Head trauma Flashcards
What is a Traumatic Brain injury (TBI)
Disruption of normal function of brain caused by trauma
What clinical signs could you observe which show alteration in normal brain function?
Loss /decreased consciousness
Memory loss of events before or after (amnesia)
Focal neurological deficits e.g. muscle weakness, loss of vision, change in speech
Alteration in mental state e.g. disorientation, slow thinking or difficulty concentrating
What symptoms could you see in a traumatic brain injury?
(very long as vary depending on severity)
Vomiting
Lethargy
Headache
Confusion
Paralysis
Coma
Loss of consciousness
Dilated pupils
Vision changes (blurred vision or seeing double, unable to tolerate bright light, loss of eye movement, blindness)
Cerebrospinal fluid (CSF) (clear or blood-tinged) appear from the ears or nose
Dizziness and balance concerns
Breathing problems
Slow pulse
Slow breathing rate with an increase in blood pressure
Ringing in the ears or changes in hearing
Cognitive difficulties
Inappropriate emotional responses
Speech difficulties (slurred speech, inability to understand and/or articulate words)
Difficulty swallowing
Body numbness or tingling
Droopy eyelid or facial weakness
Loss of bowel control or bladder control
What are the most common causes of Traumatic brain injury (TBI)
Falls
RTA -road traffic accidents
Violent physical assaults
Injuries associated with athletic activities
Who gets traumatic brain injuries (TBI)
Often young, often male
leading cause of disability and mortality between ages of 1-45
Traumatic brain injury can be caused by not only the direct result of trauma but also
complication of the primary injury (brain in a no expandable box)
What are some significant long term neurological complications pts may experience following a traumatic brain injury (TBI) ?
Seizures
dementia
Alzheimer’s disease
Parkinson’s disease
cranial nerve injuries
What are some significant psychiatric complications pts may experience following a traumatic brain injury (TBI)?
Depression
PTSD
GAD
OCD
What are the many types of traumatic brain injury (TBI)?
concussion (short LOC in response to injury)
Penetrating injuries (FB > brain)
closed head injuries (e.g. blow)
skull fracture
Haematomas
laceration (tearing of blood vessels / tissues)
anoxia (no O2 to tissue)
contusions (bruising of brain tissue)
diffuse axonal injuries
What clinic scale is used to measure the severity of a traumatic brain injury ?
Glasgow coma scale
Glasgow coma scale: what score suggests a mild Traumatic brain injury?
13-15
Glasgow coma scale: what score suggests a moderate disability in Traumatic brain injury?
9-12
Glasgow coma scale: what score suggests a severe disability in Traumatic brain injury?
3-8
Glasgow coma scale: what score suggests a vegetative /death state in Traumatic brain injury?
<3
What are some short term complications of traumatic brain injuries?
Cognitive impairment
sensory processing and communication disorders
immediate seizures
hydrocephalus
CSF leakage
vascular or cranial nerve injuries
tinnitus
organ failure
polytrauma
What are the immediate management priorities in a pt with a traumatic brain injury?
Stabilisation to prevent further injury
Adequate 02 supply
Maintaining blood flow
controlling blood pressure
Skull fractures are most often caused by what (RF) ?
Fall
RTA
Assault
male
How are skull fractures categorised?
Appearance,
location
degree of depression
open/ closed
What are open skull fractures?
Open fractures communicate with:
the skin through a wound, a sinus, the ear, or the oropharynx
What type of fractures do you get in the skull (ortho)?
linear or comminuted;
comminuted fractures are complex with multiple fracture lines.
What is the most important associated injury with a skull fracture to think of immediately?
intracranial haemorrhage
What are some clinical examination findings you could see to help diagnose a skull fracture?
RF - hx
open fracture
palpable changed in bony cortex contour
Battle’s sign
Periorbital ecchymosis
Bloody ottorhoea
CSF rhinorrhoea
Facial paralysis, nystagmus, paraestheisa
What investigations for a cranial fracture?
Cranial CT
- w/in 1 hour if suspect intrancial complication e.g. bleed
What are the factors for pt presenting to A&E that would suggest they need a CT for a head injury w/in 1 hours?
GCS <13 on initial assessment
GCS <15 2hr post injury
suspected open / depressed fracture
sign of basal skull fracture
Post-traumatic seizure
Focal neurological deficit
> 1 vomit since head injury
A patient with a head injury has no factors suggesting need a CT head within 1 hour, HOWEVER you find out they are on anticoagulants, what do you do?
Perform CT head w/in 8 hours as increased risk of bleeding
consider clotting screen PT, PTT, INR in these pts
What are the differentials for a skull fracture?
Intracranial haemorrhage
suture lines in children
cephalhaematoma
Child abuse
Osteogeneis imperfecta
What is first line management in suspected skull fracture?
ABC approach
stabilisation
suspect C spine injury - immobilisation
Analgesia e..g IV morphine sulfate titrated agains clinical response / cardio rep response
What is the treatment for a confirmed closed non-depressed (linear) skull fracture?
1st line : observation and monitoring (conservative)
Consider: tranexamic acid - seek advice from senior
Most non-depressed (linear) fractures (+basilar skull fractures) are treated conservatively as long as there is no…?
suspicion / evidence of intracranial pathology
neurological status is normal
no cranial nerve damage
no SCF leak
When treating a skull fracture conservatively. How often and what should you observe / monitor?
every 30 mins for GCS until GCS at 15.
also observe:
GCS plus pupil size and reactivity
Limb movements
Resp rate
Heart rate
BP
Temperature
Blood 02 sats
You are treating a pt for a skull fracture conservatively, what signs of neurological deterioration make you order an immediate CT ?
- Agitation/ abnormal behaviour
- drop 1 GCS point for over 30 mins (esp motor)
- any drop > 3 eye / verbal or >2 motor
- severe headache / vomiting
- neuro signs e.g. pupil inequality, asymmetry of limb or facial movement
Treatment for confirmed closed depressed skull fracture?
Observe and monitoring
Tranexamic acid (senior advice)
dural repair and cranioplasty
prophylactic anitconvulsant therapy
Treatment for confirmed open skull fracture
Observation and monitoring
Tranexamic acid (senior advice)
debridement, dural repair and cranioplasty
prophylactic anitconvulsant therapy
What are the complications of a skull fracture?
CSF leak
intracranial haemorrhage
venous sinus thrombosis / stenosis
meningitis
cranial nerve deficits
motor deficits
post-traumatic seizure
post surgical anosmia
