TBI

Question 1

S/S basal scull fracture and considerations

Answer 1

• Rhinorrhea - leaking CSF from nose
• Otorrhea - CSF from ears
• Raccoon eyes - hematoma leaking around eye socket
• Battle’s sign - hematoma around ears, leaking out
• risk of meningitis
• No NGs, go OG

Question 2

DAI

Answer 2

• Diffuse axonal injury
• Causes of sheering of more and less dense regions of the brain, causing axons to break off neurons and they die
• Immediate and severe change in LOC lasting >6hrs
• Deep and prolonged coma, inc ICP, BP and temp
• Deficits in speech, memory, motor coordination, cognition, personality

Question 3

Complications of TBI

Answer 3

• coagulation disorders
• hyperthermia
• gastroparesis
• sz
• DI
• SIADH

Question 4

What’s DI

Answer 4

Diabetes Insipidus

• Damage to hypothalamus/pituitary gland
• leads insufficient release of ADH, therefore get massive diuresis and hypotension
• Urine osmolality with be decreased

Question 5

SIADH

Answer 5

Syndrome of inappropriate ADH

• increased secretion of ADH
• dec UO
• HTN
• Inc urine osmolality

Question 6

Types of hematoma in TBI commonly

Answer 6

• Epidural hematoma
• Subdural hematoma
• Intracerebral hemorrhage
• Brainstem infarct

Question 7

Parameters within which autoregulation works effectively

Answer 7

CPP >60
ICP <30
MAP 60-100

Question 8

How do we manage TBI surgically

Answer 8

Craniotomy/craniectomy - release pressure in brain by giving it more space to swell
IVC/EVD- draining away blood/CSF to decrease ICP