TBI Flashcards
What is the glascow coma scale based on?
Eye opening, verbal response, and motor control
Highest GCS score?
15
Lowest GCS score?
3
When should GCS be performed?
At triage and repeatedly during evaluation
What does a decreasing GCS score mean?
BAD NOT GOOD NO GET HELP
Rate these 1-4 on GCS Scale: No eye opening, Eye opening in response to pain, eye opening to speech, eyes opening spontaneously
No eye opening = 1
Eye opening in response to pain = 2
Eye opening to speech = 3
Eyes opening spontaneously = 4
Rate these 1-5 on GCS scale: No verbal response, incomprehensible sounds, inappropriate words, confused, oriented
No verbal response = 1 Incomprehensible sounds = 2 Inappropriate words = 3 Confused = 4 Oriented = 5
Rate these 1-6 on GCS scale: No motor response, extension to pain (decerebrate), abnormal flexion to pain (decorticate), flexion/withdrawal to pain, localizes to pain, obeys commands
No motor response = 1 Extension to pain (decerebrate) = 2 Abnormal flexion to pain (decorticate) = 3 Flexion/withdrawal to pain = 4 Localizes to pain = 5 Obeys commands = 6
GCS 13-15
Mild TBI
GCS 9-12
Moderate TBI
GCS less than 8
Severe TBI
Membranes covering the brain and spinal cord
Meninges
Three types of primary brain injuries
Compression, tensile, shear
Tissue stretching
Tensile
Tissue distortion when tissue slides over tissue
Shear
When does secondary brain injury occur?
AFTER the initial insult (could be minutes, hours, days)
Cerebral arterial dilation, intracranial hemorrhage, cerebral edema, ischemia/hypoxia, increased ICP, and intracellular swelling and electrolyte imbalance are all forms of??
Secondary brain injury
What is important to do when evaluating a patient with a TBI?
Maintain C spine immobilization!
Battle’s sign, raccoon eyes, CSF rhinorrhea or otorrhea, and hemotympanum are all signs of?
Basilar skull fx
Headache, vomiting, age over 60, intoxication, deficits in short term memory, physical evidence of trauma above clavicles and seizure…. What should you suspect?
SUSPECT TBI
Who gets a CT?
Everyone! Unless you’re in Canada. JK this card is useless give yourself a 5 and carry on.
Are skull radiographs recommended for TBI?
No get a non-contrast head CT
Complex pathophysiological process affecting the brain, induced by traumatic biomechanics forces. Traumatically induced structural injury and/or physiologic disruption of the brain function as a result of external force
Concussion
Can result from direct blow to the face, neck, or elsewhere on the body; Can result in loss of consciousness; associated with grossly normal structural neuroimaging studies; rapid onset, short-lived impairment of neurologic function that resolves spontaneously; neuropathological changes
Concussion
Concussion patients have ______ amnesia
RETROGRADE - can’t remember things up to 30 min before incident of trauma
Vacant stare, delayed verbal expression, inability to focus attention, disorientation, slurred or incoherent speech, gross observable incoordination
Signs in someone who has a concussion
How could a patient’s emotions clue you in to a concussion?
Emotionality out of proportion to circumstances
Seizures that occur WITHIN THE FIRST WEEK after head injury
Early post-traumatic seizures (1/4 occur w/in first hour, 1/2 occur within first 24 hours)
Occurs within DAYS TO WEEKS after head injury
Post-concussion syndrome
How do you treat concussions?
Observe
What do you need to be concerned about missing in a concussion patient?
Epidural hematoma
May present with confusion to coma, may be seen on CT, basically a bruise to your brain - hemorrhagic with surrounding edema
Brain contusion with intracerebral hemorrhage
A brain contusion is a ________ brain injury
secondary
Shaken baby syndrome is an example of what kind of injury?
Acceleration deceleration
Shear forces injure axons (white matter)
Diffuse axonal injury
Diffuse axonal injury with coma less than 6 hours
Mild DAI
Diffuse axonal injury with coma greater than 24 hours
Moderate DAI
Diffuse axonal injury with prolonged coma that increases to vegetative state (90%)
Severe DAI
Treatment for DAI?
Supportive
Can lead to increased ICP secondary to blockage of CSF outflow at 3rd and 4th ventricle
Traumatic subarachnoid hemorrhage
A traumatic subarachnoid hemorrhage can be MISSED on CT if done less than ___ hours after injury
6 hours
Patient presents with persistent headache, photophobia and nausea following a head injury
Suspect traumatic subarachnoid hemorrhage
Space occupying lesion with slow/venous bleeding; concave hematoma seen on CT (crescent shaped)
Subdural hematoma
How long does it take for a subdural hematoma to occur?
Within 24 hours of injury to more than 2 weeks from injury!
Patient presents with a brief loss of consciousness followed by a lucid period
Epidural hematoma
What is the source of intracranial bleed for an epidural hematoma?
Arterial – high pressure
Fixed dilated pupil on ipsilateral side, with contralateral hemiparesis are _____ findings of epidural hematoma
Late
What is the treatment for epidural hematoma?
IMMEDIATE surgical treatment to decompress the brain and prevent herniation
Normal ICP
0-10mmHg
Pathologic ICP
Greater than or equal to 20mmHg
When is cerebral perfusion pressure critical?
50-70mmHg
