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Flashcards in Head Injury Deck (17)
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1
Q

What is the pathophysiology in a primary brain injury?

A

Release of excitatory amino acids (glutamate, aspartate)
Binding to receptors (eg NMDA)
Release of intracellular calcium, activation of phospholipases, breakdown of cell membrane, cell swelling, activation of apoptosis.

2
Q

What is the pathophysiology in a secondary brain injury?

A

Loss of blood-brain-barrier, leucocyte infiltration - inflammation
Loss of cerebral autoregulation of blood pressure - ischaemia
Loss of cerebral autoregulation of blood flow – metabolic de-coupling – even more ischaemia causing further brain oedema

3
Q

What does cerebral perfusion pressure equal?

A

CPP=MAP-ICP

4
Q

What CPP should be aimed for after head injury?

A

> 60mmHg

5
Q

What physical findings can be found in head injury?

A

Scalp swelling/laceration
Skull vault fracture- linear, depressed, compound
Skull base fracture- ACF:panda eyes, MCF:Battle sign

6
Q

What are the eye opening components of the GCS?

A

Spontaneously
To command
To pain
None

7
Q

What are the verbal response components of the GCS?

A
Orientated
Confused
Inappropriate words
Incomprehensible sounds
None
8
Q

What are the best motor response components of the GCS?

A
Obeys commands
Localised pain
Flexes to pain
Abnormal flexion
Extension
None
9
Q

What is the definition of a coma?

A

Does not open eyes, obey commands, or speak. GCS <=8

10
Q

What kills patients with head injury?

A

Hypoxia
HT
Raised ICP

11
Q

Within what time does irreversible neuronal damage occur in circulatory arrest?

A

5 minutes

12
Q

What percentage of carried glucose does the brain use?

A

12%

13
Q

When should a head CT be requested in trauma?

A
Any patient with: (1 required)
a skull fracture
not orientated (GCS <15)
with focal neuro signs
taking anti-coagulants
14
Q

What are the types of traumatic intracranial bleeding from outside to in?

A
Extradural haematoma
Subdural haematoma
Traumatic subarachnoid haemorrhage
Intracerebral contusion
Intracerebral haematoma
Intraventricular haemorrhage
15
Q

What is the intensive care management of head injury?

A

Sedation-Reduces cerebral metabolic rate, reduces cerebral blood flow, reduces ICP
Ventilation- Maintain adequate oxygenation
Maintain normocapnia
BP-Manipulate to maintain CPP of >60mmHg
Glucose- Maintain normoglycaemia
Temperature- Maintain euthermia

16
Q

What cerebral protection can occur following injury?

A

CSF Drainage - reduces ICP
Mannitol- improves micro-perfusion
Hypertonic saline- may be better than mannitol
Hyperventilation- temporary effect (2-4 hrs)
Hypothermia- weak evidence for effect
Decompressive craniectomy – randomised trial underway

17
Q

What is post concussion syndrome?

A

Poor concentration, headache, poor memory, lethargy post-head injury