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BB2 > Head Injury > Flashcards

Head Injury Flashcards

1
Q

Head injury

A

Injury to scalp skull or brain

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2
Q

Traumatic brain injury

A

Non degenerative non congenital insult to the brain from an external mechanical force, possibly leading to permanent/temporary impairment of cognitive, physical, and psychosocial functions, w an associated diminished/altered state of consciousness

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3
Q

Traumatic brain injury mechanisms

A

Penetrating injury
Closed head injury
Blast injury

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4
Q

What are coup and contrecoup injuries

A

Coup - brain hits skull side of impact
Contrecoup - brain hits skull opposite to impact

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5
Q

Effects of closed head injuries

A

Skull fracture
Contusion
Haematoma
Laceration
Diffuse axonal injury

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6
Q

Primary measure for TBI severity

A

Glasgow coma scale

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7
Q

What GCS scores are mild, moderate, and severe

A

Mild 14-15
Mod 9-13
Severe <8

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8
Q

What 3 factors are measured in the GCS and what are they measured out of

A

Eye opening /4
Verbal response /5
Best motor response /6

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9
Q

What does the loss of consciousness scale measure

A

Time pt unconscious

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10
Q

What does the post traumatic amnesia scale measure

A

Interval from injury until pt is orientated and can form and recall new memories

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11
Q

TBI diagnostic imaging

A

CT
MRI

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12
Q

Signs of basal skull fracture

A

Battle sign
Ottorhea
Raccoon eyes
Hemotympanum

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13
Q

What component in the head acts as a shock absorber

A

CSF

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14
Q

Pathophysiologies of TBI

A

Direct Neural tissue injury
Incr ICP
Herniation
Haematoma
EDH
SDH
Traumatic SAH
ICH
Seizures

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15
Q

Why is MRI not used for gunshot wounds

A

Metal fragments

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16
Q

What creates ICP

A

Cerebral blood flow + CSF

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17
Q

What is used to measure ICP in unconscious patients

A

ICP bolt

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18
Q

What can increased ICP lead to

A

Herniation
Decreased CSF and blood flow to brain -> ischaemia

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19
Q

Normal supine adult ICP

A

5-15 mmHg

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20
Q

At what ICP can herniation occur

A

20+ mmHg

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21
Q

Herniation

A

Abnormal protrusion of brain tissue through folds and openings in the brain

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22
Q

6 types of brain herniation

A

Uncal
central (transtentorial)
Cingulate (subfalcine)
Transcalvarial
Upward cerebellar (transtentorial)
Downward cerebellar (tonsillar)

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23
Q

Brain herniation symptoms

A

Dilated pupil
Headache
Drowsiness
High BP
loss of consciousness
Loss of reflex
Seizures
Decorticate/decerebrate posturing

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24
Q

What causes decorticate posturing

A

Damage to cerebral cortex and/or internal capsule

25
Q

What causes decerebrate posturing

A

Damage to midbrain, brainstem, and/or pons

26
Q

Difference between decorticate and decerebrate posturing

A

DeCORticate - arms adducted, flexed, at CORE
DEcErEbratE - arms adducted Extended pronated

27
Q

Types of brain haematoma

A

Epidural haematoma
Subdural haematoma
Subarachnoid haematoma
Intracerebral haematoma

28
Q

Epidural haematoma

A

Blood clot between skull and outer dura

29
Q

Damage to which artery is the most common cause of EDH

A

Middle meningeal artery

30
Q

EDH shape on CT

A

Lemon

31
Q

Subdural haematoma

A

Haematoma in subdural space between dura and arachnoid

32
Q

Subdural haematomas are usually caused by damage to which vessels

A

Bridging cortical veins

33
Q

How does SDH appear on CT

A

Banana shape

34
Q

How quickly must a SDH be evacuated

A

Within 4 hrs

35
Q

Subarachnoid haematoma

A

Haematoma in subarachnoid space between pia and arachnoid mater

36
Q

How does SAH appear on CT

A

White in sulci or cisterns

37
Q

Why do traumatic SAH have better prognosis than aneurysmal SAH

A

More areas affected in aneurysmal
Aneurysm in circle of Willis

38
Q

What injuries often cause SAH

A

Skull fracture
Cerebral contusion

39
Q

Intracerebral haematoma

A

Blood clot in brain parenchyma

40
Q

Age range for EDH, SDH, and SAH

A

EDH - young adults
SDH - all age groups
SAH - older middle age

41
Q

Seizure

A

Abnormal sudden electrical disturbance in brain

42
Q

Clinical signs of seizure

A

Strange movements
Unresponsive
Staring
Sudden tiredness or dizziness
Not able to communicate or understand others

43
Q

Early post traumatic seizures vs late post traumatic seizures

A

Early - within 1 wk of TBI
Late - >1wk after TBI

44
Q

GCS, LOC, and PTA in mild TBI

A

GCS 13-15
LOC <30 mins
PTA <1 day

45
Q

Acute management of mild TBI

A

GCS 15 - minor clinic + discharge
GCSE 13/4 -> CT - normal discharge, abnormal observe 24hrs+

46
Q

GCS LOC and PTA in moderate TBI

A

GCS 9-12
LOC 30min-24 hrs
PTA 1-7 days

47
Q

Moderate TBI acute management

A

Transfer to neurological unit for observation
Surgical evaluation of haematoma
Transfer to ICU to allow brain bruising and swelling to reduce

48
Q

Severe TBI GCS LOC and PTA

A

GCS 3-8
LOC 24+hrs
PTA 7+days

49
Q

Severe TBI acute management

A

Stabilise ABC
Seizure prophylaxis - phypenytoin/levetiracetam
Sedate/induce coma - propofol/benzodiazepines
Rapid reversal of warfarin if taking - fresh frozen plasma + vit K

50
Q

Why are severe TBI patients put into an induced coma

A

Prevent secondary brain injury by
Decr ICP
terminate seizures
Facilitate + optimise ventilation
Decr cerebral metabolic rate

51
Q

Raised ICP acute management

A

Hyperosmolar therapy - short term
Extraventricular drainage
Decompressive craniectomy

52
Q

How does Hyperosmolar therapy reduce ICP

A

Use osmotic gradient to shift water into blood vessels across BBB

53
Q

Which drugs are used for Hyperosmolar therapy

A

20% mannitol or 3-5% hypertonic saline

54
Q

Methods of extraventricular drainage (long term TBI management)

A

Extraventricular drain
External ventricular drain
Ventriculostomy

55
Q

How does a decompressive craniectomy help raised ICP and when is it used

A

Provide space for brain to swell
Used when ICP incr is uncontrollable

56
Q

Decompressive craniectomy complications

A

Bleeding
Infection
Seizures
Further brain damage

57
Q

Tranexamic acid

A

Antifibrinolytic drug
Pre hospital intervention, must be within 3 hrs of injury

58
Q

Can TBI be treated

A

No, only managed

59
Q

How long until most clinical signs of TBI appear (eg raccoon eyes, battle sign)

A

~24 hrs

BB2 (26 decks)

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