TBI

Question 1

TBI Incidence

Answer 1

Approximately 1 million Americans have a TBI yearly
Among men less than 35 years of age, accidents are a chief cause of death; falls in the elderly we are number two
Approximately 2/3 of all severe MVC’s involve head trauma
Leading cause of death in all trauma cases

Question 2

Monroe-Kelli Doctrine

Answer 2

When one of the contents of the skull increases, another must decrease to compensate and maintain normal ICP

Question 3

TBI Sign/Symptoms

Answer 3

Important to assess: time in place of injury, how the event occurred, onset symptoms, LOC, occurrence of a lucid interval ( suggests, expanding hematoma), seizure activity associated with the event, whether amnesia occurred afterward (indicative of severity of the blow)

Decompensating patients may show signs of “Cushing’s Triad”
Battle’s sign
Raccoon eyes
Ottorhea or rhinorrhea

Question 4

Cushing’s Triad

Answer 4

Widening pulse pressure [ systolic BP increases Ed in an attempt to maintain a constant CPP (CPP=MAP-ICP)]
Decreased RR
Decreased HR

Question 5

Battle’s Sign

Answer 5

Bruising behind ear at mastoid process

Question 6

TBI Lab/Diagnostics

Answer 6

Cervical spin films should be obtained for all patients

Skull films and head CT

Question 7

TBI Management

Answer 7

Airway, breathing, circulation, and cervical spine must be assessed and any patient with altered LOC or significant trauma
Stabilization of vital signs and I’m going neurological evaluations
Neurosurgical consultation