WEEK 1:TRAUMATIC HEAD INJURIES Flashcards
Describe the two types of head injuries
- Primary injury: occurs at the time of impact
2.Secondary : involves factors comprising adequate oxygenation
This is due to increased intracranial pressure resulting in hypoxia, lesions and brain oedema
What causes most of head injuries?
*TRAUMA
*fall, thermal, community assaults, interpersonal violence, drowning , road accidents
NOTE : Most traumatic injuries result in neuropsychologic impairements in survivors
Describe the monro-kellie doctrine
The Monro-Kellie Doctrine describes the relationship between the contents of the cranium and intracranial pressure
As the cranium is made from solid bone*, its structure is fixed and therefore the volume contained within cannot be changed.
Alongside the brain tissue, the other major components found within the cranium are blood (mostly venous blood from within dural sinuses) and the cerebrospinal fluid (CSF). The volume of each of these components is restricted by the fixed space within the cranium.
State the 3 components that are found in the cranium
- brain
- CSF
3.blood
Why does the monro kellie doctrine apply to babies and infants
*This concept only applies to adults, as the presence of fontanelles and open suture lines in infants that have not yet fused means there is potential for a change in size and intracranial volume
How does the body regulate increased intracranial pressure
- CSF and venous blood leave the skull to moderate the ICP
What is the normal range of intracranial pressure?
approximately 10mmHg
How does increased intracranial pressure result in death of brain cells?
- increased ICP results in LOW Cerebral blood flow as the venous blood has to leave the skull to moderate ICP as a result there is hypoxia and the brain cells end dying due to lack of oxygen
State the symptoms associated with high ICP
High VP, Slow or irregular pulse, severe headache, weakness, cardiac arrest, loss of brain stem reflexes, respiratory arrest,
What are assessments that should be done to patients with traumatic head injury
HISTORY TAKING
*presenting complain: headache, vomiting, dizziness, headache, amnesia
*mechanism of injury
*witness
*underlying conditions
*bleeding disorders
*loss of consciousness
EXAMS
*level of consciousness
*dilation of pupil
*loss of pupillary response to light
*lateralizing symptoms
*gait
Differentiate between epidural and subdural hematoma
EPIDURAL HEMATOMA
* result from tear of the middle meningeal artery due to fracture on the cranium
*usually at the site of pterygoid
*forms a lentiform
SUBDURAL HEMATOMA
*result from severe brain injuries
*from shearing of small surface underlying blood vessels of the cerebral cortex
Describe the management of the hematomas in the brain
- oxygenation
*nurse in head up position( elevated)
*Evacuate bleeds via surgery
Why is the mechanism of injury important?
- clues to CNS injury
- clues to other injuries(NON- CNS)
*consistency and plausibility
if absent, suspense abuse or non- accidental trauma
Describe the mechanisms of coup and contre coup
In head injury, a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was
Why are symptoms important?
*headache, vomiting and decreased consciousness are markers of increased ICP
- Time course of symptoms
IMMEDIATE ; direct primary injury
DELAYED: secondary injury
Seizure or amnesia
*general marker of brain injury
Outline ways of dealing with head injuries
*School education campaigns
*Wearing of protective clothing such as helmet
What is the difference between a psychriatrist and a psychologist?
Psychiatrists are medical doctors who are able to prescribe medications, which they do in conjunction with providing psychotherapy, though medical and pharmacological interventions are often their focus.
Though many psychologists hold doctorate degrees, they are not medical doctors, and most cannot prescribe medications. Rather, they solely provide psychotherapy, which may involve cognitive and behavioral interventions.
Ouline the characteristics of a psychologist
Have a doctorate degree in psychology
Provide a variety of talk therapies
Offer psychological testing and evaluation
Cannot prescribe medications in most cases
Outline duties of a psychiatrist
Have a medical degree
Offers psychological assessment and may provide some talk therapy
Addresses conditions from a bio/neurochemical perspective
Can prescribe medications
Differentiate between a neurologist and a psychiatrist
Neurologists and psychiatrists both work with conditions and diseases that affect the brain and mind.
However, neurologists specialize in physiological illnesses, while psychiatrists specialize in psychological disorders.
Outline the physical exams necessary for patients with traumatic brain injury
*External head trauma (look & feel)
Lacerations (cuts), scalp hematomas (swellings aka “goose eggs”), bony deformity/crepitus
*Ears
blood or CSF inside canal or behind ear drum
*Neurologic exam
State of consciousness, confusion
Movement: abnormality/asymmetry
Sensation: abnormality/asymmetry
Pupils: abnormality/asymmetry
Reflexes: abnormality/asymmetry
Why are physical findings important?
*Ability to talk or move specific side
Compression or direct brain damage
Helps localize the problem
*Reflexes
Helps localize the problem
Babinsky reflex: indicator of upper motor neuron damage/dysfunction
*Pupils
Indicator of brain herniation
Consciousness and alertness
General indicators of brain health/injury
*Clinical manifestations of TBI
Vomiting, seizures, headache
Abnormal consciousness, reflexes, & pupils
*Patho-physiologic mechanism of TBI
Direct injury then secondary injury from bleeding and swelling in a confined space
*Basics of diagnosis and treatment
Imaging & surgery
*TBI as a public health problem
Epidemiology and prevention
KEY POINTS
*Clinical manifestations of TBI
Vomiting, seizures, headache
Abnormal consciousness, reflexes, & pupils
*Patho-physiologic mechanism of TBI
Direct injury then secondary injury from bleeding and swelling in a confined space
*Basics of diagnosis and treatment
Imaging & surgery
*TBI as a public health problem
Epidemiology and prevention
