Traumatic Brain & Head Injury

Question 1

What is the initial approach to stabilizing someone who comes in with a traumatic head injury?

Answer 1

Airway with C spine control
Breathing
Circulation

Question 2

What are some investigations you would do to assess someone who has come in with a traumatic head injury?

Answer 2

GCS
Pupil check
Assess for secondary injuries (C-spine)

Question 3

When should CT be used with traumatic head injury?

Answer 3

GCS <13 on presentation
GCS <15 after 2 hrs
Open or depressed skull fracture
Basal skull fracture
Post traumatic seizure
Focal neurological deficit
More than one episode of vomiting

Question 4

What are some signs of a basal skull fracture?

Answer 4

Bleeding from ear

Question 5

How does extradural hematoma present?

Answer 5

Normally younger population
- Injury with LOC
- Recovery ‘lucid interval’
- Rapid progression of neurological symptoms:
(deteriorating GCS, Hemiparesis, Unilateral fixed dilated pupil, apnoea & death)

Question 6

Who do acute subdural haematomas mostly present in?

Answer 6

Older population

Question 7

What is the target PCO2 level for ideal cerebral blood flow and ICP?

Answer 7

~4kPa

Question 8

What angle should the head be held at for the best balance of cerebral blood flow and ICP?

Answer 8

30 degrees head up

Question 9

What is the final option to reduce ICP if all the options to manipulate what is inside the skull has failed?

Answer 9

Decompressive craniectomy

Question 10

What is cerebral perfusion pressure?

Answer 10

CPP = MAP - ICP

Question 11

Why does blood pressure have to be closely controlled in a patient with a brain injury?

Answer 11

They can lose the autoregulation of cerebral blood flow and therefore small changed in BP can greatly effect cerebral blood flow

Question 12

When are anti-epileptics considered in patients with head injury?

Answer 12

In patients who have multi-lobar injury and are having early seizures
- Prophylactic anti-epileptics aren’t very useful

Question 13

What conditions must a patient be under to assess brainstem death?

Answer 13

• Cannot be under the influence of any drugs (take of anesthetic)
• No hypothermia
• No severe metabolic or endocrine disturbances

Question 14

What reflexes are tested in brainstem death testing?

Answer 14

No pupil response (II, III)
No Corneal reflex (V, VII)
No motor response (CN distribution, V, VII)
No Vestibulo-ocular reflex (III, VI, VIII)
No Gag/cough reflex (IX, X)
No respiration (Apnoea test)