head injury Flashcards
GCS chart components
E4: spontaneous
E3: speech
E2: pain
E1: nil
V5: oriented
V4: confused
V3: inappropriate words
V2: incomprehensible
V1: nil
M6: obey command
M5: localises pain
M4: withdrawal
M3: decorticate
M2: decerebrate
M1: nil
manifestations of brain injury (3)
- pupil reflex
- function of brainstem and CN 2 and 3
- may indicate brain herniation
- increase in ICP may impair eye movement controlled by CN 3, 4 and 6 - oculovestibular reflex
- brainstem dysfunction
- doll’s eye test or caloric ice water test - corneal reflex
- absence of blink response
- indicates severe brain function
what manifestations can indicate basal skull fracture (4)
- hemotympanum
- CSF in ear and nose
- periorbital ecchymoses (raccoon’s eye)
- postauricle ecchymoses (battle’s sign)
causes and clinical features of concussion
causes
- rotation of cerebral hemisphere on relatively fixed brainstem
features
- retrograde and antegrade amnesia
- immediate transient LOC
causes and clinical features of contusion
head injury resulting in hemorrhgae into brain tissue
causes
- due to deceleration of the brain against the skull rupturing the blood vessels on the surface of the brain
features
- hemiparesis, glaze paralysis, visual defect in occipital injury, cranial nerve dysfunction, decorticate and decerebrate, coma
clinical features of extradural haematoma
brief LOC, short lucid interval, coma
clinical features of subdural haematoma
brief LOC, longer lucid interval, coma
clinical features of chronic subdural haematoma
personality changes, fluctuating drowsiness, confusion, weakness, seizures
ICP management in head injury
- blood pressure
- maintain MAP 90mmHg
- maintain CPP 50-70mmHg - hypocarbia
- low PCO2 = vasoconscriction
- hyperventilation - infusion of osmotic diuretics
- mannitol, glycerol IV
- to reduce brain edema
- watch for hypernatremia and water depletion
