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TBI > TBI > Flashcards

TBI Flashcards

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1
Q

What are the three points in time after TBI that death can occur?

A
  • Immediately after the injury (from direct head trauma or from massive hemorrhage and shock)
  • Within 2 hours after the injury (by progressive worsening of the head injury or internal bleeding)
  • 3 weeks after the injury. (from multisystem failure)
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2
Q

It is any injury or trauma to the scalp, skull, or brain

A

Head injury

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3
Q

What are the two most common cause of TBI?

A

falls and motor vehicle accidents

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4
Q

What are the causes of TBI?

A 
Motor vehicle collisions
Falls
Firearm-related injuries
Assaults
Sports-related injuries
Recreational accidents 
War-related injuries
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5
Q

Females are twice likely to sustain TBI than males. True or False.

A

False. Males are twice likely to sustain TBI than females.

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6
Q

What are the types of TBI?

A

Scalp lacerations and skull fractures

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7
Q

What are scalp lacerations?

A
  • They are external head trauma
  • easily recognized
  • scalp is highly vascular with poorly constricting blood vessels
  • cause profuse bleeding
  • complications - blood loss and infection
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8
Q

What are the different types of skull fractures?

A
  • linear (break in continuity of bone - low velocity injury )
  • depressed (inward indentation - powerful blow)
  • simple (fracture without fragments or serious lacerations - low to moderate impact),
  • comminuted (multiple linear with many fragments of bone - direct high momemtum impact)
  • compound (depressed skull + scalp laceration= severe head injury)
  • can be closed or open
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9
Q

The clinical manifestations of skull injury is determined by the _____ of the fracture.

A

location

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10
Q

What are the complications of skull fracture?

A

intracranial infections, hematoma, meningeal and brain tissue damage

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11
Q

The ____ and ____ of a skull fracture depend on the velocity, momentum, direction and shape (blunt or sharp) of the injuring agent, and site of impact.

A

type and severity

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12
Q

postauricular ecchymosis is also called ___’s ___.

A

Battle’s sign

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13
Q

periorbital ecchymosis is also called ___ ____

A

raccoon eyes

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14
Q

In cases where a basal skull fracture is suspected, a nasogastric or oral gastric tube should be inserted under ____ (x-ray or fluroscopy).

A

fluoroscopy

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15
Q

A basilar skull fracture is a specialized type of _____ fracture that occurs when the fracture involves the base of the skull.

A

linear

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16
Q

CSF leakage from the nose

A

Rhinorrhea

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17
Q

CSF leakage from the ear

A

otorrhea

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18
Q

The risk of meningitis is ___ (high or low) with a CSF leak, and ______ should be administered to prevent the development of meningitis.

A

high; antibiotics

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19
Q

What are the two methods of testing fluid from ear or nose for CSF?

A
  1. Test fluid with Dextrostix or TesTape Strip for glucose. CSF is positive for glucose, mucous is not.
  2. Let the fluid drip on a white gauze pad. In a few minutes as the blood coalesces into the center, and a yellowish ring encircles the blood, halo or ring sign, if CSF is present
    (Note: Both methods can give false positive so the color, appearance, and amount of leaking fluid must be observed)
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20
Q

It is alright to insert NG tube in a patient with basilar skull fracture. True or false.

A

False. NG tube should NEVER be inserted instead an orogastric (OG) tube should be inserted.

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21
Q

What are the different categories of brain injury?

A
  • Diffuse (generalized - cannot be localized to a particular area. Eg. concussion, diffuse axona injury)
  • Focal (localized, contusion, lacerations, hematoma)
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22
Q

How are brain injuries classified?

A
  • Minor (GCS 13-15)
  • Moderate (GCS 9-12)
  • Severe (GCS 3-8)
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23
Q

It is a sudden transient mechanical head injury with disruption of neural activity and a change in the LOC that usually last a short duration.

A

concussion

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24
Q

Concussion is considered a ____ (minor or major) diffuse head injury?

A

minor. Patient may or may not lose consciousness.

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25
Q

What are the signs of concussion?

A

a brief disruption in LOC, amnesia regarding the event (retrograde amnesia), and headache. that usually last for a short time

26
Q

If the patient has not lost consciousness, or if the loss of consciousness lasts less than 5 minutes, the patient is usually discharged. True or False.

A

True

27
Q

What patient teaching is needed at discharge of concussion patient?

A

Notify the health care provider if symptoms persist or if behavioral and neurological changes are noted.

28
Q

How long after concussion can a patient develop post-concussion syndrome?

A

anywhere from 2 weeks to 2 months after the injury.

29
Q

What are the clinical manifestations of post-concussion syndrome?

A
  • persistent headache,
  • lethargy,
  • personality and behavioral changes,
  • shortened attention span,
  • decreased short-term memory, and
  • changes in intellectual ability
30
Q

Post-concussion syndrome can affect activities of daily living. True or False.

A

True

31
Q

It is widespread axonal damage occurring after a mild, moderate, or severe TBI.

A

Diffuse axonal injury

32
Q

In this type of TBI, the damage occurs primarily around axons in the subcortical white matter of the cerebral hemispheres, basal ganglia, thalamus, and brainstem.

A

Diffuse axonal injury

33
Q

Diffuse axonal injury develops within a few minutes of TBI. True or False.

A

False. axon swelling and disconnection. This process takes approximately 12 to 24 hours to develop and may persist longer.

34
Q

What are some of the clinical manifestations of diffuse axonal injury (DAI)?

A
  • decreased LOC,
  • increased ICP,
  • decortication or decerebration, and
  • global cerebral edema
35
Q

Approximately 90% of patients with DAI recover quickly. True or False.

A

False. They remain in a persistent vegetative state.

36
Q

It is the actual tearing of the brain tissue.

A

Laceration

37
Q

What are some causes of lacerations?

A

depressed and open fractures, and penetrating injuries.

38
Q

Surgery can fix lacerations. True or False.

A

False. Surgical repair of the laceration is IMPOSSIBLE because of the nature of brain tissue.

39
Q

What are the medical management of lacerations?

A
  • antibiotics (until meningitis is ruled out), and

- prevention of secondary injury related to increased ICP.

40
Q

What are some delay responses to head trauma?

A

hemorrhage, hematoma formation, seizures, and cerebral edema

41
Q

Intracerebral hemorrhage is generally associated with ____ (concussion/cerebral laceration/contusion).

A

cerebral laceration

42
Q

What are the clinical manifestations of intracerebral hemorrhage?

A

space-occupying lesion accompanied by:

  • unconsciousness,
  • hemiplegia on the contralateral side, and
  • a dilated pupil on the ipsilateral side.
43
Q

What are different hemorrhages that can occur with head trauma?

A
  • Intracerebral hemorrhage
  • Subarachnoid hemorrhage
  • Intraventricular hemorrhage
44
Q

It is the bruising of the brain tissue within a focal area.

A

Contusion

45
Q

As the hematoma expands, increased ICP decreases. True or False.

A

False. ICP increases.

46
Q

Intracerebral hemorrhage is usually associated with cerebral laceration, and
contusion is usually associated with closed head injury. True or False.

A

True

47
Q

Where can contusion occur?

A

areas of hemorrhage, infarction, necrosis, and edema, and frequently occurs at a fracture site.

48
Q

Coup-contrecoup injury often occurs with ___ (concussion/contusion).

A

Contusion

49
Q

What is coup-contrecoup injury?

A

when the brain moves It occurs inside the skull due to high-energy or high-impact injury. Contusions or lacerations occur both at the site of the direct impact of the brain on the skull (coup) and at a second area of damage on the opposite side away from injury (contrecoup), leading to multiple contused areas

50
Q

What is coup in coup-contrecoup injury?

A

injury at the site of the direct impact of the brain on the skull

51
Q

What is contrecoup in coup-contrecoup injury?

A

second area of damage on the opposite side away from injury

52
Q

Which is more severe coup or contrecoup?

A

contrecoup

53
Q

What does prognosis of contusion depend on?

A

amount of bleeding around the contusion site.

54
Q

Which is primary impact - coup or contrecoup?

A

coup

55
Q

Which is secondary impact - coup or contrecoup?

A

contrecoup

56
Q

A physician notices “blossom” on CT scan of brain injury patient. What does it mean?

A

Bleeding from contusion

57
Q

What is the patient at risk for if brain contusion occurs especially if frontal or temporal lobes are involved?

A

Seizures

58
Q

What assessment is most important in patients with brain injury?

A

Neurological assessment

59
Q

How do anticoagulants and coagulopathy affect TBI patients?

A

They are associated with increased hemorrhage, more severe head injury, and a higher mortality rate especially in older adults.

60
Q

Risk for falls should be assessed in all head injury patients taking anticoagulants. True or False.

A

True

61
Q

It is the bleeding between the dura and inner surface of the skull.

A

epidural hematoma

62
Q

Is epidural hematoma an emergency condition?

A

Yes. It is a neurologic emergency and is usually associated with a linear fracture crossing a major artery in the dura, causing a tear.

TBI (1 decks)

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