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CATA 462 > Major TBI > Flashcards

Major TBI Flashcards

1
Q

Sometimes the presence of concussion signs makes it difficult to determine

A

whether a more serious focal injury exists or will develop.

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2
Q

Depending on the area of the brain that is injured, it can result in a wide range of deficits.
❑These include changes

A

changes in personality, loss of speech, inability to comprehend speech, motor impairment, attention and/or memory deficits to name a few.

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3
Q

max score of GCS to have no disability

A

15 but may still have minor TBI

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4
Q

lowest score of GCS

A

3

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5
Q

GCS for major injury, moderate, minor

A

<8 Major injury
9-12 Moderate injury
13-15 Minor injury

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6
Q

what is one of the most commonly used severity scoring systems.

A

The Glasgow Coma Scale (GCS), a clinical tool designed to assess coma and impaired consciousness

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7
Q

T/F The prognosis for milder forms of TBIs is better than for moderate or severe TBIs.

A

T

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8
Q

what is the most vascular part of our skin

A

scalp

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9
Q

meninges layer

A

Dura Mater- closest to skull
▪ Arachnoid- crossed over by cerebral veins
▪ Pia Mater - closest to brain

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10
Q

what is contain is the sub arachnoid space

A

Between arachnoid and Pia Mater is the sub arachnoid space. Within the space is CSF.

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11
Q

what is CSF

A

This fluid forms a watery sac that supports the brain and helps to absorb impacts and shock.

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12
Q

what is a indirect TBI

A

Force applied to other parts of the to the body causing rapid acceleration/deceleration of the brain in the skull.

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13
Q

angular acceleration increase rate of concussion of _ %

A

25-80

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14
Q

what is a closed TBI

A

an injury to the brain caused by movement of the brain within the skull. Causes may include falls, motor vehicle crash, or being struck by or with an object.

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15
Q

what is a penetrating TBI

A

an injury to the brain caused by a foreign object entering the skull. Causes may include firearm injuries or being struck with a sharp object.

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16
Q

what is intra-axial TBI

A

Intra-Axial (diffuse injury)
-occur within brain parenchyma itself
More diffuse, more of a challenge to manage directly, potentially devastating. Many of them suffer long-term or permanent cognitive impairment.

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17
Q

what is extra-axial TBI

A

Extra-Axial (focal injury)
-involve bleeding within skull, but outside the brain tissue itself
Among these are subdural hematomas, epidural hematomas and subarachnoid hemorrhages. The symptoms experienced in these injuries usually result from swelling of an expanding hematoma, puts pressure on the brain.

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18
Q

what a diffuse TBI

A

DIFFUSE type refers to an injury where there has been a widespread disruption of neurological function usually caused by shearing of neuronal connections.

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19
Q

what is a focal TBI

A

refers to injuries that are more localized (linear acceleration) and potentially life threatening
(red flags) caused by increased intracranial pressure
from bleeding (epidural or subdural) or swelling (edema).

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20
Q

what is a DAI

A

DAI an intra-axial injury that results from stretching and shearing of axons in the white matter of the brain. This can happen when the brain is injured as it shifts and rotates inside the bony skull. The brain changes are often microscopic and may not be evident on CT or MRI scans.

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21
Q

how is DAI often diagnosed

A

coma lasting six hours or more in the absence of a significant brain lesion.

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22
Q

what are the impairment patient may have when they wake up from their coma with DAI

A

Many of the patients who awaken from their coma may have impairments of memory or language skills, or impairments in higher-order thinking or planning, such as executive dysfunction disorder.

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23
Q

what are the 3 phase of EDH

A

1.Initial concussion symptoms -Not caused by bleed
2.Period of Lucidity
-After concussion fades in 5-20 min
3.Rapid decline in Level of Responsiveness
-Rapid arterial bleeding causes pressure on brain and herniation of brain stem
Fatal if not decompressed surgically

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24
Q

t/F Epidural bleeds usually presents initially with “concussion-like” symptoms. Important to remove from play and monitor
(within AT field of vision) especially during first 20-30 minutes post injury.

A

T

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25
Q

how does EDH occurs

A

Epidural hematomas occur when an artery is injured and there is arterial blood accumulation between the dura and the calvarium.
It does not cross suture lines because of the tight adherence of the dura to the calvarium and thus have a biconvex or elliptical appearance.

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26
Q

which artery is usually involved in EDH

A

middle meningeal artery

27
Q

what is associated with a lucid interval

A

EDH

28
Q

EDH is associated with what

A

with a “lucid interval“ (victim can be conscious and appear “normal” right after an injury, but as the blood accumulates… the headache will worsen and mental status will decline as the intracranial pressure rises.

29
Q

Classic sign of an epidural hematoma

A

temporary loss of consciousness at moment of impact, followed by awakening, and then a rapid decline in level of responsiveness shortly thereafter. This brief period of wakefulness is called a lucid interval. This may not be present in all epidural hematomas, but a complaint of a “severe” headache usually is.

30
Q

how a EDH look on a CT

A

lika a lemon

31
Q

how a SDH look on a ct

A

like a banana

32
Q

what is SDH

A

Subdural hematomas are typically a venous bleeds resulting from rupture of the bridging veins connecting the cerebral venous sinuses to the superficial veins of the skull. This causes a venous bleed between the dura mater and the arachnoid membrane.

33
Q

subdural bleed are slow or rapid

A

slow

Subdural bleeds are slow, the onset of symptoms may be delayed, but no less serious. A significant number of patients do not seek medical attention until symptoms develop, and often these symptoms lead to increased intracranial pressure.

34
Q

which type of brain bleed is most likely to be missed

A

SUBDURAL BLEEDS - Tend to develop more slowly. These are the types most likely to be missed. Important to monitor athlete (within field of vision) Especially first 4-6 hours post injury. Must also monitor (close by) first 48-72 hours for any changes or signs.

35
Q

how does subdural hematoma occurs

A

Tearing of bridging veins during rapid or sudden changes in velocity thereby causing an accumulation of venous blood below the dura but above the arachnoid membrane (i.e., the “subdural space”).

36
Q

what can occurs if subdural hematoma is left untreated

A

Can result in mass effect leading to uncal and/or tonsillar herniation if left untreated.

37
Q

which type of hematoma is more frequently in elderly patient and why

A

subdural hematoma due to reduced brain volume and “stretched” bridging veins.

38
Q

what is SAH

A

Subarachnoid hemorrhages occur beneath the arachnoid membrane and the pia mater, the microscopic meningeal layer covering the brain parenchyma itself.

39
Q

what is the most common cause of SAH

A

Trauma is most common cause of SAH, but spontaneous subarachnoid hemorrhage may result from rupture of a berry aneurysm in the Circle of Willis, or from arteriovenous malformations

40
Q

who are particularly at high riks for spontaneous hemorrhagic stroke of SAH even at young age

A

Individuals with connective tissue disorders like Marfan’s Syndrome and vascular Ehlers-Danlos Syndrome have weakened arterial wall

41
Q

Classic complaint of spontaneous SAH is the

A

“thunderclap” headache, often described as the worst headache of the patient’s life.

42
Q

Signs and symptoms of SAH closely mimic those of

A

migraine

43
Q

what SIS (secondary impact syndrome)

A

Rapid brain swelling shortly after a person suffers
a second concussion-type injury before symptoms from an earlier concussion have subsided.Death or lifelong disability occurs because the brain suddenly loses its ability to regulate cerebral spinal fluid pressure, leading to severe swelling of the brain (edema) and possible herniation of the brain.

44
Q

incidence of SIS

A

usually male 13-24 years old

45
Q

does the second impact need to be strong to trigger sis

A

no,A minor blow to the head, chest or back that moves the head enough to cause the brain to move inside the skull can trigger the damage

46
Q

does a concussed athlete whose symptoms have not yet resolved sustains a second impact, may lose consciousness at the moment of the impact.

A

they may not even lose consciousness

47
Q

S/S of SIS

A

They may appear stunned, usually able to complete a play in a game and make it to the sideline. They may end up collapsing in a few minutes and rapid decline. In several few minutes they may lose consciousness, have loss of eye movement, dilated pupils, then eventually respiratory failure and death.

48
Q

how to prevent SIS

A

prevent the first concussion from happening by following rules for safety and using well maintained appropriate sports equipment consistently and correctly.

49
Q

action plan of SIS

A

Any concussed patient who still shows signs of concussion should not be allowed to RTP or engage in any activities where impact is possible.

50
Q

what are the 4 type of brain herniation

A

Central, Subfalcine, Tonsillar, Uncal

51
Q

how does brain herniation occurs

A

As the ICP increases, the CSF is initially forced to move down through the spinal canal, then ventricles and then the cisterns begin will collapse.
The ICP can rise rapidly resulting in a shift of the brain parenchyma away from the accumulating blood.If swelling continues to progress, the parenchyma will have to shift through several different spaces with final movement through the foramen magnum causing compression of the brainstem and subsequent death.

52
Q

definition of brain herniation

A

“portion of the brain pushed out of place or out of the skull itself, usually a result of inflammation and edema of injured brain tissue”.

53
Q

definition of uncal herniation

A

medial portion of the temporal lobe is pressed downward, putting pressure on the oculomotor nerve and brainstem.

54
Q

uncal herniation result in what

A

a dilated pupil on that side, and that pupil will often look down and out due to oculomotor nerve palsy. Compression of the posterior cerebral artery may result in a peripheral visual field deficit on the contralateral side.

55
Q

central herniation occurs from

A

“occurs from downward displacement of the brainstem. It can result in fixed and dilated pupils, as well as a downward deviation of gaze (“sunset eyes” sign).

56
Q

hyperventilation may reduce what

A

arterial carbon dioxide resulting in vasoconstriction, thus decreasing the space blood occupies in the cranium, but at the cost of impairing blood flow to already damaged brain tissue.

57
Q

*Do not hyperventilate head injury patients, even those with signs of increased intracranial pressure. Instead, aim for

A

restoring as close to “normal” oxygenation and ventilation as you can get - keep spO2 at 94% or better and keep etCO2 on the physiologically low end of normal, at roughly 35 mmHg.

58
Q

what is intra-cranial hypertension

A

Increasing pressure in non-yielding skull.Increase BP stimulates baro-receptors activating para- sympathetic system via vagus nerve which:

59
Q

intra-cranial hypertension do what to HR and bp

A

Slows down HR…leading to ↑BP ↓HR.

60
Q

what is chefne-stoke ventilation

A

Cycle of: slow, shallow breathes, deeper, more rapid…
returns slow… some brief periods of apnea.

61
Q

what is decortication and decerebration

A

Decortication: flex upper extremities
extension lower extremities
Decerebration: all extremities in extension arching of the spine

62
Q

can you elevate the head with a head trauma

A

If no contraindications exist (such as thoracic or lumbar spine injury without stabilization), raise the head of the spine board / stretcher to 30 degrees, keep head and neck midline, and avoid tight fitting cervical collars.

63
Q

what do you do if elevation of the head with head trauma athlete is contraindicated

A

place patient in reverse Trendelenburg (i.e., elevate the entire the bed up higher from the ground and then lower portion of the bed where the legs are so that the head is higher than the level of the heart).

64
Q

how do you transport a head trauma athlete

A

ransport with head elevated around 30 deg. (never ↑ legs) ❑Oxygen+++94% SpO2

CATA 462 (22 decks)

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