TBI

Question 1

What is a TBI?

Answer 1

A TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.

The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury.

Question 2

Who is at most risk for TBI?

Answer 2

males

Question 3

Risk Factors for TBI?

Answer 3

Male gender
Older age
Previous TBI
Drug/Alchohol Use

Question 4

TBI Incidence is:

Answer 4

BIMODAL

Young – leading cause of death for individuals aged 1-34 years

Old - > 65

Question 5

What is used to measure severity of TBI?

Answer 5

GCS is most commonly used measure

Good prognostic value

Loses validity after a few days

Question 6

What are the issues with the GCS?

Answer 6

Score affected by intoxication

Intubation can alter scoring between mild and moderate

Not scorable if patient cannot understand examiner’s language

Question 7

What is the best predictor of outcome?

Answer 7

Depth and duration of unconsciousness

Question 8

Post-Traumatic Amnesia is related to:

Answer 8

TBI Severity

Question 9

How do you assess post-traumatic amnesia?

Answer 9

Galveston Orientation Amnesia Test (GOAT) (Scores ≥75 twice within 48 hours)

Orientation Log
(Scores ≥ 25 on 2 consecutive days)

Question 10

Primary Injury

Answer 10

Occurs at moment of impact

Focal – bleeding, bruising or penetrating injury isolated to a portion of the brain

Diffuse – brain tissue suffers more widespread damage

People can experience both at the same time

Question 11

Secondary Injury

Answer 11

Triggered by primary injury; causes even more damage to brain

Usually diffuse, but can also be delayed focal events

Inflammation

Cell receptor-mediated dysfunction

Free radical and oxidative damage

Calcium or other ion-mediated cell damage

Question 12

Primary Mechanisms of Injury

Answer 12

Contusions
Diffuse Axonal Injury
Open Head Injury
Bleeding

Question 13

Contusions

Answer 13

Bruising

Coup and Contrecoup

Coup – at site of impact

Contrecoup – opposite impact site

Question 14

Diffuse Axonal Injury

Answer 14

Shearing
Tensile Stress
Widespread Injury

Question 15

Open Head Injury

Answer 15

Skull Fracture

Question 16

Bleeding

Answer 16

Epidural
Subdural
Subarachnoid
Intraparenchymal
Intraventricular

Question 17

Where does epidural bleeding occur? What causes it?

Answer 17

Bleeding between the skull and the dura

Usually arterial, therefore it can expand rapidly

Question 18

What can an epidural bleed cause?

Answer 18

Can cause significantly increased ICP and brain shifting

Question 19

What is the mortality rate for epidural bleeding?

Answer 19

15-20%