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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
What causes decerebrate posturing
Damage to midbrain, brainstem, and/or pons
26
Difference between decorticate and decerebrate posturing
DeCORticate - arms adducted, flexed, at CORE DEcErEbratE - arms adducted Extended pronated
27
Types of brain haematoma
Epidural haematoma Subdural haematoma Subarachnoid haematoma Intracerebral haematoma
28
Epidural haematoma
Blood clot between skull and outer dura
29
Damage to which artery is the most common cause of EDH
Middle meningeal artery
30
EDH shape on CT
Lemon
31
Subdural haematoma
Haematoma in subdural space between dura and arachnoid
32
Subdural haematomas are usually caused by damage to which vessels
Bridging cortical veins
33
How does SDH appear on CT
Banana shape
34
How quickly must a SDH be evacuated
Within 4 hrs
35
Subarachnoid haematoma
Haematoma in subarachnoid space between pia and arachnoid mater
36
How does SAH appear on CT
White in sulci or cisterns
37
Why do traumatic SAH have better prognosis than aneurysmal SAH
More areas affected in aneurysmal Aneurysm in circle of Willis
38
What injuries often cause SAH
Skull fracture Cerebral contusion
39
Intracerebral haematoma
Blood clot in brain parenchyma
40
Age range for EDH, SDH, and SAH
EDH - young adults SDH - all age groups SAH - older middle age
41
Seizure
Abnormal sudden electrical disturbance in brain
42
Clinical signs of seizure
Strange movements Unresponsive Staring Sudden tiredness or dizziness Not able to communicate or understand others
43
Early post traumatic seizures vs late post traumatic seizures
Early - within 1 wk of TBI Late - >1wk after TBI
44
GCS, LOC, and PTA in mild TBI
GCS 13-15 LOC <30 mins PTA <1 day
45
Acute management of mild TBI
GCS 15 - minor clinic + discharge GCSE 13/4 -> CT - normal discharge, abnormal observe 24hrs+
46
GCS LOC and PTA in moderate TBI
GCS 9-12 LOC 30min-24 hrs PTA 1-7 days
47
Moderate TBI acute management
Transfer to neurological unit for observation Surgical evaluation of haematoma Transfer to ICU to allow brain bruising and swelling to reduce
48
Severe TBI GCS LOC and PTA
GCS 3-8 LOC 24+hrs PTA 7+days
49
Severe TBI acute management
Stabilise ABC Seizure prophylaxis - phypenytoin/levetiracetam Sedate/induce coma - propofol/benzodiazepines Rapid reversal of warfarin if taking - fresh frozen plasma + vit K
50
Why are severe TBI patients put into an induced coma
Prevent secondary brain injury by Decr ICP terminate seizures Facilitate + optimise ventilation Decr cerebral metabolic rate
51
Raised ICP acute management
Hyperosmolar therapy - short term Extraventricular drainage Decompressive craniectomy
52
How does Hyperosmolar therapy reduce ICP
Use osmotic gradient to shift water into blood vessels across BBB
53
Which drugs are used for Hyperosmolar therapy
20% mannitol or 3-5% hypertonic saline
54
Methods of extraventricular drainage (long term TBI management)
Extraventricular drain External ventricular drain Ventriculostomy
55
How does a decompressive craniectomy help raised ICP and when is it used
Provide space for brain to swell Used when ICP incr is uncontrollable
56
Decompressive craniectomy complications
Bleeding Infection Seizures Further brain damage
57
Tranexamic acid
Antifibrinolytic drug Pre hospital intervention, must be within 3 hrs of injury
58
Can TBI be treated
No, only managed
59
How long until most clinical signs of TBI appear (eg raccoon eyes, battle sign)
~24 hrs

BB2 (26 decks)

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