Head Injury And Seizures Flashcards

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1
Q

Define impact brain apnoea

A

Cessation of spontaneous breathing following TBI leading to hypoxia and hypercarbia

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2
Q

How should we be managing patients with TBI in order to minimise IBA

A

Artificial ventilation is needed throughout the apnoeic period but this is unrealistic so good airway management and rescue breaths

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3
Q

What does the catecholamine surge following TBI lead to

A
Hypertension
Hyperglycaemia 
Pro-inflammatory response
Coagulopathy
Neurogenic pulmonary oedema 
Myocardial injury
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4
Q

What is the benefit of being hypertensive following TBI

A

Increased systemic pressure to the brain to overcome intracranial pressure allowing for perfusion

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5
Q

Describe the series of events arising from insular cortex and hypothalamus dysfunction in TBI to hypotension and the inability to perfuse the brain

A

Sympathetic activation and dysfunction
Catecholamine release from efferent cardiac sympathetic neurones
Ca influx, ATP depletion, mitochondrial damage, myocyte death
LV failure
Inability to pump+
+ there is coronary artery vasoconstriction = increased afterload

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6
Q

What is the relationship of skull fracture, consciousness and the likelihood of intracranial haematoma?

A

No fracture and full orientated = home
One of the other = observe
Fracture and not fully orientated= CT

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7
Q

What is happening in a seizure at a cellular level

A

Hypersynchronus activity of cortical neurones results in a spreading wave of electrical activity

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8
Q

What is a seizure

A

Transient appearance of signs and symptoms due to hypersynchronus neural activity

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9
Q

What is epilepsy

A

2 unprovoked seizures >24 hours apart

1 unprovoked seizure with a high risk of another occurring

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10
Q

What are the classifications of seizures

A

Focal onset aware
Focal onset impaired awareness
(Either of the above can progress to bilateral tonic-clonic)
Generalized onset - motor or absence

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11
Q

Define status epilepticus

A

Seizure activity lasting >30 minutes or a cluster of shorter duration seizures with no recovery

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12
Q

How is status epilepticus managed

A
Oxygen
Buccal midazolam 0.5mg/kg
Rectal diazepam 10mg
IV lorazepam 4mg 
Repeat a second does of first line drug choice
IV phenytoin 1g
IV phenobarbitone 4mg/kg
GA using propofol
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