3- Traumatic Brain Injury Flashcards
What is GCS based on?
Eye, verbal, motor response
(more useful for mod to severe TBI)
GCS score of 13-15 is classified as?
Mild TBI (concussion)- functional changes, but not structural damage
GCS score of 9-12 is classified as?
Moderate TBI
GCS score of 3-8 is classified as?
Severe
A GCS should be obtained prior to intubation if possible. If a pt arrives intubated, what is the max score they can receive?
10T
How do you assess GCS in an unresponsive pt?
Try to obtain pupillary response or motor function
What score (other than GCS) is used for intubated pts?
FOUR score- no verbal response, assesses brainstem
Pt presents with confusion and amnesia +/- LOC. What are you concerned for?
Acute mTBI
Pt presents with HTN, bradycardia, and irregular breathing with hx of a head injury. What are you concerned for?
Cushing reflex/ triad; Late sign of increased ICP (concerning TBI presentation)
Individual who incurs a head trauma during a football game is likely to be evaluated for TBI with which assessment tool?
SCAT 5 (sport concussion assessment tool)
What is considered a (+) test for cognitive impairment if using the Westmead Post-Traumatic Amnesia Scale?
Any incorrect response
(9 A+O questions, 3 pictures)
What is the preferred diagnostic study for acute/ initial imaging if suspicion of TBI?
Head CT w/o contrast
Pt with hx of TBI presents with neurologic decline despite initial CT with normal findings. What follow up imaging should be ordered?
Brain MRI w/o contrast
(ex. possible PCS)
What are the indications for a head CT in an adult with mTBI? (10)
- ≥ 60 yo
- GCS < 15
- ≥ 2 episodes of vomiting
- Amnesia > 30 min prior to event
- Dangerous mechanism
- Any sign of skull fracture (basilar, open, depressed)
- New neuro deficits
- Seizure
- Bleeding diathesis/ on anticoagulant
Under what conditions should you always order imaging (CT) if suspicious for TBI? (5)
- Persistent amnesia (≥ 30 min anterograde/ retrograde)
- Intoxication
- HA
- Abn behavior
- Pt lives alone
When would you order a CT for a pediatric patient with concern for TBI?
GCS = 14, AMS, signs of basilar skull fracture, palpable skull fracture
What is 1st line in the management of TBI?
ATLS and obtain GCS
What GCS score indicates need for intubation?
≤ 8
What is included in the management of moderate and severe TBI? (4)
Maintain cerebral perfusion and oxygenation
Prevent secondary injury
Neurosurgical intervention
Tranexamic acid (GCS 8-13, w/i 3 hrs of injury)
Management of mild TBI includes 24 hours of observation with admission or d/c home. When should a pt be admitted? (6)
- GCS < 15
- Abns on head CT
- Seizures
- Hx bleeding disorder/ on anticoagulant
- Recurrent vomiting
- Other neuro deficit
What pt edu should be provided for mild TBI?
24-48 hrs cognitive rest if sxs, gradual return to work/ school/ sport, no return to sport until able to fully return to school
Does severity of injury fully correlate with recovery/ risk of developing post-concussion syndrome (PCS)?
NO
Pt presents with recent hx of head trauma and c/o HA and dizziness. What are you suspcious for and what is the management?
Post-concussion syndrome (PCS)
Management: Reassurance (worst @ 7-10 days post trauma), relative cognitive/ physical rest
Pt with recent hx of head trauma and unresolved sxs presents with new head trauma. You note rapid, diffuse cerebral edema with increased ICP. What are you concerned for and what is the management?
Second impact syndrome
Management: reduce ICP (and prevention)
Pt with hx of recurrent TBI presents with cognitive impairment, behavior abnormalties and mood disorders. What are you concerned for and what post-mortem patholgic/ histologic abns would be evident?
Traumatic encephalopathy
Extensive tau-protein accumulation
(no definitive dx study, manage sxs)
