Traumatic Brain Injury

Question 1

what is involved in the initial assessment of a head injury?

Answer 1

ABCDE
secondary survey
history taking

Question 2

what are the three components of the GCS and what are they scored out of?

Answer 2

eye opening - 4
verbal - 5
motor - 6

Question 3

what are the four possibilities for eye opening on the GCS, from best to worst?

Answer 3

open spontaneously
to speech
to pain
no eye opening

Question 4

what are the five possibilities for verbal on the GCS, from best to worst?

Answer 4

orientated
confused
inappropriate
incomprehensible
no verbal

Question 5

what are the six possibilities for motor on the GCS, from best to worst?

Answer 5

obeying
localising
flexing
abnormal flexing
extending 
no motor response

Question 6

what are the lowest and highest possible scores in the GCS?

Answer 6

lowest = 3
highest = 15

Question 7

what GCS suggests a mild head injury?

Answer 7

14-15

Question 8

what GCS suggests a moderate head injury?

Answer 8

9-13

Question 9

what GCS suggests a severe head injury?

Answer 9

3-8

Question 10

what GCS indicates that patients need a head CT within an hour of idenification with a head injury?

Answer 10

<13 on initial assessment

<15 at 2 hours after injury

Question 11

what factors identify patients who need a CT scan <1 hour after head injury?

Answer 11

open/depressed/basal skull fracture
post traumatic seizure
focal neurological deficit
>1 episode of vomiting

Question 12

when should an immediate CT be done in patients who have experienced loss of consciousness/amnesia after a head injury?

Answer 12

age >65
coagulopathy
dangerous mechanism of injury

Question 13

when may ICP need to be monitored?

Answer 13

in patients who need to be heavily sedated/are not conscious so their neurological state can be assessed

Question 14

how is ICP monitoring achieved?

Answer 14

drilling a hole in the skull and placing a wire

Question 15

what five things are involved in the medical management of raised ICP?

Answer 15

sedation
maximise the venous drainage of the brain
CO2 control
osmotic diuretics
CSF release

Question 16

what options are there for sedation in a patient with raised ICP?

Answer 16

propfol
benzodiazepines
barbiturates

Question 17

how can venous drainage of the brain be maximised for patients with raised ICP?

Answer 17

tilted head of the bed
cervical collars
ET tube ties

Question 18

what is the most extreme treatment option for raised ICP (very rarely done)?

Answer 18

decompressive craniectomy

Question 19

describe the appearance of an extradural haematoma on CT

Answer 19

concave shape

doesn’t cross suture lines

Question 20

how does an extradural haematoma present?

Answer 20

loss of consciousness

lucid interval followed by rapid progression of neurological symptoms

Question 21

which is easier to treat - an acute or chronic subdural haematoma? and how are both managed?

Answer 21

chronic is easier - drained through boreholes

acute may require a large craniotomy

Question 22

what is an intracerebral haematoma?

Answer 22

bleeding from within the brain substance itself

Question 23

how can a diffuse axonal injury appear on head CT?

Answer 23

small hyperdense area

especially at junctions between grey and white matter or around the brainstem

Question 24

what causes a diffuse axonal injury?

Answer 24

shearing forces that disrupt axons