1(E): Head Injury

Question 1

What is head injury

Answer 1

Physical damage to brain secondary to external impact

Question 2

How is head injury classified

Answer 2

1. Open

2. Closed

Question 3

What is open head injury

Answer 3

Dura mater is disrupted

Question 4

What is closed head injury

Answer 4

Dura mater remains intact

Question 5

In which groups are head injuries more common

Answer 5

Children under-5
Adolescences
Over 65’s

Question 6

How may a head injury present

Answer 6

• Loss of consciousness
• Amnesia
• Nausea and vomitting
• Dizziness
• Seizures

Cushing’s triad

Question 7

What is Cushing’s triad

Answer 7

HTN
Bradycardia
Decrease respiration

Question 8

What are the features of anterior basal skull fracture

Answer 8

Rhinorrhoea

Racoon eyes

Question 9

What are the features of posterior basilar skull fracture

Answer 9

CSF Otorrhoea
Battle sign
Haemotympanum

Question 10

What is haemotympanum

Answer 10

Blood behind ear drum

Question 11

What causes battle sign

Answer 11

Subcutaneous haematoma

Question 12

When should TBI be suspected

Answer 12

Individual with rapidly deteriorating consciousness

Question 13

What is primary brain injury

Answer 13

Injury at immediate time of impact

Question 14

What is coup

Answer 14

Injury caused by contusion of the brain

Question 15

What is counter-coup

Answer 15

Cerebral contusion opposite impact

Question 16

What is secondary brain injury

Answer 16

Injury occurs due to inflammation and oedema following the primary injury

Question 17

How is head injury investigated in pre-hospital setting

Answer 17

ATLS approach, GCS

Question 18

what GCS should be intubated

Answer 18

GCS Less than 8

Question 19

what is recommended imaging for head injury

Answer 19

CT

Question 20

what is the criteria for CT head in one-hour

Answer 20

FVBOGGS:

Focal neurological deficit 
Vomitting 
Basal skull fracture 
Open fracture
GCS less than 15 
GCS less than 13 after 2-hours 
Seizure

Question 21

what is the criteria for CT head in eight hours

Answer 21

BAAM:

Bleeding or anticoagulant disorder
Age over-65
Anticoagulant
Mechanism of injury - high

Question 22

what other imaging may be ordered in head injury

Answer 22

X-Ray C-Spine

Question 23

what is important for head injury assessment

Answer 23

Head Injury Observations: every 30-minutes until GCS 15

Question 24

in GCS, what is motor score out of

Answer 24

6

Question 25

``` What are the following in the motor section A. GCS 6 B. 5 C. 4 D. 3 E. 2 F. 1 ```

Answer 25

a. Obeys commands b. Localises pain c. Flexes from pain d. Abnormal Flexion to pain e. Extension to pain f. No response

Question 26

In GCS. what is voice score out of

Answer 26

5

Question 27

``` What are the following in the voice A. 5 B. 4 C. 3 D. 2 E. 1 ```

Answer 27

``` A. Orientated B. Confused C. Words D. Sounds E. Nothing ```

Question 28

In GCS, what is the eye score out-of

Answer 28

4

Question 29

What are the following for eyes a. 4 b. 3 c. 2 d. 1

Answer 29

A. Eyes open spontaneously B. Eyes open to voice C. Eyes open to pain D. Eyes closed

Question 30

If a pupil is unilaterally dilated, what does it indicate

Answer 30

CN3 Palsy

Question 31

If a pupil is bilaterally dilated, what does it indicate

Answer 31

Bilateral CN3 Compression

Question 32

How is raised ICP managed in head injury

Answer 32

IV Mannitol or Hypertonic Saline

Question 33

When is ICP monitoring indicate

Answer 33

GCS 3-8

Question 34

How is cerebral oedema managed

Answer 34

Decompressive craniotomy

Question 35

What CPP is aimed for in adults

Answer 35

70mmHg