TBI & Concussions Flashcards
Cause of TBI
- head injury usually d/t contact, acceleration/deceleration force (MVA, falls)
Complications of a TBI
- brain contusions, localized ischemia, edema, focal neuro signs, evolving hematoma/hemorrhage
Diagnostic testing for TBI
CT/MRI without contrast to look for bleeding
Characteristics of a concussion/Mild TBI
- trauma induced alteration in mental status +/- LOC
- direct force or brain being slapped against intracranial surfaces (contre-coup)
- axonal damage
Symptoms of a concussion/mild TBI
- confusion and amnesia +/- LOC
- headache, dizziness, n/v, visual disturbances, mood change, photosensitivity, sleep disturbance
Diagnostic testing for concussion/mild TBI
GCS for medically trained
SAC, ACE, SCAT-5 for non-medically trained
Return to play guidelines following a concussion
complete resolution of all symptoms
- return of memory and concentration
- no symptoms after testing
- 6 step process
What are the Canadian Head CT Rules
Minor head injury presenting with GCS 13-15 after witnessed LOC, amnesia, confusion
High risk for neurosurg
- GCS <15 at 2 hrs post injury
- suspected open/depressed skull fx
- sign of basal skull fracture
- vomiting 2+ times
- age 65+
Medium Risk
- amnesia 30+ mins before incident
- dangerous mechanism
What are the signs of basal skull fracture
What is the GCS score for a moderate TBI
GCS 9-13 within 48 hours
What is the GCS score for a severe TBI
GCS 3-8 within 48 hours
Describe the primary and secondary injuries related to moderate-severe TBIs
Primary = occurs at moment of trauma
- skull fx
- hematoma
- auditory symptoms
Secondary = occurs immediately after trauma and produces long term effects
- excitatory AA
- increased ICP
What are the characteristics of moderate to severe TBI
permanent or temporary impairment of cognitive, physical, and psychosocial functions
What is the treatment for moderate TBI
tranexamic acid, avoid hypotension and hypoxia
What is the treatment for severe TBI
- neuro trauma center
- prevent hypotension and hypoxia
- treat ICP
- intubation if GCS <9
What are some treatments for increased ICP
mannitol, keppra, decompressive craniectomy, extraventricular drain
What is one of the most life threatening complications of a TBI
subarachnoid hemorrhage
Define a subarachnoid hemorrhage
rupture of small cortical arteries/veins bleeding into the subarachnoid space
- worst headache of life, thunderclap, meningeal signs
Diagnostic testing for SAH
- CT without contrast may show bleeding following circle of willis, “star of death”
- lumbar puncture may show presence of RBCs and xanthochromia
SAH treatment
- calcium channel blocker to prevent vasospasm (Nicardipine)
- phenytoin
- neurosurg consult for potential aneurysm clip or coil
Define post concussive syndrome
prolonged symptoms related to initial head injury
- headache, dizziness, memory loss, loss of libido, ataxia, difficulty sleeping, fatigue
Define second impact syndrome
Fatal brain swelling occurring after minor head trauma, occurs in pts <20
- headache, neck pain, n/v
- get head CT and treat with hyperventilation and osmotic agents
Define chronic traumatic encephalopathy (CTE)
progressive degenerative dz beginning months-years after last brain trauma, results from repetitive trauma
- progressive dementia, confusion, judgement, aggression, impulsive
Signs and symptoms of an impending cerebral herniation
- increase in ICP d/t CSF, brain tissue, blood shift in the skull
- significant pupillary asymmetry
- cushing triad
- decorticate/decerebrate
- respiratory depression
Describe the cushing triad
Increased ICP
- bradycardia
- irregular respiration
- widened pulse pressure
How to treat an impending cerebral herniation
-intubate
-head of bed elevation
-hypertonic saline or mannitol
-seizure prophylaxis
Describe blunt cerebrovascular injury
Injury to carotid/vertebral arteries with skull base or vertebral fracture
- Dx with CBC, BMP, coags, EtOH
- Tx with 81mg ASA qd
What are the components of the glasgow coma scale
- Eye opening response
- Verbal response
- Motor response
List the components and points of the Eye Opening response of the GCS
4 pts - spontaneous eye opening and blinking at baseline
3 pts - open to verbal stimuli, command, speech
2 pts - open to pain only (not on face)
1 pt - no response
List the verbal response components of the GCS
5 pts - oriented
4 pts - confused conversation but able to answer questions
3 pts - inappropriate words
2 pts - incomprehensible speech
1 pt - no response
List the motor response components of the GCS
6 pts - obeys commands for movement
5 pts - purposeful movement to painful stimulus
4 pts - withdraws in response to pain
3 pts - flexion/decorticate response to pain
2 pts - extension/decerebrate response to pain
1 pt - no response to pain
What is the GCS for a mild TBI
13-15 30 mins after the injury, 14-15 48 hours after
Primary injuries in TBIs
- skull fracture (vault, basal)
- Epidural hematomas (tear in mid meningeal artery)
- subdural hematomas (cortical vein injury)
- coup/contrecoup contusion
- diffuse axonal injury
- audiovestibular dysfunction
Secondary injuries in TBIs
- excitatory amino acids
- increased ICP
- apoptosis
- etc.
Describe
frontal cerebral contusion
Describe
traumatic subdural hematoma
Describe
diffuse axonal injury
Describe
traumatic epidural hematoma
E2 V4 M4 = GCS 10
