red blood cells (PRBCs) in 24 h Preferred temperature of packed red blood cells or peritoneal or thoracic cavity crystalloid solutions for hypothermia - 39 degrees centigrade (102.2) Most common cause of poor response to IV fluids in the setting of shock. - Undiagnosed source of bleeding. Central venous pressure reflects? May not represent Left heart function in what pt? - Reflects *right* heart function. May not represent left heart function in patients with primary myocardial dysfunction or abnormal pulmonary circulation. Conditions to consider if a patient does not respond to fluid therapy - Unrecognized fluid loss, Ventilatory problems Tension pneumothorax Cardiac tamponade Hypoadrenalism Neurogenic shock Massive hemothorax findings on physical exam - Tracheal deviation *FLAT* neck veins (due to heavy blood loss) Percussion dullness Absent breath sounds Distended neck veins are seen in what two conditions - 1. Cardiac tamponade 2.Tension pneumothorax Conditions to consider in transient responders in the setting of shock. - 1. Hemorrhagic: Bleeding within the abdomen, pelvis, retroperitoneum, extremity fracture, or obvious external bleeding. 2. Nonhemorrhagic: Tension pneumothorax or cardiac tamponade NONresponder to IV fluids. Diagnostic consideration - Blunt cardiac injury. Intraosseous needle size. - 18 gauge spinal needle with stylet. Physical signs suggesting a pelvic fracture on physical exam - 1. Scrotal hematoma 2. Blood at the urethral meatus Perineal hematoma, Leg length difference Mobile or high-riding prostate gland, Gross or occult blood in the stool. Life-threatening thoracic injuries that need to be addressed in the primary survey - Airway obstruction Tension pneumothorax Open pneumothorax Flail chest and pulmonary contusion Massive hemothorax Cardiac tamponade Most common cause of tension pneumothorax - Mechanical ventilation with positive pressure ventilation in patients with visceral pleural injury Flail chest radiograph - Initial treatment of flail chest - Adequate ventilation, humidified oxygen, fluid resuscitation. Later, analgesia. Short Term intubation and ventilation may be necessary. Local nerve block preferred over IV narcotics. MASSIVE hemothorax definition - > 1500 milliliters of blood or one third or more of the patient's total blood volume in the chest cavity. Neck veins can be distended (if concomitant tension pneumothorax) or *flat* (if blood loss results in hypovolemia). Treatment of MASSIVE hemothorax - 1. Restoration of blood volume (crystalloid then type specific blood) 2. Decompression of the chest cavity. 36 or 40 French chest tube required MASSIVE Hemothorax. Indications for thoracotomy: - If Greater than 1500 ml of fluid is immediately evacuated. Less than 1500 milliliters of fluid evacuated but continued blood loss of 200 milliliters per hour for 2 to 4 hours *200 mL/hr for 2-4 hrs* Beck's triad in cardiac tamponade - Venous pressure elevation, decline in arterial pressure, muffled heart tones. JVD Hypotension Muffled Heart Sounds Kussmal's sign definition and seen when? - Paradoxical RISE in central venous pressure with inspiration. Seen in cardiac tamponade. Resuscitative thoracotomy indications - Patients with PENETRATING injuries to the chest, pulseless, but with myocardial electrical activity may be candidates. Patients with BLUNT injuries to the chest, arrive pulseless but with myocardial electrical activity are NOT candidates. SIMPLE hemothorax Current of energy pattern that occurs in pericardiocentesis - Extreme ST wave changes Widened and enlarged QRS complex. Organs contained within the retroperitoneum (SAD PUCKERS are in the BACK (posterior). - Duodenum, pancreas, kidneys and ureters; posterior aspect of the ascending and descending colon, part of the pelvic cavity. S = Suprarenal (adrenal) glands A = Aorta/Inferior Vena Cava D = Duodenum (second and third segments) P = Pancreas U = Ureters C = Colon (ascending and descending only) K = Kidneys E = Esophagus R = Rectum Relative contraindications to DPL (4) - 1. Coagulopathy 2. obesity 3. previous abdominal operations 4. liver cirrhosis. DPL- what makes it positive? - Positive test: -greater than 100,000 RBCs/ cubic mm -500 WBCs -Gram stain positive for bacteria. Evaluation of penetrating (such as knife wound) trauma to the abdomen and the thoracoabdominal region needs what? - Serial physical exam or DPL. Generally manage more selectively but approximately 30% associated with intraperitoneal injury. Management of gunshot wounds to the abdomen are mostly managed by? - Most are managed by laparotomy. Indications for laparoscopy in PENETRATING abdominal wound - -Any hemodynamically abnormal patient -Gunshot wound with transperitoneal trajectory -signs of peritoneal irritation -signs of fascial penetration. Management options for flank and back stab wounds and gunshot wounds. - Initially, serial physical exams if patient is asymptomatic except for local pain If patient becomes symptomatic: laparotomy. Triple contest CT scan. More fully evaluates the retroperitoneum. Earlier diagnosis in relatively asymptomatic patients. DPL can also be used as an early screening test. If it is positive, urgent laparotomy. Indications for laparotomy in abdominal and pelvic trauma. - Duodenal injury or trauma findings and Dx? - -Suggested by free air on flat plate or upright of the abdomen -Bloody *gastric* aspirate. Diagnosed using upper gastrointestinal series or double contrast CT scan. Direct blows to the back or flank resulting in hematomas or ecchymosis. - Gross hematuria and microscopic hematuria with an episode of indicate they are at risk for NONRENAL abdominal injuries. Order a CT scan with IV contrast. Anterior urethral injuries or disruptions usually present in? - Usually present in patient with anterior pelvic fractures from a straddle injury. Usually an isolated finding only. Posterior urethral injury usually present in? - Usually associated with multisystem injuries and pelvic fractures. Blunt injury to the intestines is associated with what physical exam finding? A/w with what traumatic injurt? - 1. Linear ecchymosis on the abdominal wall or a chance fracture Classic sign of uncal herniation - Ipsilateral dilated pupil with contralateral hemiparesis. What is the normal intracranial pressure in the resting state. - Normal 5 to 15 mm Hg Physical signs of a basilar skull fracture - Raccoons eyes Otorrhea Battle's sign CSF leakage from nose Definition of MINOR traumatic brain injury GCS in 13 and 15 - History of disorientation, and amnesia, or transient loss of consciousness in a patient who is conscious and talking. CT scan indicated in the setting of minor traumatic brain injury (GCS 13-15) when the following are seen - GCS of less than 15 *two hours* after injury Suspected open or depressed skull fracture Any signs of basilar skull fracture Vomiting more than *2* episodes Age more than *65 years* Loss of consciousness *more than five minutes* More *than 30 minutes amnesia* before impact Dangerous mechanism of trauma Management of moderate brain injury GCS 9-12 - CT scan of the head in all cases Admission to *intensive care unit* for frequent neurologic checks repeat CT scan. (10 to 20% of these patients deteriorate and lapse into coma) Management of patients with severe brain injury GCS 3-8 Goal PaC02? - *CT Scan and admit to *neurosurgical* ICU *Therapeutic agents if needed including mannitol, hypertonic saline, moderate hyperventilation: PaCO2 of ~35mmHg. *Repeat CT scanning as needed. *Intubation. A midline shift of 5 millimeters or greater on CT scan of the brain indcates? - Indicate the need for surgery to evacuate the blood clot or contusion causing the shift Indication for the use of Mannitol (1gm/kg) Patient must be what to use it? - 1. Acute neurologic deterioration such as development of a dilated pupil, loss of consciousness, or hemiparesis in a severe head trauma patient. 2. Patient must be euvolemic. Three main factors linked to a high incidence of late epilepsy in post traumatic patients - 1. Seizures occurring within the *first week* 2. Intracranial hematoma 3. Depressed skull fracture. Diagnosis of brain death criteria (4) - *GCS score of 3 *Nonreactive pupils *Absent brainstem reflexes (Doll's eyes, corneal, gag reflexes) Displaced thoracic spine fracture can be associated with - Thoracic aortic rupture Spine fractures can be associated with - Intraabdominal injury Femur fracture can be associated with - Femoral neck fractures posterior hip dislocation Fracture / dislocation of the elbow can be associated with - Brachial artery injury Median, anterior interosseus, and radial nerve injury. Posterior knee dislocation can be associated with what orthopedic injuries - Femoral fracture Posterior hip dislocation Near this location or displaced tibial plateau fracture can be associated with - Popliteal artery and nerve injuries. Calcaneal fracture can be associated with - Spine injury or fracture, fracture dislocation of the hind foot, to be a plateau fracture. Open fractures can be associated with - 70% incidence of associated non skeletal injury. Characteristics of pediatric trauma - Motor vehicle associated injuries are the most common cause of death in children of all ages. Most serious pediatric trauma is blunt trauma that involves brain. As a result apnea, hypoventilation and hypoxia after five times more often. Multisystem injury is the rule and should be presumed. Internal organ damage is often noted without overlying bony fractures. Use of atropine for drug assisted intubation should be used when? - Should be reserved for infants only. What blood volume loss is needed to decrease child's systolic BP? What about hypotension? - What blood volume loss is needed to decrease child's systolic BP? -30% What about hypotension? -45% Vitas for pediatric population - Characteristics of chest trauma in children. - Mediastinal structures are mobile.; pneumomediastinum is rare. *tension pneumothorax is most common life threatening injury.* Chest tube placement is required but thoracotomy is generally not needed in children. Rib fractures are rare. The present, indicates significant energy impact. Typical characteristics of paediatric abdominal trauma. - Most pediatric internal injuries occurred as a result of blunt trauma. The presence of shoulder or lap belt marks increases likelihood of intraabdominal injuries. FAST should not be relied upon as the sole diagnostic tool in pediatric abdominal trauma. If a small amount of interim nominal through it is found and the child is hemodynamically normal a CT scan should be obtained. Most pediatric patients have self limiting intra-abdominal injuries and no hemodynamic abnormalities. Diagnostic peritoneal lavage volume in pediatric patients - 10 milliliters per kilogram. A DPL or FAST exam that is positive for blood alone does not mandate laparotomy in a child who was hemodynamically normal, or who stabilizes rapidly with fluid resuscitation. Laparotomy is indicated if child's hemodynamic condition cannot be normalized Characteristics of pediatric head trauma. - Subarachnoid space is relatively small and offers less protection to the brain because there is less buoyancy. parenchymal damaged structurally is more common. Outcome in children suffering severe brain injury less than three years of age is *worse* than a similar injury in an older adult. Hypo*volemia* is a single worse risk factor for secondary brain injury in children. An infant who is not in a coma but who has bulging fontanelle or suture diastasis should be treated as having a more severe injury. Impact seizures, that occurs shortly after a brain injury, are more common in children and are usually self-limited. Increased intracranial pressure is more frequent in children than adults after head trauma. Spinal cord injury characteristics in the pediatric trauma group. - Force is applied to the upper neck are relatively greater than in the adult. This accounts for more injuries at the level of the occiput to C3 Pseudo subluxation frequently complicates ingredient graphic evaluation and the child cervical spine. 40% of children younger than 7 years of age show anterior displacement of C2 on C3. Pseudo subluxation can mimic a true cervical spine injury in children. Ligamentous injuries are more common in children. SCIWORA - Spinal cord injury without radiographic evidence is MC than adults. A normal cervical spine series may be found in up to two-thirds of children who have suffered spinal cord injuries. Ligamentous injuries are more common in children than adults. Musculoskeletal trauma in children. - Blood loss associated with long bone and pelvic fractures is proportionately greater in children than in adults and may lead to haemodynamic instability Hemodynamic instability in the presence of an isolated femur fracture should prompt evaluation for other sources of blood loss which usually will be found within the abdomen. Characteristics of geriatric patients in trauma. - Most common mechanism of injury in older adults are falls. The account for 40% of death in this age group. Consider early intubation in geriatric trauma patients with underlying chronic lung disease. Metabolic acidosis is a predictor of mortality. Head trauma in the elderly. - Elderly with brain injuries have fewer severe cerebral contusions but higher incidence of subdural and intraparenchymal hematomas. Spinal trauma in the elderly. - Because of osteoarthritis increase risk for spinal canal stenosis and posterior ligament I purchase food increases the risk for central and anterior cord syndrome. What is the cause of preventable death after truncal trauma? - Unrecognized abdominal and pelvic injuries What space do we always forget about that it's really difficult to evaluate? - The retroperitoneum. Name 4 common blunt abdominal/ pelvic injuries. - 1). Liver 2). Spleen 3). Small bowel 4). Pelvis True or false? Gunshot wound damaged tissue by kinetic injury? - True-this is why there is increased damage around the track as compared to stab wounds True or false? You can look at entry and exit wounds and get a general sense of the organs involved in the injury. - False-you don't know where that bullet has been! 4 patients that get an exploratory lap - 1). Free air under the diaphragm 2). Diaphragmatic rupture 3). Peritonitis 4). Violation of the peritoneal cavity What is the FAST not very good at detecting? - Small bowel, pancreas, or diaphragm injuries What can a diagnostic peritoneal lavage ( DPL) diagnose? - Small bowel injuries When would you give your patient rectal as well as IV contrast in the trauma bay? - When you suspect a colon injury *** this might be the case of flank ecchymoses You have a patient with an unstable pelvis in a rural hospital. What would you do? - Bind the pelvis tightly with a sheet. Finding the thighs and ankles can also help. Recognize the source of a occult hemorrhage - "blood on the floor + 4 more" Chest Abdomen Pelvis (retroperitonium) Thigh Pre-intubation evaluation: LEMON - L-Look facial and neck injuries can distort exterior and interior structures E-Evaluate 3-3-2: intro oral, mandibular and hyoid to thyroid notch distance (open C collar) M-Mallampati score: Open mouth, determine how much retro pharynx is visible, pooled blood, vomitus etc O- Obstruction/ Obesity N-Neck Mobility What metabolic Disturbance can you get with normal Saline resuscitation? - Hyperchloremic metabolic acidosis A 33 week pregnant patient is s/p MVC. Her PaCO2 is 40. ? Normal? - No- as pregnancy progresses, women have a permissive hypocapnia because they have an increased respiratory rate. In very pregnant women, a PaCO 2 of 40 is hypercapnia Why do we put long bone injuries into traction? - To minimize bleeding How do you treat frostbite? - Rapid rewarming with moist heat What is the best way to implement a surgical airway and a pediatric patient? - Needle cricoidostomy with jet insufflation You just placed an ET tube in your rural ER. Patient has been approved for transfer. You don't have to wait on anything before transfer, except - CXR confirming place meant. You cannot transfer patient with a bad intubation What are the categories of the GCS? - Eyes opening Verbal response Best motor response What are the EYE scores? - 1). No response 2). Open to pain 3). Open to voice 4). Open spontaneously What are VERBAL scores? - 1). No response 2). Incomprehensible sounds 3). Inappropriate words 4). Confused conversation 5). Orientated What are the MOTOR scores? - 1). None 2). (Decerebrate) extension 3). (Decorticate) abnormal flexion 4). Flexion withdraw to pain 5). Localization of pain 6). Obeys commands True or false? Because of their increased intravascular volume, pregnant patients can lose a significant amount of blood without damage to themselves or the fetus. - False- because of increased in intravascular volume, they can lose a lot of blood before their vital signs reflect that loss. Thus, the fetus may be in distress and the placenta deprived of vital perfusion while the mother's condition and vital signs appear stable. How low can a normal PaCO2 be in a pregnant female? - 25-30 mmHg What is the most common immediately life-threatening injury and children? - Tension pneumothorax The mobility of mediastinal structures makes a child more susceptible to this process What is the tape called that you lay out next to the pediatric trauma patient? - Broselow Pediatric Emergency Tape. It shows a rapid determination of weight based on length, appropriate fluid volumes, drug doses, and equipment size What is the "rule of nines"? - The adult body is generally divided into surface areas of 9% each and or fraction or multiples of 9 Leg=18% TBSA Arm=9% TBSA Ant/Posterior trunk, each 18% TBSA Head=9% TBSA Does the rule of nines work differently in children? - The infants or young child's head represents a larger proportion of the surface area and lower extremity's represent a smaller proportion than the adult How much resuscitation do burn patients need? - 2-4ml LR/kg/ % BSA deep partial thickness and full thickness burns during the first 24 hours to maintain circulating blood volume** calculate does, give The first half to be delivered in eight hours, and watch urine output. If this is fine then resuscitation is fine. If poor response increase your resuscitation dose A Doppler ankle/brachial index of less than is indicative of an abnormal arterial flow, 2/2 injury or peripheral vascular disease - 0.9 It means that there is significantly less flow in the legs then in the arms True or false? All patients with open fractures should be treated with IV anabiotic's as soon as possible - True List the three important spinal tracts of ATLS - 1). Corticospinal tract Pitfall - Key management is aggressive pain control without respiratory depression in the patients with multiple rib fractures Pitfall - Hypothermic contributes to allopathy an ongoing bleeding Name three major thoracic injuries that affect breathing that must be recognized and addressed during the primary survey - 1). Tension pneumothorax 2). Open pneumothorax (open chest wound) 3). Flail chest and pulmonary contusion What are the signs of cardiac Tamponade? - BECKS TRIADE: 1). Venous pressure elevation 2). Decline in arterial pressure 3). Muffled heart sounds ***** seen on echo Name the 7 specific anatomic guidelines for examining CXR - 1) trachea and bronchi 2) plural spaces and lung parenchyma 3) mediastinum 4) diaphragm 5) bony thorax 6) soft tissue 7) tubes and lines What are the 4 views used in FAST exam? - 1) pericardial 2) RUQ to include diaphragm/liver Interface and Morrison's pouch 3) LUQ to include diaphragm/spleen and spleen/kidney Interface 4) Suprapubic view What are the clinical signs of a basilar skull fracture? - 1) raccoon eyes (peri orbital ecchymoses) 2) Battle's sign (retro auricular ecchymoses) 3) CSF leakage from nose, ear 4) facial paralysis, hearing loss (CN 7-8 nerve dysfunction) Classify the severity of brain injury by GCS scores - Minor= 13-15 Moderate=9-12 Severe=3-8 After consulting with neurosurgeon, what are the therapeutic agents used in initial management of severe brain injury? - 1) mannitol 2) moderate hyperventilation (PaCO2 32-35) 3) hypertonic sailine What is the function and method of testing for the dorsal columns? - Function: carries position sense, vibration sense and some light touch sense from the SAME side Test: proprioception in toes and fingers or vibration using a tuning fork What is the function and method of testing for the spinothalamic tract? - Function: transmits pain and temperature sensation from the OPPOSITE side Test: pinprick and light touch What is the function and method of testing for the corticospinal tract? - Function: Controls motor power on the SAME side of body Test: voluntary muscle contractions or involuntary response to painful stimuli