Traumatic Brain Injury Flashcards
what is involved in the initial assessment of a head injury?
ABCDE
secondary survey
history taking
what are the three components of the GCS and what are they scored out of?
eye opening - 4
verbal - 5
motor - 6
what are the four possibilities for eye opening on the GCS, from best to worst?
open spontaneously
to speech
to pain
no eye opening
what are the five possibilities for verbal on the GCS, from best to worst?
orientated confused inappropriate incomprehensible no verbal
what are the six possibilities for motor on the GCS, from best to worst?
obeying localising flexing abnormal flexing extending no motor response
what are the lowest and highest possible scores in the GCS?
lowest = 3 highest = 15
what GCS suggests a mild head injury?
14-15
what GCS suggests a moderate head injury?
9-13
what GCS suggests a severe head injury?
3-8
what GCS indicates that patients need a head CT within an hour of idenification with a head injury?
<13 on initial assessment
<15 at 2 hours after injury
what factors identify patients who need a CT scan <1 hour after head injury?
open/depressed/basal skull fracture
post traumatic seizure
focal neurological deficit
>1 episode of vomiting
when should an immediate CT be done in patients who have experienced loss of consciousness/amnesia after a head injury?
age >65
coagulopathy
dangerous mechanism of injury
when may ICP need to be monitored?
in patients who need to be heavily sedated/are not conscious so their neurological state can be assessed
how is ICP monitoring achieved?
drilling a hole in the skull and placing a wire
what five things are involved in the medical management of raised ICP?
sedation maximise the venous drainage of the brain CO2 control osmotic diuretics CSF release
what options are there for sedation in a patient with raised ICP?
propfol
benzodiazepines
barbiturates
how can venous drainage of the brain be maximised for patients with raised ICP?
tilted head of the bed
cervical collars
ET tube ties
what is the most extreme treatment option for raised ICP (very rarely done)?
decompressive craniectomy
describe the appearance of an extradural haematoma on CT
concave shape
doesn’t cross suture lines
how does an extradural haematoma present?
loss of consciousness
lucid interval followed by rapid progression of neurological symptoms
which is easier to treat - an acute or chronic subdural haematoma? and how are both managed?
chronic is easier - drained through boreholes
acute may require a large craniotomy
what is an intracerebral haematoma?
bleeding from within the brain substance itself
how can a diffuse axonal injury appear on head CT?
small hyperdense area
especially at junctions between grey and white matter or around the brainstem
what causes a diffuse axonal injury?
shearing forces that disrupt axons
