1(E): Head Injury Flashcards
What is head injury
Physical damage to brain secondary to external impact
How is head injury classified
- Open
2. Closed
What is open head injury
Dura mater is disrupted
What is closed head injury
Dura mater remains intact
In which groups are head injuries more common
Children under-5
Adolescences
Over 65’s
How may a head injury present
- Loss of consciousness
- Amnesia
- Nausea and vomitting
- Dizziness
- Seizures
Cushing’s triad
What is Cushing’s triad
HTN
Bradycardia
Decrease respiration
What are the features of anterior basal skull fracture
Rhinorrhoea
Racoon eyes
What are the features of posterior basilar skull fracture
CSF Otorrhoea
Battle sign
Haemotympanum
What is haemotympanum
Blood behind ear drum
What causes battle sign
Subcutaneous haematoma
When should TBI be suspected
Individual with rapidly deteriorating consciousness
What is primary brain injury
Injury at immediate time of impact
What is coup
Injury caused by contusion of the brain
What is counter-coup
Cerebral contusion opposite impact
What is secondary brain injury
Injury occurs due to inflammation and oedema following the primary injury
How is head injury investigated in pre-hospital setting
ATLS approach, GCS
what GCS should be intubated
GCS Less than 8
what is recommended imaging for head injury
CT
what is the criteria for CT head in one-hour
FVBOGGS:
Focal neurological deficit Vomitting Basal skull fracture Open fracture GCS less than 15 GCS less than 13 after 2-hours Seizure
what is the criteria for CT head in eight hours
BAAM:
Bleeding or anticoagulant disorder
Age over-65
Anticoagulant
Mechanism of injury - high
what other imaging may be ordered in head injury
X-Ray C-Spine
what is important for head injury assessment
Head Injury Observations: every 30-minutes until GCS 15
in GCS, what is motor score out of
6
What are the following in the motor section A. GCS 6 B. 5 C. 4 D. 3 E. 2 F. 1
a. Obeys commands
b. Localises pain
c. Flexes from pain
d. Abnormal Flexion to pain
e. Extension to pain
f. No response
In GCS. what is voice score out of
5
What are the following in the voice A. 5 B. 4 C. 3 D. 2 E. 1
A. Orientated B. Confused C. Words D. Sounds E. Nothing
In GCS, what is the eye score out-of
4
What are the following for eyes
a. 4
b. 3
c. 2
d. 1
A. Eyes open spontaneously
B. Eyes open to voice
C. Eyes open to pain
D. Eyes closed
If a pupil is unilaterally dilated, what does it indicate
CN3 Palsy
If a pupil is bilaterally dilated, what does it indicate
Bilateral CN3 Compression
How is raised ICP managed in head injury
IV Mannitol or Hypertonic Saline
When is ICP monitoring indicate
GCS 3-8
How is cerebral oedema managed
Decompressive craniotomy
What CPP is aimed for in adults
70mmHg
