Head/Brain Injury Flashcards
Any injury or trauma to the
- Skull
- Scalp
- Brain
- Traumatic brain injury (TBI)
- High incidence
Causes
- Motor vehicle collisions & falls (most common)
- Firearm-related injuries
- Assaults
- Sports-related injuries
- Recreational accidents
- War-related injuries
- High potential for poor outcome
- Deaths occur @ 3 time points > inj:
1. Immediately > the inj (most common; either from the direct head trauma or from massive hemorrhage & shock)
2. Within 2 hrs > the inj (c/b progressive worsening of the head inj or internal bleeding)
3. 3 wks > the inj (result from multi-system failure)
Types of Head Injuries
Scalp Lacerations
- External head trauma
- Scalp is highly vascular → profuse bleeding
- Major complications → blood loss & infection
Types of Head Injuries
- Skull fx’s freq occur w/head trauma
- Linear or depressed
- Simple, comminuted, or compound
- Closed or open
- Location determines manifestations
Complications
- Infections
- Hematoma
- Tissue damage
?
Occurs when there’s a break in continuity of bone w/o alteration of relationship of parts
Is assoc w/low-velocity inj
Linear fx
?
Is an inward indentation of skull & is assoc w/a powerful blow
Depressed skull fx
A simple linear or depressed skull fx is w/o fragmentation or communicating lacerations; c/b low to moderate impact
?
Occurs when there are multiple linear fx’s w/fragmentation of bone into many pieces; is assoc w/direct, high-momentum impact
Comminuted fx
An example of a compound fx is a depressed skull fx & scalp laceration w/communicating pathway to intracranial cavity
- Assoc w/severe head inj
Fx’s may be closed or open, depending on the presence of a scalp laceration or extension of the fx into the air sinuses or dura
Location of the fx determines clinical manifestations
- The major potential complications of skull fx’s are intracranial infections & hematoma, as well as meningeal & brain tissue damage
- Also important to note that in cases where a basal skull fx is suspected, an NG or oral gastric tube should be inserted under fluoroscopy
?
Is a specialized type of linear fx that occurs when the fx involves the base of the skull
- Manifestations can evolve over the course of several hrs, vary w/the location & severity of fx, & may incl CN deficits, Battle’s sign (post-auricular ecchymosis), & peri-orbital ecchymosis (raccoon eyes)
basilar skull fx
- Is generally assoc w/a tear in the dura & subseq leakage of CSF
- Rhinorrhea (CSF leakage from the nose) or otorrhea (CSF leakage from the ear) generally cnfms that the fx has traversed the dura
- Rhinorrhea may also manifest as postnasal sinus drainage
! The significance of rhinorrhea may be overlooked unless the pt is spec assessed for this finding
! Risk of meningitis is high w/a CSF leak, & abx should be admin to prevent the development of meningitis
- 2 methods of testing can be used to determine whether the fluid leaking from the nose or ear is CSF
- Test the leaking fluid w/a Dextrostix or Tes-Tape strip to determine whether glucose is present
> CSF gives a positive glucose reading
- If blood is present in the fluid, testing for the presence of glucose is unreliable b/c blood also contains glucose
> Look for the halo or ring sign
- Allow the leaking fluid to drip onto a white gauze pad (4x4) or towel, & then observe the drainage
- Within a few min, the blood coalesces into the center, & a yellowish ring encircles the blood if CSF is present
! both tests can give false (+) results
Types of Brain Injuries
1°
- Happens @ time of inj
- Focal or diffuse
- Open or closed
- Mild, moderate, severe
2°
- Occurs > the initial inj & worsens outcomes
- e.g., post-concussion synd, hypotension & hypoxia, IICP, hemorrhage, etc.
Brain injuries are classified as diffuse (generalized) or focal (localized)
- In a diffuse inj (e.g., concussion, diffuse axonal), damage to the brain cannot be localized to one particular area of the brain
- In a focal inj (e.g., contusion, hematoma), damage can be localized to a spec area of the brain
Classification
- Minor/Mild (GCS 13-15)
> probably d/c’d to home w/teaching to have someone monitor for problems - Moderate (GCS 9-12)
> gets admitted to the hosp but on a reg med/surg floor, most likely, & is monitored for any complications
- Severe (GCS 3-8)
> admitted to critical care
?
> a minor diffuse head inj
* Brief disruption in LOC
* Retrograde amnesia
* HA
* Short duration
Concussion
?
May develop in some pts & is usually seen anywhere from 2 wks to 2 mos > the inj
- persistent HA
- lethargy
- personality & behavior changes
- shortened attention span, decr short-term memory
- changes in intellectual ability
postconcussion syndrome
Diffuse Axonal Injury (DAI)
- Widespread axonal damage > a mild, moderate, or severe TBI
- Decr LOC
- IICP
- Decortication, decerebration
- Global cerebral edema
- Approx 90% of pts w/DAI remain in a persistent vegetative state
Coup-Contrecoup aka Acceleration-Deceleration Injury
- Occurs when the brain moves inside the skull d/t high-energy or high-impact inj mechanisms
- Contusions or lacerations occur both @ the site of the direct impact of the brain and on the opposite side away from inj (contrecoup), leading to multiple contused areas
- Contrecoup inj tend to be more severe, & overall pt prognosis depends on the amt of bleeding around the contusion site
- Also called acceleration-deceleration inj
Epidural Hematoma
- Initial period of unconsciousness
- Brief lucid interval followed by decr in LOC
- HA, n/v
- Focal findings
- Requires rapid evacuation
Brain Death
Criteria to determine brain death:
✓ Coma of known cause as est by hx, clinical exam, lab testing, & neuro imaging
✓ Normal/near normal core body temp (> 96.8°F)
✓ Normal systolic BP (≥100 mmHg)
✓ Neuro exam (1-2 dep on state)
Skull Fractures
- Conservative treatment
- Surgery if depressed
Subdural & epidural hematomas
- Surgical evacuation
> Craniotomy, burr holes
> Craniectomy if extreme swelling
