Head injury/trauma Flashcards Preview

1. Neurology > Head injury/trauma > Flashcards

Flashcards in Head injury/trauma Deck (16)
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1
Q

Who are at high risk of head injuries/trauma?

A
young men
elderly - think about anticoagulation
previous head injury
alcohol and drug abuse
low income
2
Q

When must you give treatment for head injuries?

A

within an hour - GOLDEN HOUR

3
Q

What is a mild score on the GCS?

A

14 or 15

4
Q

What is a moderate score on the GCS?

A

9-13

5
Q

What is a severe score on the GCS?

A

3-8

6
Q

What people qualify to have a CT within an hour of a head injury being identified?

A
GCS <13 on initial assesment
CGS <15 after 2 hours of injury
suspected open or depressed skull fracture
any sign of basal skull fracture
focal neurological deficit
>1 episode of vomiting
suspicion of non accidental injury in children
if >65years
on anticoagulants
dangerous mechanism of injury eg RTA
7
Q

What are important signs to look out for?

A

racoon eyes - basilar skull fracture
battle sign - basilar skull fracture
CSF/blood from the ears

8
Q

What is the worst prognostic factor?

A

skull fracture and loss of conciousness

9
Q

What are other prognostic factors to take into consideration?

A

age >65 - independant risk factor for brain surgery
depth of coma
motor response
pupil reaction

10
Q

What are the principles of treatment for head injuries?

A

prevent secondary insults: hypoxia, hypertension, mass lesions and control ICP and CPP

11
Q

How is ICP controlled?

A

increased MAP = decreased ICP
removing a large mass from the skull can decrease ICP
keep head at 30 degrees to maximise venous drainage and decrease ICP
can give diuretics
control CO2
make sure they are fully sedated - benzodiazepines

12
Q

What is the last resort treatment option for raised ICP?

A

decompressive crainiectomy

13
Q

What does the body loose the ability to do in brain injuries?

A

autoregulate BP

14
Q

What is diffuse axonal injury?

A

swelling of the axons

occur where the density difference is highest - between gray and white matter

15
Q

What does diffuse axonal injury cause?

A

excitotoxicity - where glutamate activates NMDA receptors leading to calcium mediated activation of lipases and proteases -> cell death

16
Q

What is the criteria for brainstem death?

A

recovery must be impossible - must be normothermic, on no drugs and no severe metabolic or endocrine disturbance
two doctors must quantify this and carry out the procedure twice