LOC and Coma Flashcards
1
Q
Another name for a concussion?
What is it caused by?
What does it result in?
A
- TBI
trauma induced alteration in mental status may or may not involve loss of consciousness - caused by direct blow to head, face, neck or body
- result in neuropathological changes: fxnl not structural
- resolution of clinical and cognitive sx follows a sequential course
- assoc with grossly normal neuroimaging studies
2
Q
Eye opening - Glasgow scale?
A
- spontaneous 4
- response to verbal command 3
- response to pain 2
- no eye opening 1
3
Q
Best verbal response - glasgow scale?
A
- oriented 5
- confused 4
- inappropriate words 3
- incomprehensible sounds 2
- no verbal response 1
4
Q
Best motor response - glasgow scale?
A
- obeys commands 6
- localizing response to pain 5
- withdrawal response to pain 4
- flexion to pain 3
- extension to pain 2
- no motor response 1
5
Q
What is a TBI? pts at highest risk?
Rating on GCS?
A
- head injury due to contact and/or acceleration and/or deceleration forces
- 1.5 mill reported incidents/yr in US
- TBI leading cause of death for persons age 1-45 in north america, males greater than females, 5 mill people suffer TBI disability
- pts at higher risk: less than 5 and older than 60 (fall prone)
- mild: GCS 13-15 measured 30 min after injury
- moderate: GCS 9-12
- severe: GCS less than 8
6
Q
Etiologies of TBI?
A
- MVAs (20-45%)
- falls (30-38%, increasing in older pt)
- occupational accidents (10%)
- assaults (5-17% - increasing)
- contact sports
- soldiers in combat
7
Q
Primary injury phase - cortical contusion (direct trauma)
A
- coup-direct blow to brain
- contrecoup injury to brain on opp side of head
- severe: axonal rupture
- mild: diffuse axonal injury: disruption of axonal neurofilament organization, impairs axonal transport and leads to axonal swelling
8
Q
Secondary brain injury pathophys?
A
- begins quickly after primary phase
- continues for hours to days
- cascade of molecular injury mechanisms:
- NT mediated excitotoxicity causing glutamate, free radical injury to cell membranes
- electrolyte imbalances
- mitochondria dysfxn
- apoptosis
- secondary ischemia from vasospasm, focal microvascular occlusion and vascular injury
9
Q
Clinical features of TBI?
Assoc sxs?
A
- or - LOC, confusion, stupor, amnesia: impt to know presence and length of any of these sxs
- assoc sxs:
HA, dizziness, disorientation, N/V
10
Q
TBI signs?
A
- vacant stare
- inabilty to focus
- gross incoordination
- memory difficulties
- delayed verbal expression
- slurred or incoherent speech
- emotionality out of proportion to events
11
Q
Complicated TBI? assoc signs and sxs?
A
- indicates more serious brain injury or rising ICP:
seizures
focal neuro signs
worsening HA, confusion, lethargy
protracted N/V
other injuries to head/neck
decreasing GCS (keep on repeating GCS - is it deteriorating?)
12
Q
Management of TBI?
A
- examine - look at pupils, do neuro exam: CNs, reflexes, strength, touch, movements
- amnesia almost always involves loss of memory of traumatic event and frequently includes loss of recall for events immediately before and after trauma
- longer the frame of amnesia - more serious the injury
13
Q
What are the guidelines for CT scan in ER?
A
- GCS less than 15
- open or depressed skull fracture
- any sign of basilar skull fracture: CSF leak
- 2 or more episodes of vomiting
- 65 yo or older
- amnesia b/f impact of 3 or more minutes
- dangerous mech (ejected from vehicle, fall from more than 3 ft)
- bleeding diathesis or an oral anticoagulant (increased chance of brain bleed)
- seizure or focal neuro sign
- intoxication (drunk or brain injury - have to rule it out)
14
Q
What are signs of a basilar skull fracture?
A
- raccoon eyes
- hematoma behind ears (battle sign)
- hemotympani
- CSF draining out of ears or nose
- fracture is hard to detect on CT - do MRI
15
Q
CT scan abnormalities?
A
- subdural hematoma
- intracranial bleeding
- cerebral edema
- skull fracture
