Neuro - Tramatic Brain Injury Flashcards
According to Quality Standards Subcommittee of the American Academy of Neurology what is a concussion?
trauma-induced alteration in mental status that may or may not involve loss of consciousness.
What key clinical signs will a patient with a concussion present with?
Confusion
Amnesia
Loss of Consciousness (may or may not occur)
Symptoms can occur several minutes after these findings
What are some later signs and symptoms of a concussion?
(minutes or hours later) Dizziness Headache Nausea and vomiting Lack of awareness of surroundings
Over the next hours or days:
Mood and cognitive disturbance
Sensitivity to light and noise
What cognitive dysfunctions might a patient with a concussion display?
Delayed verbal expression Inability to focus attention Disorientation slurred or incoherent speech Memory Deficits Loss of consciousness
What personality signs of someone with concussion?
Vacant befuddled stare
Emotionality out of proportion with circumstances
What motor symptoms?
Gross uncoordinated movements, falling stumbling, inability to walk tandem straight
What language deficiencies might be shown?
Delayed verbal expression
Slower to answer questions or follow instructions
Slurred or incoherent speech
What are components of the Glasgow coma scale?
Eye response, verbal response and Motor response
What are the eye response in GC scale?
1 - does not open eyes
2 - eye opening in response to pain
3 - eye opening to speech
4 - eyes open spontaneously
What are the verbal response in GC scale?
1 - no verbal response 2 - incomprehensible 3 - slurred speech, random 4 - confused disoriented, patient responds to questions but there is some disorientation 5 - oriented conversing normally
What are the motor responses in GC scale?
1 - no motor response 2 - decerebate to painful stimuli 3 - decorticate to painful stimuli 4 - flexion withdrawal to painful stimuli 5 - localizes painful stimuli 6 - obeys commands
What is recommended in outpatient observation for patients admitted after a concussion?
It is recommended that the patients with a mTBI should be observed for 24 hours to rule out intracranial complications. Patient’s with normal GC (15), normal CT findings and someone to monitor the progress of the symptoms can go home.
How should you monitor a patient with the first 24 hours of outpatient observation?
Patient must be awakened from sleep every 2 hours the first night and no strenuous activity for first 24 hours.
What signs are red flags for outpatient monitoring?
Inability to awaken patient Severe or worsening headaches Somnolence or confusion Restlessness, unsteadiness, or seizures Difficulties with vision Vomiting, fever and stiff neck Urinary or bowel incontinence Weakness or numbness involving any part of the body
What do warning signs observed with mTBI patients indicate? What should be done?
Warning signs indicate intracranial complications like hemorrhage or evolving cerebral edema.
A thorough neurological examination and a CT. If CT shows new intracranial pathologic finding get consultation.
What is second impact syndrome?
Diffuse cerebral swelling occuring after a second concussion, while an athlete is still symptomatic from an earlier concussion.
What the physiological cause of second impact syndrome?
The process is thought to be caused bu a disordered cerebral auto-regulation causing cardiovascular congestion and malignant cerebral edema with increase intracranial pressure.
What are the two major causes of severe head injury secondary TBI?
Hypoxia and hypotension
What are the goals for managing severe head injury?
Normalize oxygen and blood pressure have shown better outcomes
What are the standards of hypotension prevention?
Keep systolic blood pressure above 90 mmHg
Adequate fluid resuscitation using isotonic cystalloids (saline not albumin)
Ongoing monitoring of the patient vital signs
Continually asses neurological status
What treatments are used for prevention of hypoxia?
Maintain of PaO2 greater than 60 mmHg (normal 75 - 100 mmHg
GCS below 8 indicates an endotracheal intubation is recommend if well trained provider is present (if not than bag-mask ventilation is used)
Still important the vital signs and neurological status
What is a secondary neurological injury?
An indirect result of the insult secondary to the processes of the trauma. It occurs hours and days following the primary injury and plays a large role in the brain damage and death that results from TBI.
What factors should be avoided with Secondary Neurological injury?
Hypoxia Hypotension Hyperventilation Increased ICP Low cerebral perfusion pressure
What are some simple techniques to prevent a rise in ICP following a severe head injury.
- Elevate head and torso to 30 degrees
- Optimizing of venous drainage: Keep neck in neutral position and losing neck brace if too tight.
- Monitor central venous pressure and asses hypervolemia
