ICP/head injury

Question 1

swelling of brain can cause what

Answer 1

arterial hypotension - blood leakage elsewhere in the body
hypotension + hypoxia = hypoxic ischaemic brain damamge w swellin

arterial hypoxia - airway obstruction ass chest injury or an epileptic fit

infection

intracranial haematoma

Question 2

clinical features of mild head injury

Answer 2

concussion maybe + reterograde and post-traumatic amnesia

Question 3

clincal features of moderate head injury

Answer 3

persistent coma after accident w fairly good scores of GCS and no signs of brainstem malfunction

Question 4

clinical features of sever head injury

Answer 4

persistent coma after the accident

poor scores in GCS

evidence of failing brainstem function

Question 5

clinical features and evidence of hypotension

Answer 5

• scalp laceration
• ass major injury to major organ
• pt propped up after injury with known blood loss and probable hypotension

signs
development of shock
- low BP
- rapid pulse
- sweating

Question 6

clinical features and signs of hypoxia

Answer 6

• found face down, unconscious
• upper airways obstruction whilst unconscious
• severe ass facial injury
• aspiration of blood
• prolonged epileptic fit

signs
- noisy obstructed breathing
- abnormal chest movement
- abnormal respiratory rate
- abnormal chest xray
abnormal blood gases

Question 7

when to perform a CT head scan with a sustained head injury

Answer 7

1. GCS <13 on initial assessment
2. GCS<15 2 hours afters injury
   - suspected oprn or depressed skull fractures
   - any sign of basal skull fracture
   - post-traumatic seizure
   - focal neurological deficit
   - more than 1 episode of vomiting

Question 8

when to perform CT wtihin 8 hours of injury

Answer 8

some loss of consciousness or amnesia since injury

• age 65 or above
• Hx of bleeding or clotting disorders
• dangerous mechaism o finjury
• more than 30 mins reterograde amnesia

Question 9

when to perform a CT cervical spine scan

Answer 9

GCS <13
Intubated
plain x-rays are technically inadequate
plain xrays suspicious
alert and stable
- above 65
- dangerous mechanism of injury
- fical peripheral neurological deficit
- paraesthesia in the upper or lower limbs

Question 10

what observations are made head injury

Answer 10

GCS; pupil size and reactivity; limb movements; respiratory rate; heart rate; blood pressure; temperature; blood oxygen saturation

Half-hourly for 2 hours.
Then 1-hourly for 4 hours.
Then 2-hourly thereafter.

Question 11

what is post concussion syndrome

Answer 11

follows minor conclusive head injury

post-traumatic amnesic periods

Question 12

Sx of post-concussion syndrome

Answer 12

headache
dizziness
impaired concentration
impaired memory
fatigue
anxiety
depression
indecisiveness
impaired self-confidence
lack of drive
impaired libido

Question 13

what is post-traumatic epilepsy

Answer 13

epileptogenic scar in the brain -> focal or secondarily generalised epileptic attacks

within a year of the accident

Question 14

what increases the risk of post-traumatic epilepsu

Answer 14

• post-traumatic amnesia lasting more than 24 hours
• focal neurological signs during the week after the head injury
• epilepsy during the week after the head injury
• depressed skull fracture
• dural tear
• intracranial haeamtoma