Traumatic brain injury Flashcards

1
Q

What is a traumatic brain injury?

A

A non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to temporary or perimanent impairment of cognitive, physical and psychosocial functions

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2
Q

What are some high risk groups of traumatic brain injury?

A
  • Young men and elderly
  • Previous head injuries
  • Residents of inner cities
  • Alcohol and drug abuse
  • Low income
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3
Q

What are some mechanisms of traumatic brain injury?

A
  • Assault
  • Falls
  • RTCs
  • Sports
  • Over 1/2 involve alcohol
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4
Q

What are some government methods of preventing traumatic brain injury?

A
  • Seatbelt laws
  • Drink driving testing
  • Helmets on bikes and motorbikes
  • Improving car safety
  • Awareness of anti-coagulation
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5
Q

What is the Monto-Kellie principle?

A

The sum of the volumes of brain matter, CSF and intra-cerebral blood is constant, so an increase in 1 should cause a reciprocal decrease in either 1 or 2 of the remaining components

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6
Q

What is a coup and contra-coup brain injury?

A

Coup - Head hits a surface, the brain is pushed into the front of the skull

Contra-coup - Brain rebounds backwards and hits the back of the skull

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7
Q

What is “Racoon eyes” a sign of?

A

Basal skull fracture

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8
Q

How will extra-dural haemorrhage in traumatic brain injury present?

A

There will often be a recovery period (Lucid period) before rapid progression of neurological symptoms

These include:

  • Deteriorating GCS
  • Possible hemiparesis
  • Unilateral fixed or dilated pupil
  • Apnoea
  • Death
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9
Q

What is ATLS?

A

Advanced Trauma Life Support
Airway with C-spine control, breathing and circulation

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10
Q

What are the criteria for CT scan within 1 hour in traumatic brain injury?

A
  • GCS < 13 on initial assessment
  • GCS < 15 at 2 hours
  • Suspected open or depressed skull fracture
  • Any sign of basal skull fracture
  • Post traumatic seizure
  • Focal neurological deficit
  • > 1 episode of vomiting
  • Suspicion of NAI (Non-accidental injury)
  • Age over 65
  • Anti-coagulated
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11
Q

How will extra-dural haematoma present on CT

A

Lemon shaped white area

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12
Q

How will acute sub-dural haematoma present on CT

A

Crescent shape, white

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13
Q

How will chronic sub-dural haematoma present on CT

A

Crescent shape, Dark

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14
Q

What are some signs of brainstem death?

A

No:
- Pupil response (II, III)
- Corneal reflex (V, VII)
- Motor response (V, VII)
- Vestibule-ocular reflex (III, VI, VIII)
- Gag/cough reflex (IX, X)
- Respiration

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15
Q

What are some management options to reduce ICP in TBI?

A

Surgery
Maximise venous drainage
Osmotic diuretics
CSF release

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16
Q

What surgery may be required in TBI?

A

Decompressive craniectomy
Surgical haematoma (Removal of haematoma)

17
Q

How is venous drainage of the brain maximised?

A

Head of bed tilt (30º)
Cervical collars
ET tube ties

18
Q

What are some other conservative managements of TBI?

A

CO2
Sedation
Intubation and ventilation

19
Q
A