TBI

Question 1

limitations to the GCS

Answer 1

medical sedation, paralysis endotracheal intubation and intoxication

Question 2

the four score scaling has been created to correct some issues in the GCS primarily by including

Answer 2

a brainstem exam

Question 3

what are the two CT based grading score exams

Answer 3

marshal scale and rotterdam scale

Question 4

What parameters are included in the marshal scale how many different classifications are there which is worse

Answer 4

1. swelling –> midline shift and basal cistern compression
2. presence or size of hemorrhage –> high density or mixed densities

scaled from 1-6
6 being the worst

Question 5

What parameters are included in the rotterdam scale how many different classifications are there which is worse

Answer 5

1. degree of basal cistern compression
2. midline shift
3. epidural hematomas
4. intraventricular and or subarachnoid blood

also score 1-6
6 being worst

Question 6

________ are the most frequently encountered lesions. contusions are commonly seed in basal frontal and temporal areas.

Answer 6

focal cerebral contusions

Question 7

___________ visualized as multiple small lesions seen within white matter tracts. presents with profound coma without elevated ICP

Answer 7

Diffuse axonal injury DAI

Question 8

best imaging study for DAI– diffuse axonal injury

Answer 8

MRI is more sensitive than CT for detecting DAI

Question 9

__________ are generally encountered when forces are distributed to the cranial vault and the most superficial cerebral layers

Answer 9

extraaxial hematomas

Question 10

__________ are typically associated with torn dural vessels such as the middle meningeal artery and are almost always associated with brain fracture

Answer 10

epidural hematomas

Question 11

_______ are lenticular shaped and tend not to be associated with underlying brain damage

Answer 11

epidural hematomas

Question 12

________occur with disruption of small piall vessels and commonly occur in the sylcian fissures and interpenduncular cisterns

Answer 12

Subdural hematoma

Question 13

________is believed to result from tearing of subependymal veins, or by extension from asjacent intraperenchymal or subarachnoid hemorrhage

Answer 13

Intraventricular hemorrhage

Question 14

1/3 of patients with severe TBI develop a _______ which is associated with an increased risk of _______

Answer 14

hemorrhage enlargement (poor neuro outcomes and death)

Question 15

acute TBI is also thought to produce a ________through the systemic release of tissue factor and brain phospholipids into the circulation

Answer 15

coagulopathy

Question 16

What secondary brain injuries can cause secondary brain insults which would normally be tolerated

Answer 16

hypotension and hypoxia
fever and seizures
hyperglycemia

Question 17

primary goal of prehospital management for TBI

Answer 17

prevention of hypotension and hypoxia

Question 18

______________ is recommended in patients with TBI and a GCS score less than 9

Answer 18

prehospital endotracheal intubation

Question 19

How can emergency medical service prevent hypotension in a patient with TBI

Answer 19

adequate fluid resuscitation using isotonic crystalloids`

Question 20

in an emergency medical service for a patient with TBI the neurological assessment should always assume

Answer 20

that the patient has a spinal fracture and stabilize and immobilize spine

Question 21

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?

Answer 21

pupillary examination

Question 22

“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?

Answer 22

impending or ongoing cerebral herniation (in which immediate lifesaving measures should be instituted)

Question 23

_________is the preferred imaging modality in the acute phase of head trauma

Answer 23

CT

Question 24

Current guidelines recommend head CT in all TBI patients with a_______ _____

Answer 24

a GCS score of 14 or lower

Question 25

In the absence of clinical deterioration, repeat imaging in six hours is reasonable in patients with __________________________

Answer 25

a hematoma present on the initial scan, particularly in patients with a GCS <9

Question 26

Indications for surgery after head injury are based upon neuro status, defined by the (GCS), and findings on (CT) criteria such as ________

Answer 26

large hematoma volume or thickness and evidence of mass effect including midline shift.

Question 27

when should there be a surgical treatment for an epidural hematoma?

Answer 27

larger than 30 mL in volume regardless of a patient’s GCS score

when patients hav GCS score <8 and anisocoria **

Question 28

when should there be a surgical treatment for an subdural hematoma?

Answer 28

> 10 mm in thickness or associated with midline shift >5 mm on CT

Question 29

when should there be a surgical treatment for an intracranial hemorrhage

Answer 29

ICH in the posterior fossa when there is evidence of significant mass effect

Question 30

what surgical treatment should be employed when there is a TBI due to a penetrating injury?

Answer 30

Superficial*****debridement and dural closure to prevent cerebrospinal fluid (CSF) leak is generally recommended

Question 31

what surgical treatment should be employed when there is a refractory inracranial hypertension?

Answer 31

Decompressive craniectomy