Head trauma Flashcards by Sanjana Shaunak

What is a Traumatic Brain injury (TBI)

Disruption of normal function of brain caused by trauma

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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

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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

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What are the most common causes of Traumatic brain injury (TBI)

Falls

RTA -road traffic accidents

Violent physical assaults

Injuries associated with athletic activities

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Who gets traumatic brain injuries (TBI)

Often young, often male

leading cause of disability and mortality between ages of 1-45

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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)

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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

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What are some significant psychiatric complications pts may experience following a traumatic brain injury (TBI)?

Depression

PTSD

GAD

OCD

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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

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What clinic scale is used to measure the severity of a traumatic brain injury ?

Glasgow coma scale

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Glasgow coma scale: what score suggests a mild Traumatic brain injury?

13-15

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Glasgow coma scale: what score suggests a moderate disability in Traumatic brain injury?

9-12

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Glasgow coma scale: what score suggests a severe disability in Traumatic brain injury?

3-8

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Glasgow coma scale: what score suggests a vegetative /death state in Traumatic brain injury?

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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

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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