Head Injury

Question 1

what is the commonest cause of trauma death?

Answer 1

head injuries

Question 2

what is primary head injury?

Answer 2

occurs at time of injury

Question 3

what is secondary head injury ?

Answer 3

occurs after primary injury event

Question 4

what is a concussion?

Answer 4

primary head injury and temporary decrease in brain function

Question 5

what are the symptoms of concussion?

Answer 5

headache, nausea, vomiting, confusion, visual symptoms, amnesia

Question 6

what is diffuse axonal injury?

Answer 6

primary brain injury when shearing forces disrupt axons

Question 7

what are the symptoms of diffuse axonal injury ?

Answer 7

coma and persistent vegetative state

autonomic dysfunction - fever, HTN, sweating

Question 8

what are the symptoms of a focal contusion of the brain

Answer 8

focal neurological deficit

Question 9

what are the different types of intracranial haemorrhages ?

Answer 9

extradural
intradural
subarachnoid
parenchymal haemorrhage

Question 10

state some causes of secondary brain injury?

Answer 10

hypoxia 
hypercapnoea
hypotension 
increased ICP 
infection

Question 11

what is the Munroe kelly doctrine ?

Answer 11

the cranium is a rigid box and therefore a total volume of intracranial contents must remain constant if ICP is not to change

Question 12

what is a complication of increased ICP

Answer 12

herniation

Question 13

what three steps should be taken to prevent vicious circle of increasing cerebral blood flow?

Answer 13

ventilate to normocapnoea (4.5KPa)
IV fluid to normovolaemia
mannitol bolus

Question 14

what are the three symptoms of cushing reflex?

Answer 14

hypertension
bradycardia
irregular breathing

Question 15

what questions should be asked for a head injury Hx?

Answer 15

loss of consciousness 
amnesia 
nausea/vomiting 
fits 
focal neurology - speak, vision, hearing 
mechanism of injury 
drugs Hx

Question 16

what would be some clinical sign of a basal skull fracture ?

Answer 16

CSF rhinorrhoea and otorrhoea
battle sign
pando sign
haemotypmanum

Question 17

what is haemotypmanum ?

Answer 17

blood within the middle ear behind the ear drum which suggests a basal skull fracture

Question 18

what test can be done to check for CSF rhinorrhoea and otorrhoea ?

Answer 18

drip the fluid leaking from nose and ears onto a cloth and over time there should be a halo sign with the blood remaining in the centre and the CSF spreading out over a greater radius

Question 19

testing for what will a halo sign be seen?

Answer 19

CSF in fluid

- for example during a basal skull fracture

Question 20

what is a battle sign?

Answer 20

bruised mastoid

Question 21

what is pando sign?

Answer 21

bilateral orbital bruising

Question 22

when should a CT scan be done?

Answer 22

basal fracture 
amnesia >30mins retrograde 
neurological deficit 
GCS <13 at scene 
vomiting >1

Question 23

what blood tests should be done for basal fracture ?

Answer 23

glucose 
FBC 
U&E
clotting 
EtOH level 
ABG

Question 24

how often should neuro obs be taken ?

Answer 24

every 30mins until GCS 15

Question 25

what neuro obs should be taken?

Answer 25

GCS, BP, pupils, TPR

Question 26

when should someone be intubated ?

Answer 26

GCS <8
PaO2 <9KPa on air
PCO2 <4KPa
resp irregularity

Question 27

what discharge advice should be given after a head injury ?

Answer 27

stay with someone for 48hrs 
advice card on 
- confusion, dizziness, unconsciousness, fits 
- visual problems 
- very painful headaches won't go away
- vomiting