Traumatic brain injury Flashcards
What is a traumatic brain injury?
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
What are some high risk groups of traumatic brain injury?
- Young men and elderly
- Previous head injuries
- Residents of inner cities
- Alcohol and drug abuse
- Low income
What are some mechanisms of traumatic brain injury?
- Assault
- Falls
- RTCs
- Sports
- Over 1/2 involve alcohol
What are some government methods of preventing traumatic brain injury?
- Seatbelt laws
- Drink driving testing
- Helmets on bikes and motorbikes
- Improving car safety
- Awareness of anti-coagulation
What is the Monto-Kellie principle?
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
What is a coup and contra-coup brain injury?
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
What is “Racoon eyes” a sign of?
Basal skull fracture
How will extra-dural haemorrhage in traumatic brain injury present?
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
What is ATLS?
Advanced Trauma Life Support
Airway with C-spine control, breathing and circulation
What are the criteria for CT scan within 1 hour in traumatic brain injury?
- 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
How will extra-dural haematoma present on CT
Lemon shaped white area
How will acute sub-dural haematoma present on CT
Crescent shape, white
How will chronic sub-dural haematoma present on CT
Crescent shape, Dark
What are some signs of brainstem death?
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
What are some management options to reduce ICP in TBI?
Surgery
Maximise venous drainage
Osmotic diuretics
CSF release
