TBI Flashcards
What is the definition of Traumatic Brain Injury (TBI)?
A non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to impairment of cognitive, physical, and psychosocial functions, with an associated altered state of consciousness.
What are the two main types of brain injuries in TBI?
Primary brain injury and secondary brain injury.
What is the Monro-Kellie Doctrine?
The total volume within the cranium remains constant, composed of brain tissue, cerebrospinal fluid (CSF), and blood. Any increase in one component must be compensated by a decrease in another.
What are the common causes of TBI?
Road traffic accidents (RTA), falls from height, assault (penetrating and non-penetrating), contact sports, and instrumental deliveries.
What is the leading cause of TBI in young adults?
Road traffic accidents (RTA).
What is the leading cause of TBI in the elderly?
Falls.
What is the difference between primary and secondary brain injury?
Primary injury occurs at the time of impact due to mechanical forces, while secondary injury results from subsequent pathophysiological changes like hypoxia, hypotension, and raised intracranial pressure.
What are the common mechanisms of TBI?
Contact/Impact, Non-contact/Inertial, and Blast injuries.
What are the three components that determine cerebral perfusion pressure (CPP)?
CPP = Mean arterial pressure (MAP) - Intracranial pressure (ICP).
What are the three types of skull base fractures?
Anterior skull base, middle skull base, and posterior skull base fractures.
What is a depressed skull fracture?
A fracture where a portion of the skull is sunken due to trauma. It can be open or closed.
What are the surgical indications for a depressed skull fracture?
Open depressed fracture, significantly depressed fracture, fracture through an air sinus, underlying extradural hematoma (EDH).
What is the source of bleeding in an extradural hematoma (EDH)?
Middle meningeal artery, diploe of the bone, and dural sinuses.
What is the source of bleeding in a subdural hematoma (SDH)?
Bridging veins.
What is the gold standard imaging for diagnosing TBI?
Non-contrast CT brain scan.
What is diffuse axonal injury (DAI)?
A severe brain injury caused by shearing forces affecting axons at the gray-white matter interface, often diagnosed using MRI.
What is the lucid interval in TBI?
A temporary improvement in consciousness followed by rapid deterioration, commonly seen in extradural hematoma (EDH).
What are common symptoms of TBI?
Altered consciousness, vomiting, seizures, amnesia, focal neurologic deficits, headache, and bleeding from craniofacial orifices.
What is the Glasgow Coma Scale (GCS) used for?
To assess the level of consciousness in TBI patients, ranging from 3 (deep coma) to 15 (fully awake).
What are the three components of the Glasgow Coma Scale (GCS)?
Eye response, verbal response, and motor response.
What is the initial approach to a TBI patient in an emergency setting?
Follow the Advanced Trauma Life Support (ATLS) protocol.
What is the recommended position for nursing a TBI patient to reduce intracranial pressure?
Head of the bed elevated to 30 degrees.
What is the role of osmotic diuretics like mannitol in TBI management?
Used to reduce intracranial pressure, but with caution due to risk of rebound swelling and hypotension.
Why should prophylactic antibiotics be used cautiously in TBI patients?
Routine use is not recommended due to the risk of antimicrobial resistance.
What is the most common long-term complication of TBI?
Cognitive deficits and behavioral changes.
What is post-traumatic hydrocephalus?
An abnormal accumulation of cerebrospinal fluid (CSF) following TBI, leading to increased intracranial pressure.
What are the endocrine complications of TBI?
Syndrome of inappropriate antidiuretic hormone (SIADH), cerebral salt wasting (CSW), and hypopituitarism.
What are common cardiovascular complications of TBI?
Deep vein thrombosis (DVT) and autonomic dysfunction.
What are the respiratory complications of TBI?
Pneumonia, atelectasis, and aspiration pneumonitis.
What are common gastrointestinal complications of TBI?
Cushing’s ulcers and ileus.
What are the key steps in preventing secondary brain injury?
Maintaining oxygenation, normal blood pressure, normoglycemia, preventing seizures, and avoiding hyperthermia.
What is the most common cause of mortality in severe TBI?
Raised intracranial pressure leading to brain herniation.
What is the role of decompressive craniectomy in TBI?
Used to relieve raised intracranial pressure in severe cases.
What is the NEXUS criteria used for?
To determine the need for cervical spine imaging in trauma patients.
How can TBI be prevented?
Enforcing road traffic laws, promoting helmet use, improving vehicle safety, and raising public awareness.
