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Emergency Medicine Part 1 > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

TBIs cause about ______ deaths per year in the US

A

52,000

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2
Q

TBIs cause the highest mortality in which two populations?

A

young (15-24)

and

old (over 65)

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3
Q

What is the leading cause of TBI in the US?

What are some other causes?

A

leading cause: MVC/MVA

other causes: falls, firearms, assault/violence, sports, alcohol

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4
Q

What is the Glasgow Coma Scale?

A

15 point scale used to rate mental status & function

used to rate severity of brain injury & predict outcome

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5
Q

What is the highest GCS score?

What is the lowest GCS score?

A

highest: 15
lowest: 3

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6
Q

When should the GSC score be performed?

A

at triage & repeatedly during evaluation

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7
Q

Why is it important to do multiple GSC score evaluations?

A

because any decrease in score is a danger sign

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8
Q

What are the 3 components of the GCS and how many grades are in each of them?

A

Eye reponse → 4 grades

Verbal Response → 5 grades

Motor reponse → 6 grades

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9
Q

GCS score fore minor TBI

A

13-15

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10
Q

GCS score for moderate TBI

A

9-12

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11
Q

GCS score for severe TBI

A

< 8

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12
Q

What are some things that indicate a patient is likely to NOT have a significant intracranial injury?

A

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

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13
Q

What are the 3 types of tissue deformation?

A
  1. compression- tissue compression
  2. tensile- tissue stretching
  3. shear- tissue distortion when tissue slides over tissue
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14
Q

What do we do with every p atient with a known or suspected TBI?

A

get a CT!

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15
Q

What are some signs of a basilar skull fracture?

A

CSF rhinorrhea or otorrhea

ecchymosis of the lids (racoon eyes)

ecchymosis behind the ear (Battle’s sign)

hemotympanum

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16
Q

Mild traumatic brain injury with complex pathophysiologic process induced by traumatic biomechanic forces

A

concussion

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17
Q

alteration in mental status with or without loss of consciousness

confusion

amnesia

HA

dizziness

delayed verbal responses

emotionality out of proportion

A

concussion

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18
Q

What are some signs of increasing intracranial pressure?

A

persistent vomiting

worsening HA

increasing disorientation

changing levels of consciousness

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19
Q

What will the CT scan show for a patient with a concussion?

A

all imaging will be grossly normal

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20
Q

What is the treatment for a concussion?

A

cognitive & physical rest

21
Q

Management for concussion:

  1. no loss of consciousness
  2. post-traumatic amnesia or other signs lasting less than 30 minutes
A

athletes may return to play if asymptomatic for one week

22
Q

Management for concussion:

  1. loss of consciousness for less than 1 minute

or

  1. post-traumatic amnesia or other symptoms for more than 30 minutes but less than 24 hours
A

athletes may return to play in 2 weeks if asymptomatic at rest & on exertion for 7 days

23
Q

Management of concussion:

  1. loss of concussion for longer than 1 minute

or

  1. post-traumatic amnesia or other symptoms for longer than 24 hours
A

athlete may return to play in one month if asymptomatic at rest & on exertion for 7 days

24
Q

bruise (like any other) but in an area of vital tissue

A

brain contusion

25
Q

What do we do for a brain contusion?

A

may be seen on CT

neurosurgical consult

26
Q

very common in terms of TBI

MOI is acceleration & deceleration

A

diffuse axonal injury (DAI)

27
Q

Diffuse axonal injury commonly occurs (2/3) where?

A

at junciton of grey & white matter

28
Q

What is a mild form of DAI?

A

coma for 6-24 hours

usually recover without long-term sequela

29
Q

What is a moderate form of DAI?

A

coma for > 24 hours

don’t wake up

will have long-term cognitive deficits

30
Q

What is a severe form of DAI?

A

prolonged coma

persistent vegetative state (90%)

31
Q

What is the treatment for DAI?

A

supportive

32
Q

Usually caused by injuries to the middle meningeal artery

A

epidural hematoma

33
Q

What are some S/S of an epidural hematoma?

A

brief period of unconsciousness followed by a lucid interval

fixed dilated pupil on ipsilateral side w/ contralateral hemiparesis (late finding)

34
Q

What will the CT look like for an epidural hematoma?

A

lenticular lesion

(bi-convex or football shaped)

35
Q

Which hematoma requires IMMEDIATE neurosurgical interetion for decompression to prevent herniation?

A

epidural hematoma

36
Q

usually results from injuries to bridging veins

space occupying lesion (slow/venous bleeding)

A

subdurla hematoma

37
Q

Who is at high risk for developing a subdural hematoma?

A

people with cerebral atrophy

alcoholics & elderly

38
Q

What is the time frame for an acute subdural hematoma?

Chronic?

A

acute: within 24 hours
chronic: more than 2 weeks from injury

39
Q

What are some S/S of a subdural hematoma?

A

HA

lethargy

coma

40
Q

What will the CT look like for a subdural hematoma?

A

concave lesion

(crescent shape)

41
Q

How do we manage a subdural hematoma?

A

requires prompt neurosurgical evaluation

but may only require observation

42
Q

What can lead to increased ICP secondary to blockage of CSF outflow at the 3rd & 4th ventricles

A

traumatic subarachnoid hemorrhage

43
Q

What should we do for an asymptomatic traumatic subarachnoid hemorrhage?

A

admit for observation & get neurosurgical consult

44
Q

What should we do for a symptomatic traumatic subarachanoid hemorrhage?

A

neurosurgical consult

may require ICP monitoring

45
Q

triad of coma, fixed & dilated pupils, decerebrate posturing

A

brain herniation

46
Q

What is a normal ICP pressure?

What is a pathologic ICP pressure?

A

normal: 0-10 mmHg
pathologic: > 20 mmHg

47
Q

MAP - ICP = ?

A

CPP (cerebral perfusion pressure)

48
Q

CPP is critical at ________

A

50-70 mmHg

49
Q

How can we adjust CPP?

A
  1. increase MAP with IVF & pressors
  2. decrease ICP with osmotic diuresis, HOB elevation, drain CSF (with burr holes)

Emergency Medicine Part 1 (8 decks)

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