Traumatic brain injury Flashcards
What is a traumatic brain injury?
A traumatic insult to the head that may result in injury to the soft tissue, bony structures +/- brain tissue capable of producing physical, intellectual, emotional and vocational changes to an individuals functioning
How are brain injuries characterised?
They are characterised according to mechanism, location and severity of the injury as well as patient characteristics
What are the 3 mechanisms of traumatic brain injury?
Blunt, Penetrative and secondary
What is a coup injury?
What is a contrecoup injury?
A coup injury is localised to the site of impact of the skull
A contrecoup injury is localised directly opposite to the point of impact as a result of the brain rebounding to the other side of the cranium
What are diffuse axonal injuries?
Shearing and micro-tearing, and stretching of nerve fibres which will gradually heal as the swelling subsides with rest
What is an example of a coup/contrecoup injury?
Concussions
What are the symptoms of a concussion?
Physical
- Headaches
- Nausea
- Visual problems
- Balance impariment
Emotional
- Moodiness
- Anxiety
- Irritability
Sleep
- Insomnia
- Altered sleep length
Mental
- Brain fog
- Poor concentration
- Fatigue
What is an extra-dural haematoma?
A bleed between the dura and the cranium
What is an intracerebral haemorrhage?
A bleed within the brain tissue
What would be included in the patient assessment?
Glasgow Coma Score
History/mechanism of injury
Age-related issues/risk of non-accidental injury
The initial level of consciousness
Skin colour - peripheral and central
Posture
Presence (or lack of) head wound/haemorrhage/fracture
What does Cushing’s triad indicate, and what are the vital observations associated with Cushing’s triad?
Cushing’s triad is an indicator of raised intracranial pressure
Cushing’s triad
- Hypertension with a widening gap between systolic and diastolic
- Bradycardia
- Irregular respirations
What are management strategies for head injuries?
In most cases: No intervention is required, just pain management, monitoring, and positioning to minimise intracranial pressure
in some cases: Surgery
- Removal of blood clots and to relieve intracranial pressure
- Removal of non-viable brain tissue
- Repair of fractures
What happens to brain perfusion when intracranial pressure increases?
What are some symptoms of increased intracranial pressure?
If intracranial pressure increases beyond the mean arterial pressure, the brain can no longer receive oxygen
Symptoms of increased ICP:
- Weakness
- Lethargy
- Headaches
- Vomiting
- Blurred vision
- Changes in behaviour
