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Undeleted > Traumatic Brain Injuries > Flashcards

Traumatic Brain Injuries Flashcards

1
Q

how many head injuries are there per year

A

275/100,000

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2
Q

who are most at risk of head injuries

A 
Young men 
Low-income 
Unmarried 
Ethnic minorities
Drug abusers 
Recurrent TBI
M: F = 2:1
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3
Q

what aspects of history are important for traumatic brain injury

A

Mechanism of Injury
Comorbidities- coagulopathy, alcoholism, etc
Medication history (warfarin)
Social history- broken family

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4
Q

what initial investigations should be performed for traumatic brain injury?

A 
Temperature
Pulse
Respiration 
Cheyne Stokes breathing
Biot’s (herniation)                         
BP
SATS
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5
Q

at what point in the clinical history should the glasgow coma scale be obtained?

A

at the end of resuscitation

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6
Q

a drop of what number value indicates deterioration in the GCS?

A

more than 2

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7
Q

the GCS Is insensitive to……

A

neuropsychological deficits

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8
Q

what medical factors affect GCS score

A 
endotracheal intubation
sedation
neuromuscular blockade
alcohol or drug intoxication
eye traumaspinal injury
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9
Q

what are the brainstem assessments that should be performed for traumatic brain injury?

A 
Pupils
Eye movements
Visual field
Dolls eye (Oculo-Cephalic reflex)
Corneal reflex
Gag/cough reflex
Calorie test (Vestibulo-Ocular reflex)
Respiratory pattern
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10
Q

what can cause bilateral small pupils on brainstem assessment?

A

Narcotics
Pontine injury
Early central herniation

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11
Q

what can cause bilateral dilated pupils on brainstem assessment?

A

Diffuse cerebral hypoxia

Fixed and dilated indicate an irreversible injury

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12
Q

what can cause unilateral small pupils?

A

Horner syndrome

Idiopathic Anisocoria

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13
Q

what can cause unilateral dilated pupils?

A

Sympathomimetics.

Prior cataract surgery

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14
Q

name the four cranial nerve palsies of the III nerve

A

Ptosis (drooping eyelid)
Fixed and Dilated Pupil
Convergence insufficiency
Accommodation Insufficiency

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15
Q

what are the cranial palsies of the IV nerve?

A

Limited Down Gaze of the Affected Eye when Adducted

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16
Q

what are the cranial palsies of the VI nerve?

A

Limited lateral movement of eye

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17
Q

what other cranial nerve tests can be done?

A 
Facial sensations- V nerve
Facial movements- VII nerve 
Hearing- VIII nerve
Balance assessments- Vestibular system
Tongue movements- XII nerve
Meningeal signs (SAH, Meningitis)
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18
Q

VII nerve palsies accompanied by hearing loss what?

A

a fracture in the temporal bone

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19
Q

what other examinations may be useful in traumatic brain injury?

A

Motor system
Sensory system
Gait
Fundoscopy

20
Q

what is the cognitive examination used for head injury?

A

12 minute cognitive exam

21
Q

what are the 9 features of a 12 minute cognitive examination?

A 
orientation
attention
language
memory
executive function
praxis
visuospatial
general neurological assessment
general impression
22
Q

what is the classification of mild head injury

A

GCS 13-15, LOC <24hrs

23
Q

what is the classification of moderate head injury

A

GCS 9-12, LOC 15 MINS- 6 HRS, PTA>24 HRS

24
Q

what is the classification for severe head injury

A

GCS6HRS, PTA 1 WEEK

25
Q

what is the definition of mild traumatic brain injury? (MTBI)

A 
Any period of LOC (< 30 min)
Any minimal Amnesia 
Any alteration in mental state at the time of the accident, 
Focal neurologic deficits, which may or may not be transient.
GCS score =/> 13/15 
No abnormalities on CT scan 
No operative lesions 
PTA < 1 day
26
Q

what are the two classifications for MTBI?

A

Complicated mild- CT scan abnormal

Uncomplicated mild- CT scan normal

27
Q

What are the criteria for admission for MTBI?

A 
Any positive CT or X-ray findings
Possible drug or alcohol use 
Epilepsy 
Attempted suicide 
Pre-existing neurological conditions (eg, Parkinson disease, Alzheimer disease) 
On treatment with warfarin
Coagulation disorder 
Lack of responsible adult to supervise
Any uncertainty in diagnosis
Severe Headache or neurological deficit
28
Q

what is the definition of moderate traumatic brain injury>?

A 
LOC 30 min to 6 hours
GCS score of 9-12  
Abnormal CT findings
Operative/Non operative intracranial lesion 
PTA =1 day-1 week
29
Q

what types of primary brain Injuries can occur?

A 
Extra-axial hematoma
Intra-axial hematoma
Subarachnoid hemorrhage
Penetrating brain injury
Primary hypoxia
Concussion 
Contusions
DAI (diffuse anoxal injury)
30
Q

what types of extra axial haematomas can occur?

A

Epidural hematoma

Subdural hematoma

31
Q

what type of intra axial haematomas can occur?

A

Subarachnoid hemorrhage
Intraparenchymal hematoma
Intraventricular hemorrhage
Delayed Hematoma (DTICH)

32
Q

what type of contusions can occur?

A

Direct

Contre coup injury

33
Q

what type of diffuse axonal injury’s can occur? (DAI)

A

Parasagittal
+ Corpus Callosum
+ Cerebral peduncle

34
Q

what types of seconday brain injuries can occur?

A 
Hypoxia
Hypo tension
Free radicals
Oedema (Diffuse Brain Swelling)
Increased ICP
Ischaemia 
Hydrocephalus
Herniation
35
Q

what types of hydrocephalus can occur in TBI?

A

Communicating

Non communicating

36
Q

what types of herniation can occur?

A 
Subfalcine
transtentorial cerebral
Central
Cerebellar
tonsillar
37
Q

describe the acute management strategy for TBI

A 
Glucose 
Opiods 
Alcohol 
Tricyclics 
IV fluids 
Toxicology management
Seizures Ð .
Electrolytes and acid base status
Sedation and analgesia Ð Paracetamol ,codeine
Treat ICT if suspected  (M-ICT) GO AT ITS BEST
38
Q

name four issues in TBI management

A

Seizure management
Post Traumatic amnesia
Post Traumatic agitation
Infections

39
Q

what reccurent risks can occur in MTBI

A

Low-risk
Mild headaches, dizziness, and nausea
Treatment
Minimal observation after assessment
Do not require routine radiographic evaluation.
May be discharged if a reliable individual can monitor them

Moderate-risk 
Persistent emesis, severe headache, anterograde amnesia, LOC, or signs of intoxication by drugs or alcohol 
Treatment
CT Head  
Observe for at least 8 hours
Discharge if their CT scan normal
Or when intoxication is cleared
40
Q

what should you do if a CT for a mod-TBI is positive

A

ASK NEURO SURGICAL OPINION

41
Q

what should you do if a CT for a mod-TBI is negative

A

Admit for Observation
Patients with moderate head injury + normal CT improves in few hours. If he does not improve then repeat CT scan
Neurological observations every 2 hours.
Nil by mouth until alert

42
Q

what treatments can be administered for mod TBI?

A 
Prevent hypoxia and hypotension 
Elevation of the head - to 20-30¡
IV 0.9% N saline maintenance drip
Mild analgesics (eg, paracetamol, codeine phosphate) 
Antiemetics if necessary
Sedation if required
43
Q

when should a severe TBI be intubated?

A

GCS < 4
Pa O2 < 9kPa in air (<13 in O2)
Seizures
Signs of Herniation

44
Q

how can you manage a severe TBI?

A

Elevate head to 30-45¡. Keep the neck straight
Maintain normal BP (mean BP >90).
Mannitol (1 g/kg IV immediately) if signs of raised ICP
Insert an ICP bolt.

45
Q

describe the signs of deterioration in severe TBI?

A

Development of agitation /abnormal behaviour
Drop of 1 point in motor/verbal GCS scores and 2 points in eye opening
Persisting vomiting and severe headache
New or evolving neurological deficits

46
Q

describe six signs of herniation in TBI

A 
Unilateral/ bil dilatation of the pupils
Asymmetrical pupillary reaction
Motor posturing
Increasing BP
Falling pulse/bradycardia
Increased respiration rate
47
Q

when should a TBI be referred to HDU

A 
Decreasing conscious level/GCS < 12
Multiple fractures
Serious facial injury
Post traumatic seizures
Severe co-morbidities
Significant mass effects on CT
Brain swelling

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