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Head Injury Flashcards

1
Q

What is the lowest total GCS score?

A

3 - No response to E/V/M

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2
Q

what is the highest total GCS score?

A

15

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3
Q

GCS score parameters

A

Eye opening
Verbal response
Motor response

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4
Q

Highest score for each GCS parameters

A

E - 4
V - 5
M - 6

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5
Q

Head Injury GCS classification

A

Minimal - 15, with NO LOC
Mild - GCS 13-15
Moderate - GCS 9-13
Severe - GCS 3-8

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6
Q

Head Injury Sx

A
  1. Pain in the head or neck
  2. Loss of consciousness or drowsiness
  3. Confusion or amnesia (memory loss)
  4. Seizures
  5. Vomiting
  6. Changes to vision or hearing
  7. Neurological Sx: weakness, sensory changes, ataxia or difficulty speaking
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7
Q

Head Injury clinical presentations

A

External: Scalp lacerations or haematoma
Retinal haemorrhages/papilloedema
Unequal/Unresponsive pupils
Down/out gaze: CN III palsy

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8
Q

Basal Skull Fracture presentation

A
  • Periorbital haematomas
  • Clear discharge from ear/nose (CSF leakage)
  • Battle’s sign: mastoid bruise
  • blood behind TM: Haemotypanum
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9
Q

Cushing’s Traid

Raise ICP presentations

A

HTN, Bradycardia, SOB

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10
Q

Airways Mx for GCS <8

A

Maintain Airways: Intubation/Ventilation

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11
Q

Head Injury choice of imaging

A

non-contrast CT head

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12
Q

Head Injury Acute Mx

A
  1. IV flud: Hypotensive
  2. O2: for low O2 sat
  3. Pain Mx: for Raised ICP
  4. Tranexamic acid: for GCS <12
  5. Reverse anticoagulation
  6. Maintain normoglycaemia: insulin/dextrose

how

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13
Q

GCS Eye opening scale

A

4 - Spontaneous
3 - Sound
2 - Pressure
1 - No response

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14
Q

GCS Verbal response scale

A

5 - Orientated
4 - Confusion
3 - Words
2 - Sound
1 - non verbal

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15
Q

GCS Motor scale

A

6 - Obeys commands
5 - Moves to localised pain
4 - Flex to withdraw from pain
3 - Abnormal flexion
2 - abnormal extension
1 - No response

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16
Q

1h CT head scan criteria for Head Injury

A
  1. GCS <13 on initial assesment OR GCS <15, 2h after injury
  2. > 1 vomiting
  3. Post-traumatic seizure
  4. Focal neurology deficit
  5. Open/Depressed fracture
  6. Signs of basal skull fracture
17
Q

8h CT head scan criteria for Head Injury

A

On an anti-coagulant, or they have suffered LOC / memory loss AND
1. age 65 or over
2. any current bleeding or clotting disorders
3. dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of more than 1 m or 5 stairs)
4. more than 30 minutes’ retrograde amnesia of events immediately before the head injury.

18
Q

Raised ICP Mx in head injury

A
  1. Pain analgesia
  2. Mannitol or Hypertonic saline
19
Q

Define Head injury

A

A patient who has sustained any form of trauma to the head, regardless of whether they have any symptoms of neurological damage

20
Q

Define Traumatic Brain Injury

A

Evidence of damage to the brain as a result from trauma to the head, represented with a reduced GCS or presence of a focal neurological deficit

21
Q

Time frame for assessing patient with evidence head injury

A

examined within 15 mins of arrival to assess brain / spine injury

22
Q

which other part of the body needs to be assess during a head injury

A

Cervical spine - consider immobilisation

23
Q

A in Head injury

A

GCS <8 - on-call anaesthetic team
Suspected C-spine injury - jaw thrust

24
Q

Airway Mx for basal skull fracture

A
  1. Oropharyngeal Airway (OPA): does not pass through the nose and avoids potential complications associated with a basal skull fracture
  2. Edotracheal intubation
25
Q

Airway Mx contraindicated in basal skull fracture and why

A

Nasopharyngeal airways (NPA)
- Risk of Inserting the NPA into the Brain or Cranium (further damage, particularly concerning if there is CSF leakage)
- Compromised Nasal Structures: Basal skull fractures can result in damage to the nasal passages and sinuses, and inserting an NPA may exacerbate bleeding
- Increased Risk of Infection: NPA could introduce bacteria into the cranial cavity, increasing the risk of meningitis or other infections

26
Q

basal skull fracture complications

A
  • CSF leakage
  • damage to cranial nerves
  • increased risk of infection (e.g., meningitis)
27
Q

Head injury RED FLAGS

A
  • Impaired consciousness level
  • Dilated pupils which do not respond to light (“fixed and dilated”)
  • Signs of basal skull fracture
  • Focal neurological deficit or visual disturbances
  • Seizures or amnesia
  • Significant headache or nausea and vomiting
28
Q

Raised ICP Sx

A

Worsening headaches
dull / localised frontal pain
Bilateral papillodeama

29
Q

Raised ICP gold standard Ix

A

Lumbar puncture (LP) is the gold standard for diagnosing raised intracranial pressure (ICP)

30
Q

Raised ICP CSF feature

A

elevated CSF pressure

Neurology (8 decks)

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