(4) Approach to Traumatic Brain Injury Flashcards
history for head injuries: HPC
What happened at the time?
* identify mechanism of injury and LOC, amnesia
What happened before?
* Identify any retrograde amnesia or others factors which influence evaluation
(e.g. alcohol/drugs)
What happened afterwards?
* Identify any vomiting, antegrade amnesia, further episodes of LOC
All of these questions also identify any additional injuries or safeguarding concerns
History: PMH, medications, allergies, social
**Past Medical History: ** bleeding/clotting disorders, previous head injury
Medications: anticoagulants , agents which may alter conscious level
Allergies: specifically general or local anaesthetic agents, tetanus immunisation or antibiotics
Social: Premorbid functional state
examination
- Full cranial and peripheral nervous system examination
- Pupils
- Basal skull fracture
- Wounds
- Neck/Secondary Survey
- GCS
GCS parameters
- Eye opening reponse /4
- Verbal response /5
- Motor response /6
eye opening response
4: Spontaneous
3. Open to verbal command, speech or shout
2. Eyes open to pain (not applied to face)
1. No eye opening
verbal response
- Oriented
- Confused conversation but able to answer questions
- Inappropriate responses
- Incomprehensible sounds or speech
- No verbal response
motor response
- Obeys commands for movement
- Purposeful movement to painful stimulus
- Withdrawn from pain
- Abnormal flexion (spastic) - decorticate posture
- Abnormal extension (rigid)- decerebrate posture
- No motor response
summary of the GCS
Minor brain injury: 13-15 points
Moderate: 9-12
Severe: 3-8
when to CT head within 1 hour
- GCS less than 13 on inittial assessment in ED
- GCS less than 15 at 2 hours after the injury on assessment in ED
- Suspected open or depressed skull fracture
- Any signs of basal skull fracture
- Post traumatic seizure
- Focal neurological deficit
- More than 1 episode of vomiting
when to CT head within 8 hour
- > 65
- any history of bleeding or clotting disorders
- dangerous mechanism of injury
- more than 30 mins retrograde amnesia of events immediately before the head injury
Types of brain haemorrhage
- Extradural
- Subdural
- Subarachnoid
type of bleed
Extradural
- Arterial bleed appears lentiform in appearance as blood is unable to cross tight adhesions of dura mater in skull.
- Does not cross suture lines
type of bleed
Subdural
* Slower bleed from bridging veins in the subdural space.
* Will cross suture lines
type of bleed
Contusion/ subarachnoid haemorrhage
* Also shows coup and contra coup lesions
signs of basal skull fracture
- Panda eyes
- Cerebrospinal fluid leakage from the ear or nose
- Battle sign- bruising behind the ears
- Haemotympanum
