Traumatic Brain and Head Injury Flashcards Preview

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Flashcards in Traumatic Brain and Head Injury Deck (22)
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1
Q

Define TBI

A

Non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to temporary or permanent impairment of cognitive, physical and psychosocial function

2
Q

What are the high risk groups for TBI

A
Young men & elderly
Previous head injuries
Residents of inner city
Alcohol and drug abuse
Low-income
3
Q

What are the principles of ATLS

A

Airway with C spine control
Breathing
Circulaiton

4
Q

Describe the assessment of a patient with TBI?

A

ATLS management
(GCS, pupils, other)

Secondary survey
(other injuries- C-spine)

History

  • what happened and when
  • age
  • pre-existing PMH
  • Drugs (anticoagulants)
5
Q

What is the eye opening scale in GCS?

A

Open spontaneously
To speech
To pain
No eye opening

6
Q

What is the verbal scale in GCS?

A
Orientated
Confused
Inappropriate
Incomprehensible
No Verbal
7
Q

What is the motor scale in GCS?

A
Obeying
Localising
Flexing
Abnormal Flexing
Extending
No motor response
8
Q

GCS Scale score for;
Medium
Moderate
Severe

A

Medium: 14 or 15, brief LOC
Moderate: 9-13
Severe: 3-8

9
Q

Patients who have sustained a head injury with any of the following should have a CT scan within 1 hour;

A
  • GCS<13 on initial assessment in the ED
  • GCS <15 at 2 hours after injury
  • Suspected open or depressed skull fracture
  • Any sign of basal skull fracture
  • Post traumatic seizure
  • Focal Neurological Deficit
  • More than one episode of vomiting
  • Suspicion of NAI
10
Q

CT scan should be immediately requested in patients with any of the following factors (if they have experienced some loss of consciousness or amnesia since the injury);

A
  • Age 65 years or more
  • Coagulopathy
  • Dangerous mechanism of injury
11
Q

What is the classic presentation of an extradural haematoma?

A
  • Injury with LOC
  • Recovery “lucid interval”
  • Rapid progression of neurological symptoms
  • Deteriorating GCS

Possible hemiparesis
Unilateral fixed and dilated pupil
Apnoea and death

12
Q

Describe history and examination of a TBI patient?

A
Age
GCS
Other injuries- harm-dynamically stable
PMH and drug hx
Blood results- coag, platelets
13
Q

What is the medical management of raised ICP?

A
  • Sedation
  • Maximise venous drainage of brain
  • CO2 control
  • osmotic diuretics (mannitol, hypertonic saline)
  • CSF release
14
Q

What is used for sedation in raised ICP?

A

Propofol, benzodiazepines, barbiturates

15
Q

how can the venous drainage of brain be maximised?

A

Head of bed tilt

Cervical collars, ET tube ties

16
Q

What effect will anti-epileptics have on seizures?

A

Will reduce early seizures but not late seizures

17
Q

What is DAI?

A

Diffuse axonal injury

Occurs under sheering forces?

18
Q

Where does DAI occur?

A

Where there is the greatest density difference (grey/white interface)

19
Q

What is the pathophysiology of DAI?

A

Excitotoxicity and apoptosis

Inflammatory mediator release

20
Q

What is excitotoxicity?

A
  • Excitatory amino acids (glutamate)
  • Activates NMDA receptors
  • Calcium mediated activation of proteases and lipases
  • Further cell death
21
Q

What inflammatory mediators are related in DAI?

A

Cytokines, interleukins

IL6 levels higher in non-survivors

22
Q

Describe brainstem death

A
  • No pupil response
  • no corneal reflex
  • no gag reflex
  • no vestibule-ocular reflex
  • no motor response
  • no respiration