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Ppnp 3 > head injury > Flashcards

head injury Flashcards

1
Q

how many types of brain injury are there?

A

2, primary and secondary

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2
Q

explain primary HI

A
  • caused by impact or initial insult
    Include diffuse axonal injury and the focal lesions of laceration, contusion
    and hemorrhage
    ○ Focal / Polar / Diffuse
    ○ Intracranial hematomas
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3
Q

what is focal in primary HI>

A

particular spot in the brain

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4
Q

what is polar in primary HI?

A

brain shift within the skul and meninges, injuries at 2 opposite poles

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5
Q

what is diffuse in primary Hi?

A

widespread neuronal damage

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6
Q

examples of intracranial haemorrhage in primary HI

A

➢ Epidural, Subdural Subarachnoid

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7
Q

explain secondary HI

A

Progressive damage resulting from a physiologic response to an initial insult
○ Damage results from the subsequent brain swelling, infection, and cerebral hypoxia.
○ Often diffuse or multifocal, including concussion, infection, and hypoxic brain injury

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8
Q

what causes brain injury? (5)

A

Trauma, tumours, stroke, metabolic derangements, degenerative disorders

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9
Q

explain the different score band for GCS

A

3 - 8: Coma
9 - 12: Moderate head injury
15: fully conscious
Score >11: 85% chance of recovery

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10
Q

what are the symptoms of HI?

A

Changes in level of consciousness - may fluctuate; RAS
dependent
○ Confusion, delirium, obtundation, stupor, coma
● Alterations in sensory & motor functions
● Alterations in cranial nerve reflexes

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11
Q

what is RAS?

A

Reticular Activating System

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12
Q

what is obtundation?

A

less than full alertness with decrease interest, slower reaction to stimulus

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13
Q

what is stupor?

A

near unconsciousness

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14
Q

what is decorticate posture? score 3 for motor

A

Abnormal flexor response of arms and wrist
➢ Leg and feet extend and internally

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15
Q

what is decerebrate posture (score 2 for motor)

A

extensor

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16
Q

what parts of the brain does the pupil reflex test, tests on

A

Function of the brainstem and CN II & III

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17
Q

what does it indicate if the patient’s pupil reflex test is abnormal?

A

of brain herniation

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18
Q

how does increasing ICP affect the eye?

A

Increasing ICP may impair eye movements controlled by CN III, IV, VI

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19
Q

what does the oculovestibular reflex test on. how do u do it?

A

brainstem dysfunction.

caloric water test or dolls eye. test/

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20
Q

what is the corneal reflex?

A

test if u blink to stimulus.

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21
Q

what does abnormal result in corneal reflex test indicates?

A

Absence of blink response, indicator of severely impaired brain function

22
Q

how many types of primary injury are there?

A
  1. focal, polar, diffuse, intracranial hematomas
23
Q

what is a characteristic of linear fracture?

A

Lucent lines, it indicate bone separation and dense lines, overlap

24
Q

what does linear fracture cause?

A

● Causes rupture of meningeal vessels

25
Q

how many types of depressed fracture are there? please list them

A

3 in total
● Stellate:
● Eggshell:
● Open fractures associated with infections

26
Q

how do you identify a stellate fracture? what does it mean?

A

starburst shaped, multiple fracture points that radiate outward from a central point.impact by blunt objects. Underlying brain injury

27
Q

how do u identify eggshell fracture and in which scenarios is it commonly seen?

A

fine delicate cracks in thin brittle bones such as elderly and children, child abuse

28
Q

is it easy to identify eggshell fracture on xray?

A

no :(

29
Q

how many types of skull fracture are there in terms of category?

A

3, linear depressed, basal skull fracture

30
Q

is it easy to detect basal skull fracture?

A

DIFFICULT in view of irregular dense bones

31
Q

how do you identify a basal skull fracture without the use of diagnostic machines? (4)

A

1) hemotympanum - blood in middle ear
2)CSF rhinorrhea and otorrhea
3)postauricular ecchymoses ( battle’s sign)
4) periorbital ecchymoses ( raccon’s eyes)

32
Q

what are the usual symptoms associated with a HI?

A

scalp wound
lOC
fracture
swelling, bruising
nasal discharge
stiff neck

33
Q

what are fractures at the base of skull associated with.

A

cranial nerve injuries.

anosmia,
nystagmus,
partial loss of vision,
facial palsy
vertigo

34
Q

how many types of intracranial lesions are there?

A

6

concussions, contussion
extradural haematoma
subdural haematoma
subarachnoid haematoma
intracerebral haematom

35
Q

what is concussion?

A

immediate transient LOC
- dazed, star struck situation

36
Q

what are the causes of a concussion?

A

Rotation of the cerebral hemispheres on the relatively fixed brainstem
➢ Electro-physiological dysfunction of the reticular activating system
➢ No structural lesion & residual sequelae

37
Q

what are the clinical features of concussion? (3)

A

Amnesia may occur after injury
➢ Retrograde amnesia
● Memory loss for events before the injury
● May indicate severity of the lesion
➢ Antegrade amnesia
● For events after, very brief

38
Q

how many types of amnesia are there?

A

2 retrograde
● Memory loss for events before the injury
● May indicate severity of the lesion

antegrade
● For events after, very brief

39
Q

what is contussion?

A

Head injury resulting in haemorrhage into brain tissue

40
Q

what are the causes of contussion?

A

➢ Due to deceleration of the brain against the skull rupturing the blood vessels on the surface of
the brain
➢ Frontal and occipital poles affected
➢ Coup injury
● Directly under point of impact
➢ Contrecoup injury
● At a point opposite to the point of impact

41
Q

what is coup injury?

A

● Directly under point of impact

42
Q

what is contrecoup injury?

A

At a point opposite to the point of impact

43
Q

what are the clinical features of contussion? (5)

A

Hemiparesis or gaze paralysis may occur with frontal injuries
➢ Visual defect in occipital injuries
➢ Cranial nerve dysfunction - commonly olfactory
➢ More severe injury causes cerebral edema, decorticate or decerebrate rigidity
➢ If cerebral lesions are bilateral ⇒ coma

44
Q

what is extradural haematoma?

A

Bleeding is between skull & dura Due to direct trauma causing # temporal bone and damage to middle meningeal artery
➢ As the bleeding is arterial, there is rapid worsening of the patient’s condition

45
Q

what is the clinical features of a extradural haematoma? (4)

A

➢ Brief LOC (due to concussion) followed by a short “lucid interval” then, coma again
(progressive neurological deterioration due to herniation)
➢ Carries a bad prognosis
➢ Usually requires surgical evacuation
➢ Untreated: decerebrate rigidity, coma, death

46
Q

how does the duration of LOC differes between extradural haematoma and acute SDH?

A

EDH is short, SDH is long

47
Q

what is SDH

A

Bleeding is between dura mater and arachnoid membrane

May not be associated with any surface injuries on the scalp
● Follows severe head injury – change in velocity
● Due to rupture of surface cerebral veins that join the dural venous sinuses
● Twice as common as extradural hematoma

48
Q

what are the symptoms of SDH (4)

A

Brief LOC (due to concussion) followed by a relatively longer “lucid interval” then,
coma again (progressive neurological deterioration due to herniation)
● Carries a bad prognosis if associated with cerebral injury due high velocity
● Usually requires surgical evacuation
● Untreated: decerebrate rigidity, coma, death

49
Q

what are the causes of chronic SDH?

A

➢ Cause
● Common in elderly > 60 y/o
● minor injuries which may not be remembered
● Due to shrinking of the brain coupled with fragility of blood vessels

50
Q

what are the clinical features of chronic SDH? (7)

A

Signs & symptoms appear months to years after trivial injury
● Due to slow accumulation of venous blood around atrophied brain
● Symptoms and signs may be absent, non-specific, non-localising
● Commonly experience minor headaches over a period of time because of slow
bleeding
● Other symptoms: personality changes, fluctuating drowsiness, confusion, weakness,
seizures
● Can be confused with stroke, dementia
● Potentially treatable

51
Q

what should u assess for HI patients? (7) and not do.

A

● Vital signs – ABC
● Secure airway and IV line
● Protect cervical spine in collar
● No morphine or depressants!
● Hourly vital signs, GCS
● Arrange for urgent CT scan head
● Neurological assessment for severity of head
injury

Ppnp 3 (15 decks)

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