TBI Flashcards

Pass the exam :)

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
What are the signs of concussion?
a brief disruption in LOC, amnesia regarding the event (retrograde amnesia), and headache. that usually last for a short time
26
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.
True
27
What patient teaching is needed at discharge of concussion patient?
Notify the health care provider if symptoms persist or if behavioral and neurological changes are noted.
28
How long after concussion can a patient develop post-concussion syndrome?
anywhere from 2 weeks to 2 months after the injury.
29
What are the clinical manifestations of post-concussion syndrome?
- persistent headache, - lethargy, - personality and behavioral changes, - shortened attention span, - decreased short-term memory, and - changes in intellectual ability
30
Post-concussion syndrome can affect activities of daily living. True or False.
True
31
It is widespread axonal damage occurring after a mild, moderate, or severe TBI.
Diffuse axonal injury
32
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.
Diffuse axonal injury
33
Diffuse axonal injury develops within a few minutes of TBI. True or False.
False. axon swelling and disconnection. This process takes approximately 12 to 24 hours to develop and may persist longer.
34
What are some of the clinical manifestations of diffuse axonal injury (DAI)?
- decreased LOC, - increased ICP, - decortication or decerebration, and - global cerebral edema
35
Approximately 90% of patients with DAI recover quickly. True or False.
False. They remain in a persistent vegetative state.
36
It is the actual tearing of the brain tissue.
Laceration
37
What are some causes of lacerations?
depressed and open fractures, and penetrating injuries.
38
Surgery can fix lacerations. True or False.
False. Surgical repair of the laceration is IMPOSSIBLE because of the nature of brain tissue.
39
What are the medical management of lacerations?
- antibiotics (until meningitis is ruled out), and | - prevention of secondary injury related to increased ICP.
40
What are some delay responses to head trauma?
hemorrhage, hematoma formation, seizures, and cerebral edema
41
Intracerebral hemorrhage is generally associated with ____ (concussion/cerebral laceration/contusion).
cerebral laceration
42
What are the clinical manifestations of intracerebral hemorrhage?
space-occupying lesion accompanied by: - unconsciousness, - hemiplegia on the contralateral side, and - a dilated pupil on the ipsilateral side.
43
What are different hemorrhages that can occur with head trauma?
- Intracerebral hemorrhage - Subarachnoid hemorrhage - Intraventricular hemorrhage
44
It is the bruising of the brain tissue within a focal area.
Contusion
45
As the hematoma expands, increased ICP decreases. True or False.
False. ICP increases.
46
Intracerebral hemorrhage is usually associated with cerebral laceration, and contusion is usually associated with closed head injury. True or False.
True
47
Where can contusion occur?
areas of hemorrhage, infarction, necrosis, and edema, and frequently occurs at a fracture site.
48
Coup-contrecoup injury often occurs with ___ (concussion/contusion).
Contusion
49
What is coup-contrecoup injury?
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
What is coup in coup-contrecoup injury?
injury at the site of the direct impact of the brain on the skull
51
What is contrecoup in coup-contrecoup injury?
second area of damage on the opposite side away from injury
52
Which is more severe coup or contrecoup?
contrecoup
53
What does prognosis of contusion depend on?
amount of bleeding around the contusion site.
54
Which is primary impact - coup or contrecoup?
coup
55
Which is secondary impact - coup or contrecoup?
contrecoup
56
A physician notices "blossom" on CT scan of brain injury patient. What does it mean?
Bleeding from contusion
57
What is the patient at risk for if brain contusion occurs especially if frontal or temporal lobes are involved?
Seizures
58
What assessment is most important in patients with brain injury?
Neurological assessment
59
How do anticoagulants and coagulopathy affect TBI patients?
They are associated with increased hemorrhage, more severe head injury, and a higher mortality rate especially in older adults.
60
Risk for falls should be assessed in all head injury patients taking anticoagulants. True or False.
True
61
It is the bleeding between the dura and inner surface of the skull.
epidural hematoma
62
Is epidural hematoma an emergency condition?
Yes. It is a neurologic emergency and is usually associated with a linear fracture crossing a major artery in the dura, causing a tear.