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SD- ER pt 1 > TBI Lecture > Flashcards

TBI Lecture Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Young people
Low income
Unmarried
Ethnic minorities
Residents of inner city
Men
Hx of substance abuse
Previous TBI

A

greatest risk for TBI

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2
Q

Max score on the glascow coma scale?

A

15

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3
Q

3 categories in the glascow coma scale?

A 
Eye opening (4 possible pts)
Verbal response (5 possible pts)
Motor response (6 possible pts)
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4
Q

What are the options for eye response on the glascow coma scale?

A

1 pt= no eye opening

2 pts= eyes open to pain

3= eyes open to speech

4= eyes open spontaneously

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5
Q

What are the options for verbal response on the glascow coma score?

A

1 pt= no verbal response

2= incomprehensible sounds (moaning)

3= inappropriate words

4= disorientation/confusion

5= oriented, clear speech

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6
Q

What are the options for motor response on the glascow coma scale?

A

1 pt= no motor response

2= decerebrate

3= decorticate

4= flexion/withdrawal from pain

5= localizes pain

6= obeys commands

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7
Q

A minor TBI has a GSC score of…

A

13-15

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8
Q

A moderate TBI has a GCS score of…

A

9-12

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9
Q

A severe TBI has a GCS score of…

A

under 8

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10
Q

Compression
Tensile (stretching)
Shear (tissue slides over tissue)

..all examples of what type of injury?

A

primary injury

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11
Q

What type of injury occurs minutes, hours, days after the initial injury

A

Secondary injury

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12
Q

Intracellular swelling
Electrolyte imbalances (Na, Cl, Ca, Mg)
Inflammatory response (increase in cytokines)
Cerebral arterial dilation
Intracranial hemorrhage
Cerebral edema
Ischemia/hypoxia
Increased ICP

A

Secondary injury

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13
Q

What does ABCDE stand for?

A

Airway
Breathing
Circulation
Disability
Expose

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14
Q

must maintain a MAP above…

A

90 mmHg!

MAP= [dbp + (sbp-dbp)/3]

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15
Q

Battle’s sign
Racoon eyes
CSF rhinorrhea or otorrhea
Hemotympanum

A

Signs of a basilar skull fracture

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16
Q

External exam of the head
Level of alertness
Pupils- size, reactivity, equal
Ear canals- hemotympanum
Cranial nerves
Reflexes
Posturing
Strength
Sensation

A

what to look at with a TBI patient

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17
Q

No vomiting
No HA
Under 60
Not intoxicated
No deficits in short term memory
No evidence of trauma above clavicles
No seizures

A

…NOT likely to have significant intracranial injury

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18
Q

Rapid onset of short lived impairment of neurologic function that resolves spontaneously

A

Concussion

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19
Q

With a concussion, acute clinical symptoms largely reflect a functional disturbance rather than…

A

structural injury

20
Q

No LOC
Post traumatic amnesia or other signs lasting less than 30 mins

*athletes can return if asymptomatic for 1 week

A

Concussion grade 1

21
Q

LOC under 1 min

Post traumatic amnesia or other sxs >30 mins (but under 24 hrs)

*athletes can return to play in 2 weeks if asymptomatic at rest

A

Concussion grade 2

22
Q

LOC >1 minute

OR

Post traumatic amnesia or other sxs >24 hrs

*athletes can return to play in 1 mo if asymp at rest

A

Concussion grade 3

23
Q

a “bruise”, commonly in:

  • orbitofrontal cortex
  • anterior temporal lobe
  • posterior portion of superior temporal gyrus area

can present with confusion to coma
MAY* be seen on CT

A

Brain contusion with intracerebral hemorrhage

24
Q

Acceleration/deceleration MOI (ie shaken baby syndrome)

*widespread damage
*shear forces injuring axons (white matter)

*axonal tearing- secondary injury degradation of cytoskeleton, ion imbalance (Ca) hours after primary injury

A

Diffuse Axonal Injury (DAI)

25
Q

Diffuse axonal injury (DAI) occurs commony (2/3) at the junction of…

A

grey and white matter

26
Q

Coma for 6-24hrs, usually recover without long term sequela

A

Mild DAI

27
Q

Coma >24 hours, but do wake up.

will have long term cogntive deficits*

A

Moderate diffuse axonal injury (DAI)

28
Q

Prolonged coma
Persistent vegetative state (90%)

A

Severe DAI

29
Q

Tx for DAI?

A

Supportive measures only

30
Q

can lead to increased ICP secondary to blockage of CSF outflow at 3rd and 4th ventricles

A

Traumatic Subarachnoid Hemorrhage

31
Q

If asymptomatic..admit for observation, get neurosurgical consult

if symptomatic..neurosurgical consult. may require ICP monitoring

can be missed on early CT (<6hrs)

A

Traumatic Subarachnoid Hemorrhage

32
Q

Suspect if pt has….

  • *persistent HA**
  • *photophobia**
  • *nausea**
A

Traumatic subarachnoid hemorrhage

33
Q

slow, venous bleed

high risk in ppl with cerebral atrophy
(ie alcoholics, elderly)

concave (crescent shaped) hematoma on CT scan

A

Subdural hematoma

34
Q

crescent shape on CT scan

HA, lethargy, to coma
may be acute (within 24 hours) or chronic (> 2 weeks from injury)

A

Subdural hematoma

35
Q

brief LOC followed by lucid period

arterial bleed, HIGH PRESSURE
MC = middle meningeal artery

A

Epidural hematoma

36
Q

MC artery involved in an epidural hematoma

A

Middle meningeal artery

37
Q

Fixed, dilated pupil on ipsilateral side
with contralateral hemiparesis (late findings)

seen on CT as lenticular (bi-convex or football shaped) lesion

A

Epidural hematoma

38
Q

Arterial bleed
Bi-convex, football shaped lesion on CT scan

IMMEDIATE neurosurg consult
need to decompress to prevent brain herniation

A

Epidural hematoma

39
Q
  1. subfalcial (cingulate)
  2. uncal
  3. downward (central, transtenorial)
  4. external
  5. tonsillar
A

types of brain herniations

40
Q

subfalcial (cingulate) herniation
uncal herniation
tonsillar herniation

..usually caused by?

A

focal, ipsilateral space occupying lesions

(ie tumor, axial or extra-axial hemorrhage)

41
Q

Normal ICP?

A

0-10 mmHg

42
Q

Pathologic ICP?

A

greater or equal to 20 mmHg

43
Q

Cerebral Perfusion Pressure (CPP)= MAP - ICP

CPP is critical at what range?

A

50-70 mmhG

44
Q

You can adjust CPP by ___ MAP or _____ ICP

A

increasing MAP

decreasing ICP

45
Q

You can increase MAP with…

A

IVF
Pressors

46
Q

You can decrease ICP with…

A

Osmotic diuresis
HOB elevation (above 30 degrees)
Drain CSF with Burr Hole

SD- ER pt 1 (8 decks)

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