Head Injury And Seizures

Question 1

Define impact brain apnoea

Answer 1

Cessation of spontaneous breathing following TBI leading to hypoxia and hypercarbia

Question 2

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

Answer 2

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

Question 3

What does the catecholamine surge following TBI lead to

Answer 3

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

Question 4

What is the benefit of being hypertensive following TBI

Answer 4

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

Question 5

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

Answer 5

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

Question 6

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

Answer 6

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

Question 7

What is happening in a seizure at a cellular level

Answer 7

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

Question 8

What is a seizure

Answer 8

Transient appearance of signs and symptoms due to hypersynchronus neural activity

Question 9

What is epilepsy

Answer 9

2 unprovoked seizures >24 hours apart

1 unprovoked seizure with a high risk of another occurring

Question 10

What are the classifications of seizures

Answer 10

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

Question 11

Define status epilepticus

Answer 11

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

Question 12

How is status epilepticus managed

Answer 12

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