Brain and Head Injury Flashcards
What are the three divisions that make up the Glasgow Coma Scale?
Eyes opening - 4
Verbal responce - 5
Motor response - 6
IN SBAR the GCS score should be given as a number out of 15.
False it should be broken down into its individual divisions.
List indications for a CT within 1 hour.
Any one of the following GCS <13 upon arrival GCS <15 2 hours post injury Suspected open or depressed skull fracture Any sign of basal skull fracture Post traumatic seizure Focal neurological defect >1 vomiting episode Suspicion of NAI - for evidence
When should a CT be given immediately upon arrival?
Over 65
Loss of consciousness
Anticoagulation
What are some clinical signs of a base of skull fracture?
Bruising behind the ear - Battles sign
Double black eye
CSF or blood running from the ear
On CT how does an Extradural haematoma appear?
Doesn’t cross the suture lines
Lens shaped
What can be a classic presentation of a extradural haematoma?
Lucid interval following intiall GCS reduction where symptoms improve.
Follow by a rapid deterioration.
An Extradural haematoma often presents like this.
Reduced GCS
Possible hemiparesis
Unilaterally fixed and dilated pupil
On CT how does a subdural haemotoma present?
No contained to suture lines
Cresent shaped
An acute subdural bleed on CT will appear…
Bright white
A chronic subdural bleed on CT will appear…..
Darker
How do diffuse axonal injuries appear on imaging?
Generalised and diffuse swelling
What are some imagining negative prognostic factors for a subdural bleed.
Basal cisterns are compressed or entirely obliterated.
What is the Monro Kellie Principle?
That the skull is a box which contain three substances. Blood Brain and CSF.
If one of these increases the others will decrease in order to compensate.
When there can be no more compensation there is a sudden and rapid increase in ICP.
List the steps taken in a patient with a raised ICP.
Maximise venous drainage Sedation CO2 control Osmotic diuretic CSF tap
How can venous drainage be maximised?
Top of the bed is tilted to 30 degrees
Remove front of cervical collar
What are some common sedately drugs use in a patient with a raised ICP?
Propoful
Benzodiazepines
Why do CO2 levels need to be carefully monitored in a patient with a raised ICP?
If CO2 levels are raised it triggers an increase in blood to the brain.
This plus the raised ICP compresses the brain causing it to herniate.
What are some examples of osmotic diuretics used in a patient with a raised ICP?
Mannitol
Hypetonic saline
What is the last resort in a patient with a raised ICP?
Decompressive Craniotomy
Why is a decompressive craniotomy considered a last resort?
Whilst in reduces mortality it has a very high risk of causing a severe disability.
In order to determine a brainstem death what must be done?
No pupil reaction No corneal reaction (Blinking) No motor response No vestibule ocular reflex No gag or cough reflex No respiration (apnea test)
What is and what nerves are tested in the Pupil reaction test?
CN II and III
Light shinned into the eye
What is and what nerves are tested in the Corneal reaction test?
Cornea is irritated which should evoke a blink
CN V and VII
What is and what nerves are tested in the no motor response test?
Application of supraorbital pressure to elicit a grimace.
CN VII V
Why are limbs and the trunk not tested in the motor response test?
Movement can be elicited through a spinal nerve reflex which can continue regardless of brainstem death.
What is the Vestibular Ocular Reflex test and what nerves are tested for?
Cold water placed in the ear. Should elicit a Nystagmus
CN III VIII VI
What nerves are involved in a gag or cough reflex test?
CN IX X
What is the Respiration Apnoea test?
Monitor the blood oxygen and CO2 levels in a patient when removed from ventilation and exposed to hyperbolic oxygen.
In order for a brainstem death to be pronounced what must happen?
2 different doctor must be present and it must be completed twice.
In the brainstem death tests when is the respiration apnoea test done?
Last and only if all of the other tests are negative due to considerable risks of inserting catheter.
