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Gen Med: Emergency Med > TBI and Concussion > Flashcards

TBI and Concussion Flashcards

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1
Q

Define TBI

A
  1. Caused by bump, blow, or jolt to head or penetrating head injury
  2. Disrupts normal brain function
  3. Severity may be mild to severe
  4. Includes concussion
    A. Mild TBI, usually occurring after a blow to the head
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2
Q

How is TBI classified?

A
  1. Severity
  2. Mechanism of injury
    A. Penetrating Injury
    B. Closed Injury
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3
Q

What can a TBI lead to?

A
  1. Alterations in cerebral blood flow

2. Increased ICP due to swelling

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4
Q

How is a concussion diagnosed?

A
  1. Concussion is a clinical diagnosis

2. 90% of concussions occur w/o LOC

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5
Q

What is the usual GCS for pts with a concussion?

A

ED pts w/minor head injury & GCS of 15

6-8% have an intracranial abnormality

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6
Q

What is the GCS for a mild TBI?

A

13 to 15

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7
Q

What is the GCS for a moderate TBI?

A

9-12

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8
Q

What is the GCS for a severe TBI?

A

3-8

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9
Q

What the common sxs of concussions in athletes?

A
  1. Headache or “pressure” in head
  2. N/V
  3. Balance problems or dizziness
  4. Double or blurry vision
  5. Sensitivity to light
  6. Sensitivity to noise
  7. Feeling sluggish, hazy, foggy, or groggy
  8. Concentration or memory problems
  9. Confusion
  10. Does not “feel right” or is “feeling down”
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10
Q

What are the common signs of a concussion observed by a coach?

A
  1. Appearsdazedorstunned
  2. Isconfusedabout assignmentor position
  3. Forgetsan instruction
  4. Is unsureofgame,score,oropponent 5. Movesclumsily
  5. Answersquestionsslowly
  6. Loss ofconsciousness(even briefly)
  7. Showsmood, behavior,orpersonalitychanges
  8. Can’trecalleventspriorto hit or fall
  9. Can’trecalleventsafterhitor fall
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11
Q

How is an athlete with a concussion managed?

A
  1. Remove athlete from play immediately
    A. March 2013 new AAN guidelines
    B. Ensure that the athlete is evaluated by a health care professional experienced in evaluating for concussion
    C. Keep the athlete out of play the day of the injury & until a health care professional (experienced in evaluating for concussion) releases them to return to play
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12
Q

What are the sxs, immediate treatment and follow-up of a grade 1 concussion?

A
  1. Transient confusion; no LOC; concussive sxs
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13
Q

What are the sxs, immediate treatment and follow-up of a grade 2 concussion?

A
  1. Transient confusion; no LOC; concussive sxs > 15 min
  2. Removal from contest w/out return that day
  3. See return to play progression plan
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14
Q

What are the sxs, immediate treatment and follow-up of a grade 3 concussion?

A
  1. Any LOC
  2. Removal from contest & ED evaluation
  3. See return to play progression plan
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15
Q

True/false: a concussed athlete can return to play in the same day

A

Athlete should NEVER return to practice or game same day as injury

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16
Q

True/false: Upon discharge from the ED, follow-up appt w/ PCP is necessary

A

True

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17
Q

What is the return to play progression?

A
  1. Light aerobic exercise- Step 1
  2. Moderate exercise- Step 2
  3. Noncontact exercise- Step 3
  4. Resume practice- Step 4
  5. Return to play – Step 5
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18
Q

What is included in Light aerobic exercise- Step 1 for return to play progression?

A
  1. Exercise time 5-10 minutes
  2. Exercise bike, walk or light jog
  3. NO weightlifting, jumping, or hard running
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19
Q

What is included in moderate exercise- Step 2 for return to play progression?

A

Reduced amount of activity when compared w/ normal routine

20
Q

What is included in noncontact exercise- Step 3 for return to play progression?

A
  1. More intensity but no contact

2. Running, high-intensity stationary bike, regular weightlifting routine

21
Q

How can concussions be prevented?

A
  1. Sport-specific helmets
  2. Bicycle helmets
    A. 140,000 children treated each year in ED in US for TBI sustained while riding bicycles
22
Q

When does post-concussion syndrome occur?

A
  1. Persistent sx’s following injury
  2. Most occur w/in 7-10 days & resolve w/in 3 months, can persist ≥ 1 year
  3. Risk of post-concussion syndrome not assoc. w/severity of initial injury
23
Q

How many pts experience post concussive syndrome?

A

Occurs in 5-8% of concussion pts

24
Q

How are post-concussion syndrome pts managed?

A
  1. Refer to Neurologist
  2. Avoid athletics while sx’s persist
  3. Risk of depression
  4. 504 Plan for students
25
Q

What are the common sxs for post-concussion syndrome?

A
  1. Headache
  2. Dizziness
  3. Sleep problems
  4. Psychological symptoms such as depressed mood, irritability, & anxiety
  5. Cognitive problems involving memory, concentration, & thinking
26
Q

What are the criteria for the severity of a TBI using post-traumatic amnesia guidelines?

A
  1. Mild: less than 1 day,
  2. Moderate: greater then 1 day, but less than 7 days
  3. Severe: greater than 7 days
27
Q

What are the criteria for the severity of a TBI using LOC guidelines?

A
  1. Mild: 0-30 min
  2. Mod: > 30 min, but less than 24 hrs
  3. Severe: greater than 24 hrs
28
Q

What is included in mild TBI?

A
  1. Head injury
  2. Cortical contusions d/t coup & contrecoup injuries
  3. Hallmark of concussion:
    A. Confusion & amnesia w/ or w/o LOC
  4. Post-traumatic seizure
29
Q

What is included in pt management for those with a mild TBI?

A
  1. ABC’s
    A. Oximetry
    B. Hypotension (MAP 45 mmHg (Hypercapnea/Hypercarbia) = ↑ Mortality & Morbidity
30
Q

What is included in the HEENT assessment of a pt with a mild TBI?

A
  1. Palpate for step down injury of skull, hematoma, lacs
  2. R/O basilar skull Fx
    A. Battle sign (mastoid)
    B. Hemotympanum
    C. Raccoon’s eyes (periorbital)
    D. CSF leak
    E. Hearing loss
31
Q

What is included in the Neuro assessment of a pt with a mild TBI?

A
  1. MMSE

2. Complete neuro assessment

32
Q

What is included in the CV, lungs, abd, spine, and ext assessment of a pt with a mild TBI?

A

Assess for trauma

33
Q

How is a pt with a head trauma injury approached?

A
  1. Any pt w/blunt force injury to head should be suspected of having a C-spine injury until proven otherwise
  2. Intoxication frequently accompanies head trauma
    A. Obtain BAC & toxicology screen
    B. “DON’T” Tx
  3. Accompanying systemic injuries may produce vascular collapse or resp. compromise requiring immediate attention
  4. If combative
    A. Assess O2, accucheck, BP, pain, THEN OK to sedate/give analgesic
    B. Narcotic or Benzodiazepine
34
Q

What radiographs are needed for a minor concussive injury?

A
  1. CT scan not usually ordered for minor concussive injury

2. More liberal ordering for children or elderly

35
Q

What is the treatment for minor concussive injury?

A
  1. All pts w/TBI: 100% O2 by high-flow NRB mask

2. Observe in ED for several hours

36
Q

When should a pt with a minor concussive injury be hospitalized?

A

Persistent N/V, severe HA

37
Q

When should an intracranial hemorrhage be considered in a concussion pt?

A
  1. Elderly (must get CT if taking anti-coags)
  2. Amnesia > 30 min
  3. Seizure
  4. 2 or more episodes vomiting
38
Q

What can cause intracranial hemorrhage?

A
  1. Neurological deterioration after mild TBI is highly suggestive of an evolving intracranial hematoma
  2. Intracerebral, subdural, epidural
  3. Usually 2° to tear in intracranial artery or vein
39
Q

What are the sxs for a moderate concussive injury?

A

Persistent confusion, behavioral changes, lethargy, extreme dizziness, hemiparesis

40
Q

How is moderate TBI pt managed?

A

Admit 24 hr for medical observation & interventions as needed

41
Q

What imaging is needed for a moderate TBI pt?

A
  1. CT Brain w/o contrast
    A. Cerebral Contusion
    B. Subdural hematoma
42
Q

What are the sxs of a severe concussive injury?

A
  1. Comatose patients

2. Cushing’s Response or signs of neuro deterioration

43
Q

How is severe concussive injury pt managed?

A 
1. Cushing’s Response or signs of neuro deterioration
A. Give Mannitol ( 0.25-1.0 g/kg IV bolus) to lower ICP
B. Maintain serum osmolality  Intubation
3. GCS 8 or less: 
A. Intubate
B. Start seizure prophylaxis
-Phenytoin (Dilantin) in adults
-Carbamazepine (Tegretol) in adults
-Phenobarbital in children
4. Stabilize & admit to ICU
44
Q

What images are needed for a severe TBI pt?

A
  1. Cervical X-rays
  2. CT scan w/o contrast
    A. Epidural hematoma
    B. Subdural hematoma
    C. Intracerebral hemorrhage
45
Q

What operative managment may be necessary for a severe TBI?

A
  1. Hematomas or bleed require prompt decompressive surgery
  2. Post-op
    A. Maintain appropriate ICP
    B. Treat hypoxia, hyperthermia, hypercarbia
    C. +/- Prophylactic anti-convulsants
46
Q

What are the sxs of a mild concussive injury?

A
  1. HA
  2. Dizziness
  3. Faintness
  4. N/V
  5. Difficulty w/ concentration
  6. Blurred vision
  7. Brief period of amnesia
47
Q

What are the leading causes of TBI?

A

Falls

Gen Med: Emergency Med (13 decks)

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