Traumatic Brain Injury Flashcards
TBIs cause about ______ deaths per year in the US
52,000
TBIs cause the highest mortality in which two populations?
young (15-24)
and
old (over 65)
What is the leading cause of TBI in the US?
What are some other causes?
leading cause: MVC/MVA
other causes: falls, firearms, assault/violence, sports, alcohol
What is the Glasgow Coma Scale?
15 point scale used to rate mental status & function
used to rate severity of brain injury & predict outcome
What is the highest GCS score?
What is the lowest GCS score?
highest: 15
lowest: 3
When should the GSC score be performed?
at triage & repeatedly during evaluation
Why is it important to do multiple GSC score evaluations?
because any decrease in score is a danger sign
What are the 3 components of the GCS and how many grades are in each of them?
Eye reponse → 4 grades
Verbal Response → 5 grades
Motor reponse → 6 grades
GCS score fore minor TBI
13-15
GCS score for moderate TBI
9-12
GCS score for severe TBI
< 8
What are some things that indicate a patient is likely to NOT have a significant intracranial injury?
no HA
no vomiting
age is under 60
no intoxication
no deficits in short term memory
no physical evidence of trauma above the clavicles
no seizure
What are the 3 types of tissue deformation?
- compression- tissue compression
- tensile- tissue stretching
- shear- tissue distortion when tissue slides over tissue
What do we do with every p atient with a known or suspected TBI?
get a CT!
What are some signs of a basilar skull fracture?
CSF rhinorrhea or otorrhea
ecchymosis of the lids (racoon eyes)
ecchymosis behind the ear (Battle’s sign)
hemotympanum
Mild traumatic brain injury with complex pathophysiologic process induced by traumatic biomechanic forces
concussion
alteration in mental status with or without loss of consciousness
confusion
amnesia
HA
dizziness
delayed verbal responses
emotionality out of proportion
concussion
What are some signs of increasing intracranial pressure?
persistent vomiting
worsening HA
increasing disorientation
changing levels of consciousness
What will the CT scan show for a patient with a concussion?
all imaging will be grossly normal
What is the treatment for a concussion?
cognitive & physical rest
Management for concussion:
- no loss of consciousness
- post-traumatic amnesia or other signs lasting less than 30 minutes
athletes may return to play if asymptomatic for one week
Management for concussion:
- loss of consciousness for less than 1 minute
or
- post-traumatic amnesia or other symptoms for more than 30 minutes but less than 24 hours
athletes may return to play in 2 weeks if asymptomatic at rest & on exertion for 7 days
Management of concussion:
- loss of concussion for longer than 1 minute
or
- post-traumatic amnesia or other symptoms for longer than 24 hours
athlete may return to play in one month if asymptomatic at rest & on exertion for 7 days
bruise (like any other) but in an area of vital tissue
brain contusion
What do we do for a brain contusion?
may be seen on CT
neurosurgical consult
very common in terms of TBI
MOI is acceleration & deceleration
diffuse axonal injury (DAI)
Diffuse axonal injury commonly occurs (2/3) where?
at junciton of grey & white matter
What is a mild form of DAI?
coma for 6-24 hours
usually recover without long-term sequela
What is a moderate form of DAI?
coma for > 24 hours
don’t wake up
will have long-term cognitive deficits
What is a severe form of DAI?
prolonged coma
persistent vegetative state (90%)
What is the treatment for DAI?
supportive
Usually caused by injuries to the middle meningeal artery
epidural hematoma
What are some S/S of an epidural hematoma?
brief period of unconsciousness followed by a lucid interval
fixed dilated pupil on ipsilateral side w/ contralateral hemiparesis (late finding)
What will the CT look like for an epidural hematoma?
lenticular lesion
(bi-convex or football shaped)
Which hematoma requires IMMEDIATE neurosurgical interetion for decompression to prevent herniation?
epidural hematoma
usually results from injuries to bridging veins
space occupying lesion (slow/venous bleeding)
subdurla hematoma
Who is at high risk for developing a subdural hematoma?
people with cerebral atrophy
alcoholics & elderly
What is the time frame for an acute subdural hematoma?
Chronic?
acute: within 24 hours
chronic: more than 2 weeks from injury
What are some S/S of a subdural hematoma?
HA
lethargy
coma
What will the CT look like for a subdural hematoma?
concave lesion
(crescent shape)
How do we manage a subdural hematoma?
requires prompt neurosurgical evaluation
but may only require observation
What can lead to increased ICP secondary to blockage of CSF outflow at the 3rd & 4th ventricles
traumatic subarachnoid hemorrhage
What should we do for an asymptomatic traumatic subarachnoid hemorrhage?
admit for observation & get neurosurgical consult
What should we do for a symptomatic traumatic subarachanoid hemorrhage?
neurosurgical consult
may require ICP monitoring
triad of coma, fixed & dilated pupils, decerebrate posturing
brain herniation
What is a normal ICP pressure?
What is a pathologic ICP pressure?
normal: 0-10 mmHg
pathologic: > 20 mmHg
MAP - ICP = ?
CPP (cerebral perfusion pressure)
CPP is critical at ________
50-70 mmHg
How can we adjust CPP?
- increase MAP with IVF & pressors
- decrease ICP with osmotic diuresis, HOB elevation, drain CSF (with burr holes)
