Neuro Emergencies: Traumatic Brain Injury Flashcards
How are TBI’s classified?
Mild
Moderate
Severe
According to GCS
Mild head injury GCS is?
Moderate head injury GCS is?
Severe head injury GCS is?
13-14
9-12
</= 8
What can cause the initial exam to be altered?
ETOH
Drugs
FOUR Score
Eye Response
4=
3=
2=
1=
0=
Eyelids open or opened, tracking or blinking to command
Eyelids open but not to tracking
Eyelids closed but opens to loud voice
Eyelids closed but opens to painful stimuli
Eyelids remain closed with painful stimuli
FOUR Score
Motor Response
4=
3=
2=
1=
0=
Thumbs up, fist, or peace sign
localizing to pain
flexion to response to pain
extension to response to pain
no response to pain or generalized myoclonus status
FOUR Score
Brainstem Reflexes
4=
3=
2=
1=
0=
Pupil and corneal reflexes present
one pupil wide and fixed
pupil or corneal reflexes absent
pupil and corneal reflexes absent
absent pupil, corneal or cough reflexes
FOUR Score
Respiration
4=
3=
2=
1=
0=
Regular breathing pattern
Cheyne-Stokes breathing pattern
Irregular breathing
Triggers ventilator or breaths above ventilator rate
Apnea or breathes at ventilator rate
FOUR Score
What is it?
Allows examiner to test what?
Can recognize what?
Can detect different stages of what?
Lower scores indicate higher what?
A 16 pt scale that provides greater neurological detail
brainstem reflexes
locked-in syndrome
brain herniation
coma severity
What are Primary Mechanisms of Injury?
Open
Penetrating
Skull fxs
What are Primary Mechanisms of Injury?
Closed
Concussive
Diffuse Axonal Injury (DAI)
Hematomas
Coup-countercoup
What are Secondary Mechanisms of Injury?
Ischemia
Edema
Loss of cerebral vascular autoregulation
Loss of blood brain-barrier
Mass Lesions
Pre-Hospital Care
A meta-analysis of clinical trials demonstrated that what two insults were each associated with poor outcomes?
Both were also associated w/ increase in what?
Hypoxia (PaO2 < 60)
Hypotension (SBP < 90)
Mortality
Emergency Department Care
Initial Evaluation includes?
Imaging?
ATLS (ABCDE)
Head CT
Emergency Department Care
Hearniation or deterioration may require what?
+/- Hyperventilation
+/- Mannitol
+/- Hypertonic Saline
+/- Ventricular drain
Emergency Department Care
Surgical lesion requires?
OR
Emergency Department Care
What level of care is required?
ICU management