Adult Head Injury

Question 1

What are the three criterias for High Risk TBI

Answer 1

• Moderate - Severe TBI (GCS <13)
• Penetrating Head Injury
• High Risk Fetaures (5HEDSW)
  1. LOC >5minutes
  2. Head Deformity/ #
  3. Vomiting More than once
  4. Neurological Deficit
  5. Seizure
  6. Worsening signs and symptoms

Question 2

What are the 6 criterias for Moderate Risk TBI

Answer 2

• Altered mental Status (From Baseline)
• Dangerous mechanism
• Amnesia > or equal to 30minutes
• Intoxication
• Age > or equal to 65
• Coagulopathy/Anti-Coags/ Antiplatelet

Question 3

What are the 2 criterias for Low Risk TBI

Answer 3

• No Moderate or High Risk criteria
• Competent adult available to monitor patient for 4 hours

Question 4

What is the management for High Risk TBI

Answer 4

• Mx as per Major Trauma
• Avoid Secondary Brain injury (Hypoglycaemia, Hypoxia, Hypotension)
• Transport as per Trauma Triage

Question 5

What is the management for Moderate risk TBI

Answer 5

• Transport (CT scan or Observation Required)
• Consider VVED if age/or coagulopathy are the only risk factors

Question 6

What is the management for Low Risk TBI

Answer 6

• Self care
• Safety netting
• Provide health information sheet
• GP follow up with 2-3days

Question 7

What are the 4 signs of a Base of Skull Fracture

Answer 7

• Haemotympanum (Presence of blood leaking from the middle ear)
• CSF leaking from the ears or nose
• Battle Sign (bruising over the mastoid process)
• Racoon Eytes (Bruising under the eyes)

Question 8

When can OPA/NPA be used in TBI

Answer 8

When absolutely necessary to maintain airway patency

Question 9

What is the Self care advice for TBI

Answer 9

• Rest
• Paracetamol for headaches
• Do not drive, drink or take sedatives for 24hours
• Adult should be available to observe patient for up to 4hours

Question 10

What is the safety netting for a TBI

Answer 10

• Severe or Increasing headache
• Repeated vomiting
• Increasing Confusion/agitation
• Altered conscious state, “black outs”, or cannot be worken
• Seizures
• Weakness or altered sensation in limbs

Question 11

What are some Secondary survey questions for TBI

Answer 11

• Altered Neurology
• Dizziness
• LOC
• Weakness

Question 12

What is Cushings Triad

Answer 12

• Hypertension (Widening pulse pressure)
• Irregular respirations
• Bradycardia