TBI Flashcards
limitations to the GCS
medical sedation, paralysis endotracheal intubation and intoxication
the four score scaling has been created to correct some issues in the GCS primarily by including
a brainstem exam
what are the two CT based grading score exams
marshal scale and rotterdam scale
What parameters are included in the marshal scale how many different classifications are there which is worse
- swelling –> midline shift and basal cistern compression
- presence or size of hemorrhage –> high density or mixed densities
scaled from 1-6
6 being the worst
What parameters are included in the rotterdam scale how many different classifications are there which is worse
- degree of basal cistern compression
- midline shift
- epidural hematomas
- intraventricular and or subarachnoid blood
also score 1-6
6 being worst
________ are the most frequently encountered lesions. contusions are commonly seed in basal frontal and temporal areas.
focal cerebral contusions
___________ visualized as multiple small lesions seen within white matter tracts. presents with profound coma without elevated ICP
Diffuse axonal injury DAI
best imaging study for DAI– diffuse axonal injury
MRI is more sensitive than CT for detecting DAI
__________ are generally encountered when forces are distributed to the cranial vault and the most superficial cerebral layers
extraaxial hematomas
__________ are typically associated with torn dural vessels such as the middle meningeal artery and are almost always associated with brain fracture
epidural hematomas
_______ are lenticular shaped and tend not to be associated with underlying brain damage
epidural hematomas
________occur with disruption of small piall vessels and commonly occur in the sylcian fissures and interpenduncular cisterns
Subdural hematoma
________is believed to result from tearing of subependymal veins, or by extension from asjacent intraperenchymal or subarachnoid hemorrhage
Intraventricular hemorrhage
1/3 of patients with severe TBI develop a _______ which is associated with an increased risk of _______
hemorrhage enlargement (poor neuro outcomes and death)
acute TBI is also thought to produce a ________through the systemic release of tissue factor and brain phospholipids into the circulation
coagulopathy
What secondary brain injuries can cause secondary brain insults which would normally be tolerated
hypotension and hypoxia
fever and seizures
hyperglycemia
primary goal of prehospital management for TBI
prevention of hypotension and hypoxia
______________ is recommended in patients with TBI and a GCS score less than 9
prehospital endotracheal intubation
How can emergency medical service prevent hypotension in a patient with TBI
adequate fluid resuscitation using isotonic crystalloids`
in an emergency medical service for a patient with TBI the neurological assessment should always assume
that the patient has a spinal fracture and stabilize and immobilize spine
Once a patient with a TBI is in the ER The GCS is commonly used to assess and communicate neurologic status in this setting. what other test is crucial in a patient with TBI?
pupillary examination
“Cushing triad” of hypertension, bradycardia, and irregular respiration.
and significant pupillary asymmetry, unilateral or bilateral fixed and dilated pupils, decorticate or decerebrate posturing, respiratory depression indicate what?
impending or ongoing cerebral herniation (in which immediate lifesaving measures should be instituted)
_________is the preferred imaging modality in the acute phase of head trauma
CT
Current guidelines recommend head CT in all TBI patients with a_______ _____
a GCS score of 14 or lower
In the absence of clinical deterioration, repeat imaging in six hours is reasonable in patients with __________________________
a hematoma present on the initial scan, particularly in patients with a GCS <9
Indications for surgery after head injury are based upon neuro status, defined by the (GCS), and findings on (CT) criteria such as ________
large hematoma volume or thickness and evidence of mass effect including midline shift.
when should there be a surgical treatment for an epidural hematoma?
larger than 30 mL in volume regardless of a patient’s GCS score
when patients hav GCS score <8 and anisocoria **
when should there be a surgical treatment for an subdural hematoma?
> 10 mm in thickness or associated with midline shift >5 mm on CT
when should there be a surgical treatment for an intracranial hemorrhage
ICH in the posterior fossa when there is evidence of significant mass effect
what surgical treatment should be employed when there is a TBI due to a penetrating injury?
Superficial*****debridement and dural closure to prevent cerebrospinal fluid (CSF) leak is generally recommended
what surgical treatment should be employed when there is a refractory inracranial hypertension?
Decompressive craniectomy
