Traumatic brain injury

Question 1

CPP

Answer 1

CPP = MAP - ICP

Question 2

Goal CPP

Answer 2

> 70 mmHg

Question 3

ICP limit

ICP normal range

Answer 3

> 15 mmHg requires operation

10 mmHg

Question 4

transtentorial herniation trias

Answer 4

Alteration of consciousness
Ipsilateral mydriasis
Contralateral hemiparesis

Question 5

TBI 3 classes of severity

Answer 5

Mild 13-15
Moderate 9-12
Severe 3-8

Question 6

GCS

Answer 6

EVM

456

Question 7

Eyes

Answer 7

Max 4
Open before stimulus 4
After spoken or shouted request 3
After fingertip stimulus 2
None, no interfering factor 1

Question 8

Verbal

Answer 8

Max 5
Name place and date 5
Not oriented but coherent = confused 4
Intelligible single words 3
Moans and groans 2
No audible response, no interfering factor 1

Question 9

Motor

Answer 9

Max 6
Obeys 2 part request 6
Brings head above clavicle on head neck 5
Bends arm at elbow rapidly = normal flexion 4
Bends arm at elbow abnormal = abnormal flexion 3
Extends arm at elbow 2
No movement in arms and legs 1
paralysed or limiting factor NT

Question 10

CT Scan for mild TBI (13-15)

Answer 10

Loss of consciousness
or definite amnesia
or disorientation (13-15)

GCS less than 15 at 2 h after injury
Suspected open or depressed skull fracture
Any sign of basilar skull fracture
Vomitting more than 2 episodes
Age more than 65 years
Anticoagulant use

Loss of consciousness more than 5 minutes
Amnesio before impact more than 30 minutes
Dangerous mechanism

Question 11

Goals of treatment

Answer 11

Systolic >100 mmHg
temperature 36-38°
Glucose normal
Hemoglobin > 70 g/L
INR < 1.4
Na 135-145 mmol/L
paO2 > 100 mmHg
paCO2 35-45 mmHg
pH 7.35-7.45
Plateletes > 75
CPP > 60
Intracranial rpessure 5-15 mmHg

If Seizure midazolam

Question 12

Hyperventilation

Answer 12

Normocarbia i prefered.

Hypocarbia:
Hyperventilation reduces paCo2 and causes cerebral vasoconstriction. If prolonged can lead to cerebral ischemia.

Hypercarbia
very bad as it promotes vasodilatation and increases ICP

Question 13

Mannitol

Answer 13

20g Mannitol in 100ml solution
used to reduce elevated ICP
do not give if hypotension
1g over 5 minutes and transport to OR or CT

Give if acute neurological deterioration

• dilated pupil
• hemiparesis
• loses consciousness
• if euvolemic !!!!

Question 14

Barbiturates

Answer 14

not in the acute phase

Question 15

Anticonvulsivants

Answer 15

Only use when absolutely necessary

Question 16

Uncal herniation

Answer 16

Uncus = innermost part of temporal lobe
squeezes the oculomotor nerve, mydriasis on the same side. Followed by III palsy : down and out.
Pasympatethic fibers touched first because they surround the motor fibres.

Question 17

Contralateral homonymous hemianopsia

Answer 17

Results from ipsilateral compression of posterior cerebral artery

Question 18

Cingulate herniation

Answer 18

Most common
frontal lobe scraped under the falx cerebri
Abnormal posturing and coma