TBI's

Question 1

What if the leading cause of TBI’s in the US?

Answer 1

MCV/MVA’s

Question 2

What do we use to assess mental status? What are the 3 categories of the GCS?

Answer 2

Glasgow Coma Scale

Eyes, Verbal, and Motor

Question 3

What is considered a minor TBI vs. a moderate TBI based on GCS?

Answer 3

Minor = 13-15

Moderate 9-12

Question 4

If a patient has pain to palpation over the temporal area, what do you need to think of?

Answer 4

Middle meningeal artery can lead to an EPIDURAL hematoma!

Question 5

How do you approach your patient with a suspected TBI?

Answer 5

ABCDE (airway, breathing, circulation, disability, and expose [look for other injuries])

Question 6

What type of physical exam should you do on a patient you suspect with a TBI?

Answer 6

• External exam of head
• Level of alertness
• Pupils (size, reactivity, equal)
• Ear canals (hemotympanum)
• CN’s
• Reflexes
• Posturing (decorticate/decerebrate)
• Strength
• Sensation

Question 7

Will a brain injury always present with a skull fracture or scalp laceration?

Answer 7

Nope!

Question 8

What are the different types of TBI’s?

Answer 8

Concussion; contusion; diffuse axonal injury; epidural hematoma; subdural hematoma; traumatic subarachnoid hemorrhage, or herniation

Question 9

What form of TBI is caused from acceleration/deceleration commonly occurring at the grey & white matter?

Answer 9

Diffuse axonal injury

Question 10

What are the 3 stages of diffuse axonal injuries? What are the complications?

Answer 10

Complications = cell death/myelin degeneration

Mild = coma for 6-24 hours

Moderate = coma greater than 24 hours

Severe = prolonged coma (persistent vegetative state in 90%)

Question 11

What type of TBI is seen after a serious fall or impact to the head with a persistent HA, photophobia, and nausea, that can lead to increased ICP?

Answer 11

Subarachnoid hemorrhage

Question 12

What type of TBI is the most common and involves a space occupying lesion with a slow/venous bleed?

Answer 12

Subdural hematoma

Question 13

What type of TBI has a high risk for people with cerebral atrophy (elderly & alcoholics)?

Answer 13

Subdural hematoma

Question 14

If a CT scan of a brain shows a concave hematoma or a “crescent shaped” – what is it?

Answer 14

Subdural hematoma

Question 15

What type of TBI involves a fixed dilated pupil on ipsilateral side with contralateral hemiparesis?

Answer 15

Epidural hematoma

Question 16

If a CT scan show a lenticular (bi-convex or football shaped) lesion – what TBI?

Answer 16

Epidural hematoma

Question 17

What type of TBI comes from an arterial bleed?

Answer 17

Epidural hematoma

Question 18

What type of TBI comes from a venous bleed?

Answer 18

subdural hematoma

Question 19

What type of TBI are we always concerned about, but only occurs in 1% of the population? How do we treat it? What are we preventing?

Answer 19

Epidural hematoma!

Treat with IMMEDIATE neurosurg intervention

Decompression to prevent brain herniation!

Question 20

What is normal ICP?

Answer 20

0-10mmHg

Question 21

How do you calculate Cerebral Perfusion Pressure? At what level does it become critical?

Answer 21

CCP = MAP – ICP

Critical at 50-70mmHg (*remember this is the perfusion to your brain)

Question 22

How can we adjust CCP?

Answer 22

Increase MAP (IVF & pressors – but the brain may not want it that high, thus it will compensate more)

Decrease ICP (osmotic diuresis, HOB elevation, drain CSF via Burr hole)