TBI and concussion

Question 1

why do we oxygenate TBI patients even if sats are good

Answer 1

don’t want to cause secondary damage via hypoxia, pre oxygenation for RSI if really sick.

over oxygenation is only really a concern with high flow over a long timeframe, not acutely an issue

Question 1

what is the target etC02 for a TBI patient

Answer 1

30-35, C02 is a potent vasodilator, thus the target in TBI is lower because want to decrease further bleeding

Question 2

what causes concussion

Answer 2

rapid movement to the head/impact to the skull, causing the brain to move within the skull

Question 3

sx of concussion

Answer 3

headache, confusion, memory loss, dizziness

Question 4

what patients can be treated under the concussion guideline

Answer 4

for patients that can obey commands and have a mechanism of injury consistent with a TBI

Question 5

patient has a concussion if…

Answer 5

there are abnormal vital signs, there is abnormality in memory or coordination or balance

Question 6

LOC or abnormal vitals in a patient with a head strike is an indicator off..

Answer 6

intercranal bleed

Question 7

a concussion is a TBI with what characteristics?

Answer 7

no detectable signs of bleeding/blood clot/brain tissue swelling on a CT but signs and symptoms of altered brain function

Question 8

a CT of someone with a TBI will show….

Answer 8

signs of bleeding/blood clot/brain tissue swelling

Question 9

why are the elderly more susceptible to inter-cranial bleeding

Answer 9

cerebral atrophy exposing veins, thus more likely to be damaged in even minor falls

Question 10

what is the criteria to use the severe TBI guidelines

Answer 10

Use this guideline for patients who cannot obey commands and have a mechanism of injury consistent with traumatic brain injury

Question 11

fluid management in TBI

Answer 11

Administer 0.9% sodium chloride IV if there are signs of hypovolaemia, or the systolic blood pressure is less than 120 mmHg in an adult, or less than the normal predicted systolic blood pressure in a child:
500 ml for an adult.
10 ml/kg for a child.
Repeat as required, minimising the total volume.

Question 12

management of seizure in TBI

Answer 12

treat under seizure guideline with midaz plus give prophylactic levetiracetam to minimise secondary injury

Question 13

what are the goals of management of a severe TBI

Answer 13

identify TBI

minimise secondary damage

treat distracting injuries

Question 14

what is secondary injury and list some common causes

Answer 14

further physiological insult to brain after primary injury including hypoxia, hypoventilation, hypotension and hypovolemia

Question 15

management of patient with ? TBI but suspected drug and alcohol on board

Answer 15

assume severe TBI until proven otherwise

Question 16

why do we have a high threshold for sedation in TBI

Answer 16

because sedation will likely contribute to secondary injury

Question 17

raised ICP post TBI is associated with

Answer 17

poor prognostic outcomes

Question 18

list some indicators of increased ICP

Answer 18

unilateral pupil dilation
posturing
severe HTN, with either Brady or tachy
irregular resps