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Kellie: SD EM #1 > TBI > Flashcards

TBI Flashcards

1
Q

What is the glascow coma scale based on?

A

Eye opening, verbal response, and motor control

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2
Q

Highest GCS score?

A

15

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3
Q

Lowest GCS score?

A

3

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4
Q

When should GCS be performed?

A

At triage and repeatedly during evaluation

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5
Q

What does a decreasing GCS score mean?

A

BAD NOT GOOD NO GET HELP

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6
Q

Rate these 1-4 on GCS Scale: No eye opening, Eye opening in response to pain, eye opening to speech, eyes opening spontaneously

A

No eye opening = 1
Eye opening in response to pain = 2
Eye opening to speech = 3
Eyes opening spontaneously = 4

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7
Q

Rate these 1-5 on GCS scale: No verbal response, incomprehensible sounds, inappropriate words, confused, oriented

A 
No verbal response = 1
Incomprehensible sounds = 2
Inappropriate words = 3
Confused = 4
Oriented = 5
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8
Q

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

A 
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
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9
Q

GCS 13-15

A

Mild TBI

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10
Q

GCS 9-12

A

Moderate TBI

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11
Q

GCS less than 8

A

Severe TBI

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12
Q

Membranes covering the brain and spinal cord

A

Meninges

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13
Q

Three types of primary brain injuries

A

Compression, tensile, shear

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14
Q

Tissue stretching

A

Tensile

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15
Q

Tissue distortion when tissue slides over tissue

A

Shear

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16
Q

When does secondary brain injury occur?

A

AFTER the initial insult (could be minutes, hours, days)

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17
Q

Cerebral arterial dilation, intracranial hemorrhage, cerebral edema, ischemia/hypoxia, increased ICP, and intracellular swelling and electrolyte imbalance are all forms of??

A

Secondary brain injury

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18
Q

What is important to do when evaluating a patient with a TBI?

A

Maintain C spine immobilization!

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19
Q

Battle’s sign, raccoon eyes, CSF rhinorrhea or otorrhea, and hemotympanum are all signs of?

A

Basilar skull fx

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20
Q

Headache, vomiting, age over 60, intoxication, deficits in short term memory, physical evidence of trauma above clavicles and seizure…. What should you suspect?

A

SUSPECT TBI

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21
Q

Who gets a CT?

A

Everyone! Unless you’re in Canada. JK this card is useless give yourself a 5 and carry on.

22
Q

Are skull radiographs recommended for TBI?

A

No get a non-contrast head CT

23
Q

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

A

Concussion

24
Q

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

A

Concussion

25
Q

Concussion patients have ______ amnesia

A

RETROGRADE - can’t remember things up to 30 min before incident of trauma

26
Q

Vacant stare, delayed verbal expression, inability to focus attention, disorientation, slurred or incoherent speech, gross observable incoordination

A

Signs in someone who has a concussion

27
Q

How could a patient’s emotions clue you in to a concussion?

A

Emotionality out of proportion to circumstances

28
Q

Seizures that occur WITHIN THE FIRST WEEK after head injury

A

Early post-traumatic seizures (1/4 occur w/in first hour, 1/2 occur within first 24 hours)

29
Q

Occurs within DAYS TO WEEKS after head injury

A

Post-concussion syndrome

30
Q

How do you treat concussions?

A

Observe

31
Q

What do you need to be concerned about missing in a concussion patient?

A

Epidural hematoma

32
Q

May present with confusion to coma, may be seen on CT, basically a bruise to your brain - hemorrhagic with surrounding edema

A

Brain contusion with intracerebral hemorrhage

33
Q

A brain contusion is a ________ brain injury

A

secondary

34
Q

Shaken baby syndrome is an example of what kind of injury?

A

Acceleration deceleration

35
Q

Shear forces injure axons (white matter)

A

Diffuse axonal injury

36
Q

Diffuse axonal injury with coma less than 6 hours

A

Mild DAI

37
Q

Diffuse axonal injury with coma greater than 24 hours

A

Moderate DAI

38
Q

Diffuse axonal injury with prolonged coma that increases to vegetative state (90%)

A

Severe DAI

39
Q

Treatment for DAI?

A

Supportive

40
Q

Can lead to increased ICP secondary to blockage of CSF outflow at 3rd and 4th ventricle

A

Traumatic subarachnoid hemorrhage

41
Q

A traumatic subarachnoid hemorrhage can be MISSED on CT if done less than ___ hours after injury

A

6 hours

42
Q

Patient presents with persistent headache, photophobia and nausea following a head injury

A

Suspect traumatic subarachnoid hemorrhage

43
Q

Space occupying lesion with slow/venous bleeding; concave hematoma seen on CT (crescent shaped)

A

Subdural hematoma

44
Q

How long does it take for a subdural hematoma to occur?

A

Within 24 hours of injury to more than 2 weeks from injury!

45
Q

Patient presents with a brief loss of consciousness followed by a lucid period

A

Epidural hematoma

46
Q

What is the source of intracranial bleed for an epidural hematoma?

A

Arterial – high pressure

47
Q

Fixed dilated pupil on ipsilateral side, with contralateral hemiparesis are _____ findings of epidural hematoma

A

Late

48
Q

What is the treatment for epidural hematoma?

A

IMMEDIATE surgical treatment to decompress the brain and prevent herniation

49
Q

Normal ICP

A

0-10mmHg

50
Q

Pathologic ICP

A

Greater than or equal to 20mmHg

51
Q

When is cerebral perfusion pressure critical?

A

50-70mmHg

Kellie: SD EM #1 (6 decks)

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