TBI Flashcards
types of head injury (3)
Open head injury
closed
diffuse axonal injury
what is diffuse axonal injury
shaking or strong rotation of the head causing tearing of brain tissue
mechanism of TBI (3)
penetrating
crush
acc/deceleration injury
what is Open head injury
dura is punctured
primary brain damage
result of the direct trauma to the brain tissue
2nd brain damage
result of the complications arising from the primary causes
concussion, contusion, lacerations - what are they as a group?
primary mechanisms
definition of concussion
Brief state of unconsciousness with no lasting damage to the brain
what is contusions
bruising of brain tissue; below or opposite site of injury
what is lacerations
tearing
what lead to ICP
haemorhage, oedema
intracranial haemorrhage
cerebral oedema
tentorial herniation (coning)
examples of 2nd mechanism
As a result of increasing ICP or unresolving haematoma, the brain tissue is compressed and pushed downwards through the foramen magnum. The brain stem compression leads to a stopping of vital functions
coning; tentorial herniation
3 cardinal features of brainstem death
Coma/unresponsiveness
Absence of brain stem reflexes
Apnoea
what is apnoea
breathing stops and starts while you sleep.
3 components in the skull
brain tissue, blood, cerebrospinal fluid (CSF)
ways to regulate ICP (3)
Autoregulation – blood flow
Compliance - tolerate an increase in intracranial volume
Shunting of CSF
Normal resting ICP
on coughing
on sneezing
10
30
100 mmHg
Signs and symptoms of raised ICP (7)
Headache
Nausea
Papilloedema – swelling of optic disc
Neck stiffness
Vomiting
Decrease in conscious level
Pupil dilation
Cerebral ischaemia/hypoxia - 2nd mechanism
impaired blood flow to the brain.
due to hypotension
- Prolonged state of unconsciousness
- No eye opening
- No response even to painful stimuli
- May have some non-purposeful movements = ?
coma
GLASGOW COMA SCALE range
3-15
purpose of GCS
to determine severity of brain injury
GCS category
severe (7 or less),
moderate (8-12) or mild (13-15).
mild/moderate/severe TBI?
Loss of consciousness brief if apparent at all (seconds / minutes).
Testing / scans of brain may appear normal.
Diagnosed only when there is change in mental status at the time of injury.
Symptoms usually temporary with full recovery after 1 year
Mild
mild/moderate/severe TBI?
Loss of consciousness lasts from a few minutes / hours.
Confusion can last days to weeks.
Physical, cognitive and / or behavioural impairments can last months or be permanent.
Patients generally make a good recovery via rehabilitation or learning to compensate for their deficits.
Moderate TBI
mild/moderate/severe TBI?
Prolonged unconscious state lasting days, weeks or months (coma).
Minimal or no response to stimulus.
Can develop PVS.
Patients can make significant improvements but are left with permanent physical, cognitive and / or behavioural impairments.
severe TBI
Visual Agnosia
Figure/ground discrimination
Position in Space
Spatial Relationships
Unilateral Neglect
Apraxia
are examples of ?
Perceptual Problems
personality and emotional changes
attention
memory
planning & problem solving’
are examples of?
cognitive problems
(full) Visual field
Colour agnosia
Word blindness
Visual defects problems
Dysphagia
Insomnia, sleep apnoea
Vertigo, balance
Brain stem issues
Rest via ventilation and sedation
positioning
diuretics to reduce fluid – Mannitol
steroids to reduce swelling?
ventricular drainage if hydrocephalus
tx of raised ICP
3 stages of TBI MGT
acute - unconscious/conscious ICU pts
sub-acute - rehab
chronic - post discharge
