Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD4001 - Clinical > Traumatic Brain Injury - Management > Flashcards

Traumatic Brain Injury - Management Flashcards

1
Q

Describe a Primary Brain Injury

A
  • Occurs at the moment of impact
  • Pattern & extent of damage depends in nature of impact
  • Not treatable
  • Target prevention (public health issue)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the main focus of a secondary brain injury?

A

Focus of medical intervention to minimise secondary brain injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What should be optimised and observed in secondary brain injury?

A
  • optimise oxygenation
  • optimise cerebral perfusion
  • Blood glucose
  • hypo/hyperthermia
  • Body temp –> aim for normathermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the secondary processes that occur at the cell and molecular level to exacerbate neurological damage?

A
  • NT release (glutamate)
  • Free radical damage
  • calcium mediated damage
  • inflammatory response
  • mitchondrial dysfunction
  • eary gene activation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the main results of secondary brain injury?

A
  • ischaemia, excitotoxicity and cellular energy failure
  • neuronal death cascades
  • cerebral oedema
  • inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Draw a diagram to illustrate Normal ICP

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Draw a diagram to illustrate a compensation for an expanding mass with a normal ICP

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Draw a diagram to illustrate a compensation for an expanding mass with an elevated ICP

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Draw a diagram illustrating the pathophysilogy of primary and secondary brain injury

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Draw a diagram highlighting the critical volume with regards to ICP and ICV

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the steps of early management in a secondary brain injury?

A
  • Assessment and identifcation of the patient AT RISK
  • Pre-emptive investigation (CT Scan)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Who should be sent to hospital in the cases of suspected brain injury?

A
  • Extremes of age (65years)
  • Amnesia for events before or after injury
  • Any loss of consciousness
  • High energy injury
  • Vomiting
  • Seizure (previous neurosurgery)
  • Bleeding /clotting disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the function of the Glasgow Coma Scale?

A
  • Is central to the classification,
  • initial management
  • and ongoing assessment of a patient with head injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Outline the Eye Opening classification of the GCS

A

E4

4 = Spontaneous

3 = Open to speech

2 = Open in response to pain

1 = Do not open

NT = unable to open due to swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Outline the Verbal Response classification of the GCS

A

V5

5 = Orientated

4 = Confused

3 = Inappropraite words

2 = incomprehensible sounds

1 = No response despite verbal and physical stimuli

NT = dysphasic

T = intubated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Outline the Motor response classification of the GCS

A

M6

6 = Obeys commands

5 = localised to central pain

4 = Normal flexion towards the source of pain

3 = Abnormal flexion

2 = Extension to pain

1 = No response to painful stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the different degrees of head injury?

A
  • Minimal = 15 (no history of unconsciousness)
  • Mild = 13-15
  • Moderate = 9-12
  • Severe = 8 or less
18
Q

When should a CT scan be requested in adult patients?

A
  • GCS <13 on initial assessment in A & E
  • GCS <15 2 hours after injury
  • Suspected open or depressed skull #
  • Any sign of basal skull #
  • Post traumatic seizure
  • 1 or more episode of vomiting (3 in kids)
  • Amnesia for events more than 30 mins before impact
19
Q

What are major red flags and would influence a decision not to discharge a patient?

A
  • Loss of consciousness, drowsiness, confusion, fits
  • Painful headaches which don’t settle, vomiting or visual disturbance
  • clear fluid from ear or nose, bleeding from ears, new deafness (CSF rhinorrhoea test for glucose or beta-2-transferrin)
  • Problems understanding or speaking, loss of balance, difficulty walking or weakness in arms or legs
20
Q

Why is it important to optimise oxygenation?

A

When assessed pre admission SpO2 <90% in 50% of cases

21
Q

What is the imaging of choice for a cervical spine?

A

Plain (lateral) X-Ray

22
Q

What are the main aspects to monitor in a patients breathing?

A
  • Administer oxygen
  • Monitor SpO2
  • Monitor ABGs
  • GCS <8 = INTUBATE
23
Q

What is the targeted PaCO2

A

4.5-5 kPa

24
Q

How should circualtion be balanced?

A
  • Maintain CPP above 60-70 mmHg
  • Maintain systolic BP >90 mmHg
  • ICP < 20mmHg
25
Q

How should you open the airway if there is a suspected C-spine injury?

A

Jaw thrust

26
Q

How should you deal with the supply V demand situation?

A
  • optimise oxygen supply
  • minimise demand
    • Convulsions in 15% of patients –> treat with phenytonin in early head injury
    • Brain metabolic rate increased 6-9% for every rise in degree of temperature –> treat pyrexia
27
Q

How does cerebral vessel diameter and cerebral blood flow change over PaCO2 range?

Draw a diagram to illustrate this

A

changes over a wide range

28
Q

Give an equation used to calculate cerebral perfusion pressure

A

CPP = MAP - ICP

29
Q

Describe cerebral autoregulation

A
  • Cerebral arterioles react to local changes in the environment (pressure & chemical)
  • Normally autoregulation maintains a constant blood flow between MAP 50 mmHg and 150 mmHg.
  • Traumatised or ischaemic brain, CBF may become blood pressure dependent.
30
Q

Why do some patients present with hypotension?

A
  • Not due to head injury
  • Look for other clues:
    • Chest trauma
    • Pelvic fracture

**STOP BLEEDING

**IV FLUIDS

31
Q

What can encourage venous drainage?

A
  • Nurse head up tilt (15 - 30 degrees )
  • Check straps and ties are not obstructing venous flow
32
Q

What should be taken from a history when establishing a patient is at risk of intra-cranial mass?

A
  • high impact injury
  • signficiant retrograde amnesia
  • history of coagulopathy
  • post traumatic seizure
33
Q

What does peri-orbital bruising suggest?

A

anterior cranial fossa fracture

34
Q

What does battle’s sign indicate?

A

Petrous temporal bone fracture (with bruising)

35
Q

Describe an extradural haematoma

A
  • Relatively uncommon
  • Strongly associated with skull fracture
  • Middle meningeal artery
  • 1/3 due to venous bleeding
  • Classically a lucid interval
  • Good outcome if treated!
36
Q

Describe a subdural haematoma

A
  • Common
  • Complicates 20-30% of head injuries
  • Rupture of the veins travelling from the brain surface to the saggital sinus
  • Prognosis worse
37
Q

Describe an intracerbral haemorrhage

A
  • Stretching & shearing injury
  • Impact on inside of skull
  • Often contre coup injury
38
Q

Describe a subarchnoid haemorrhage

A
  • Assoc. with ruptured aneurysm
  • More commonly caused by head injury
39
Q

What information should you give to neurosurgeons when you contact them?

A
  • Mechanism of injury
  • Age of patient
  • Respiratory and cardiovascular status
  • GCS score & pupil response
  • Alcohol/drugs
  • Associated injuries
  • Results of CT scan
40
Q

What are the clinical signs of herniation?

A
  • Dilated/unreactive pupils
  • Extensor posturing
  • Decreased GCS by 2 or more points

MD4001 - Clinical (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions