Traumatic Brain Injury Flashcards
best time to manage traumatic brain injury?
within the hour
“golden hour”
general advanced trauma life support (ATLS) in traumatic brain injury?
manage airway with C spine control breathing circulation ABCDE assess via GCS, pupils etc check C spine
what are the 3 categories of GCS?
eye opening
verbal
motor
levels of eye opening?
open spontaneously
open to speech
open to pain
no eye opening
levels of verbal?
orientated confused inappropriate incomprehensible no verbal
levels of motor?
obeying localising flexing abnormal flexing extending no motor response
how is head injury classified via GCS?
mild = 14, 15 or brief loss of consciousness moderate = 9-13 severe = 3-8
who must be given a CT scan within 1 hour of head injury?
GCS <13 in initial assessment GCS <13 2 hrs after injury suspected open or depressed skull fracture sign of basal skull fracture post traumatic seizure focal neuro deficit more than 1 vomiting episode suspicion of NAI
CT should be given to which people if they also have had some loss of consciousness of amnesia?
65+
coagulopathy
dangerous mechanism of injury
classic presentation of extradural haematoma?
injury with loss of consciousness
lucid interval recovery
rapid progression of neuro symptoms
acute vs chronic subdural haematoma on imaging?
acute = hyperdense crescent (pale area) chronic = hypodense crescent (darker area)
what does diffuse axonal injury look like on imaging?
little white blobs
initial neurosurgical role in traumatic brain injury?
prevent secondary insults
- hypoxia
- hypotension
- mass lesions
- control ICP and CPP
principles of neurosurgery?
patient must be intubated, ventilated and sedated
control ICP
how is raised ICP managed medically?
sedation (Propofol, benzodiazepines)
maximise venous drainage (tilt head of bed, cervical collar, ET tube ties)
CO2 control
osmotic diuretics (mannitol, hypertonic saline)
CSF release
why must CO2 be controlled in raised ICP?
increased arterial CO2 = increased cerebral blood flow
head of the bed should be raised to what angle in raised ICP?
30 degrees
what is used in extreme cases of raised ICP?
decompressive craniectomy
- part of skull removed to allow expansion of brain
cerebral perfusion pressure (CPP) is equal to what?
MAP - ICP
what is the danger of seizure in traumatic brain injury?
post traumatic seizures can occur (early or late) which can cause secondary insult on the brain
do antiepileptics reduce risk of post traumatic seizure?
only early, not late, seizure
still risk of secondary insult
effect of nutrition after traumatic brain injury?
every 10 kcal/kg deficit = 30-40% increase in mortality rate
must have nutrition
what happens in diffuse axonal injury?
sheering forces tears axons apart/twists them/compresses them
causes excitotoxicity and apoptosis in nerves and inflammatory mediator release (cytokines, interleukins, IL-6)
where is diffuse axonal injury most likely to occur?
grey/white matter interface (where density difference is at its greatest)
describe excitotoxicity in nerves?
excitatory amino acids (glutamate) released
activates NMDA receptors
calcium mediated activation of proteases and lipases
causes further secondary cell death
what can improve outcome at the cellular level in humans and what makes it worse?
no chemical compound known to improve
steroids make it worse
signs of brainstem death?
no pupil response no corneal reflex no gag reflex no vestibulo-ocular reflex no motor response no respiration
how can brain stem death be confirmed?
must have 2 doctors confirm (1 consultant)
