10 - Acute Head Trauma Flashcards
what are the risk factors for acute head trauma?
- male
- young (15-30) and old (65+) due to fraility
- urban areas
- substance misuse inc alcohol
what is the main way to reduce risk of head injury?
primary prevention:
* seat belts
* helmets alcohol prevention/limits
* health and safety
why is it important to ask medication history with head injury pts?
are they on anticoagulants? - increases damage of bleed
what is the primary survey for head injuries?
C - catastrophic haemorrhage
A - patency, managed vs unsupported and C spne
B - other injuries, apnoea, hypoxia
C - other injuries, hypo/hypertension, heart rate
D - GCS, pupils, C-spine, lateralising signs
E - primary survey (entire body)
alongside CABCDE protocol for head injuries, what two things should you measure?
glucose
temp
why is temperature important in pts with acute head trauma?
coagulopathy is altered quickly when hypothermic
what are 3 clinical signs of a base of skull fracture?
- racoon eyes
- battles sign
- haemotympanum
how can you tell the difference between racoon eyes and black eyes?
in racoon eyes, the tarsal plates are usually spared from bruising
when does a battles sign appear?
24 hours after injury
if CSF is leaking from the tympanic membrane, what does this indicate/
skull fracture
what is haemotympanum?
blood build-up behind the tympanic membrane
according to the NICE guidelines, when should a CT be performed within 1 hour?
- GCS less than 13 on initial assessment in ED
- GCS less than 15 at 2 hours after injury
- suspected open or depressed skull fracture
- any sign of basal skull fracture
- post-traumatic seizures
- focal neuro deficit
- more than 1 episode of vomiting
according to NICE guidelines when should a CT be performed within 8 hours of inury?
- pt aged 65 or over
- history of bleeding or clotting disorders
- dangerour mechanism of injury
- more than 30 mins retrograde amnesia of events before head injury
how can primary brain injury be treated?
it cant - it can only be prevented
what is the primary brain injury?
the original insult
what is the secondary brain injury?
the damage caused after injury b:
* hypoxia
* hypotension/hypertension
* raised ICP
what is the most common and detrimental forms of TBI?
diffuse axonal injury
what is the basic pathophysiology of diffuse axonal injury?
resistant inertia that occurs to brain at time of injury, causes shearing of axonal tracts of the white matter
how does diffuse axonal injury appear on CT?
- relatively normal CT imaging even for severe cases
what is the neuroimaging hallmark of diffuse axonal injury?
diffuse white matter tract lesions
what is an extra-dural haematoma?
extra-axial bleed between the dura and skull bone
what is the most common source of injury in extradural haemotomas?
middle meningeal artery
what is the pathophysiology of extradural haemotoma?
- blunt force trauma resulting in linear skull fracture, with no or minimal displacement
- middle meningeal artery is most common source of bleeding
