TBI

Question 1

TBI is defined as

Answer 1

An alteration in brain function, or other evidence of brain pathology, caused by an external force

Question 2

TBI is a process, not an event

Answer 2

Secondary injury can be more damaging than primary injury

Question 3

Mechanism of Brain injury

Answer 3

brain contusion, increased ICP, axonal injury

Question 4

Brain contusion

Answer 4

cell death + hemorrhage at site distant from impact

Question 5

Increased ICP

Answer 5

Edema, Blood, CSF blocked outflow - brainstem can hemorrhage through foramen magnum = brainstem compression

Question 6

Diffuse Axonal Injury

Answer 6

damage widespread - major causes of unconsciousness and persistent vegetative state after head trauma

Question 7

Primary Injury

Answer 7

Irreversible cellular injury as a direct result of the injury;
Prevent the event

Question 8

Secondary Injury

Answer 8

Damage to cells that are not initially injured, Occurs hours to weeks after injury; Prevent hypoxia and ischemia (hypotension)

Question 9

Risk factors for TBI

Answer 9

Age (weakened vessels with age), anti-coats, prior trauma

Question 10

brain consumes

Answer 10

20% O2 and 15% Cardiac Output

Question 11

Any patient presenting with head injury should receive

Answer 11

O2

Question 12

Normal ICP? increased ICP?

Answer 12

15, 20-25

Question 13

Other injuries SCIWORA!

Answer 13

spinal cord injury without radiologic abnormalities - missed C spine fracture

Question 14

Approach to TBI patient

Answer 14

Airway (check while maintaining C spine), B, C, Disability (AVPU), Exposure

Question 15

lucid interval

Answer 15

temporary improvement in a patient’s condition after a traumatic brain injury, after which the condition deteriorates = RED FLAG

Question 16

Pupil assessment

Answer 16

increased ICP

Question 17

Positioning

Answer 17

decerebrate vs decorticate

Question 18

Decorticate

Answer 18

corticospinal tract injury

Question 19

Decerebrate

Answer 19

upper brainstem injury

Question 20

occipital skull fracture

Answer 20

may have additional fractures

Question 21

basilar skull fracture most common in

Answer 21

petrous portion of temporal bone, the EAC and TM

Question 22

Battle Sing for basilar skull fracture

Answer 22

posterior auricule echimosis

Question 23

Racoon Sign for basilar skull fracture

Answer 23

hemotympanic

Question 24

basilar fracture may result in

Answer 24

CSF rhinorrhea or otorrhea, vertigo, hearing loss, CN7 palsy

Question 25

Test for CSF fluid

Answer 25

ring test: blood + CSF = ring formation

Question 26

If patient has CSF drainage

Answer 26

start prophylactic antibodies

Question 27

Epidural Hematoma rupture of

Answer 27

Middle Meningeal a.

Question 28

Subdural Hematoma rupture of

Answer 28

bridging veins

Question 29

Subarachnoid Hemorrhage cause

Answer 29

Rupture of berry aneurysm due to HTN, AVM, or blunt trauma

Question 30

Intraparenchymal Hematoma caused by

Answer 30

Systemic hypertension, vasculitis, neoplasm and trauma

Question 31

Epidural Hematoma associated with

Answer 31

fracture of temporal bone, lucid interval, CN3 palsy, rapid bleeding

Question 32

Epidural Hematoma on CT

Answer 32

bi-convex disc, does not cross suture lines but can cross falx and tentorium

Question 33

Subdural Hematoma is common in

Answer 33

Elderly, alcoholics, shaken baby

Question 34

Subdural Hematoma clinical findings/ CT

Answer 34

slow bleed, with crescent-shape on CT

Question 35

Subarachnoid Hemorrhage clinical findings/CT

Answer 35

Rapid time-course, WORST h/a of life, CT shows blood in sulci

Question 36

Intraparenchymal Hematoma clinical findings/CT

Answer 36

does not rapidly expand or cause significant edema or midline shift, patch of blood in the brain tissue

Question 37

Diffuse Axonal Injury

Answer 37

irreversible, persistent vegetative state, following MVC or shaken baby syndrome