Flashcards in 3.6 Traumatic Brain Injury Deck (59):
What is the weakest part of the skull and why?
The basilar skull because it is made up of many separate pieces of bone.
What cushions the brain within the skull?
What is a sign of a basilar skull fracture?
Leaking cerebrospinal fluid from the ear or nose.
What is epidural bleeding e.g. between what layers?
Between the duramater and the skull
What is subdural bleeding?
Bleeding beneath the duramater.
What is bleeding beneath the arachnoid layer called?
What are the three anatomical components of the brain?
Cerebrum, Cerebellum and Brainstem
What is another name for the cerebellum?
What part of the body do all messages from the brain pass through?
What are the meninges?
Layers protecting the brain.
What is another sign (other than leaking cerebrospinal fluid from the ears or nose) of a basilar skull fracture?
Bruising around the eyes or ears - but may take several hours to show up.
What is the pathophysiology of a TBI?
Can be direct from penetrating trauma or a blow to the head or secondary from lack of oxygen, CO2 build-up or change in blood pressure.
What is a closed head injury?
May be a laceration to the skin, but the skull remains intact.
What is an open head injury?
Break in the skull as well as the skin.
Explain what a diffuse axonal injury (DAI) to the brain is?
Injury to the brain as a result od shearing, tearing or stretching of nerve fibres.
What kind of incidences would you expect to see DAI brain injures?
Car accidents or pedestrians hit by cars.
What is a concussion?
Temporary loss of brains ability to function.
Appears immediately or soon after impact.
What is a contusion of the brain?
Bruising or swelling of the brain
What is a hematoma of the brain?
Pooling of blood within the brain
What is a laceration of the brain?
A tear in the brain tissue.
What signs and symptoms may you see in a person with concussion?
Altered LOC that slowly improves.
Unable to remember incident
What is coup and contrecoup injuries?
Damage to the brain at the point of blow and on the opposite side of the impact.
What can some signs and symptoms of a contusion of the brain be?
Profound personality change
Alteration of vital signs
What is a subdural hematoma?
Collection of blood between the dura mater and the arachnoid layer of the brain.
What generally causes subdural bleeding?
Low pressure venous bleeding
What are the two types of subdural hematoma?
Acute and Occult
What is the difference between acute and occult subdural hematomas?
Acute - signs and symptoms occur almost immediately
Occult - Bleeding occurs over time and signs and symptoms may not show for days to weeks after injury.
What are some signs and symptoms of a patient with a subdural hematoma?
Weakness or paralysis to one side of the body
Deterioration in responsiveness
Dilation of one pupil
Possible increase in systolic BP
What is an epidural hematoma?
Bleeding between the skull and dura mater.
What is parts of the circulatory system are involved with an epidural bleed?
Venous and arterial
Is epidural hematomas generally slow or rapid bleeding?
What are some signs and symptoms of an epidural hematoma?
Decreasing mental state
Loss of consciousness followed by lucid intervals
Fixed and dilated pupil
Increasing BP and decreasing pulse
Apnoea or abnormal breathing pattern
Posturing (with-drawl or flexion)
What conditions can worsen a brain injury in essence causing a secondary brain injury?
What is an ideal blood pressure to maintain for patients with a TBI?
What is a primary brain injury?
Injury to the brain as a direct result of trauma?
What is a secondary brain injury?
Injury to the brain as a result of hypoxia, high CO2 or change in BP
What is brain herniation?
When the brain is pushed out of the foramen magnum (hold in base of skull) as a result of too much blood or swelling inside the skull.
What is a simple test that can be performed on leaking fluid to determine if it is cerebrospinal fluid or tears/mucous?
A BGL test
CSF contains glucose
What would you suspect if your TBI patient had a climbing blood pressure?
Pressure inside the skull.
What are some signs of brain herniation?
Posturing (with-drawl or flexion)
Cushing reflex (Systolic hypertension and bradycardia)
Muscular weakness or paralysis
Decrease in GCS
What is a compression brain injury?
Accumulation of blood in the skull or swelling of the brain tissue.
What is intracranial haemorrhage?
Bleeding in the cranium.
What is Cushing's Reflex?
Caused by an increase in intracranial pressure.
Presents as increased systolic blood pressure, reduced heart rate (bradycardia) and irregular respiration.
Should you hyperventilate patients with a TBI?
What backup would you call if a patient has a poor airway and their GCS is less than or equal to 10 and they have a TBI?
ICP or doctor skilled in RSI if they can get to you faster than you can get to hospital.
What is you recommendation to all patients that suffer a loss of consciousness following trauma?
Recommendation to be transported to hospital.
If you have a TBI patient that is hypotensive - what should you suspect?
Other injury which may be bleeding.
Why do we try to maintain blood pressure at 120 systolic?
Keeps the brain well perfused.
What are some signs and symptoms a patient should look out for if a trauma patient refuses to go to hospital?
Difficulty recognising people or places
Behave unusually or confused
Weakness in arms or legs
What are the goals of treating TBI's?
Recognise TBI AND
Minimise or prevent secondary injury AND
Treat other life threatening injuries AND
Transport to hospital
What is the goal of fluid therapy with a TBI?
Minimise hypotension, but not to give too much in case of brain swelling
What do you presume about all patients with alcohol or drug intoxication following trauma who cannot obey commands?
That they have a TBI.
What is another common condition that can mimic a TBI?
What should you always do with a patient you suspect of having a TBI as part of your vital signs assessment?
Is it common for a TBI child patient to have a seizure?
What medications patient may be taking can pose a greater risk to developing bleeding after a injury to the brain?
Those on blood thinners and antiplatelet medications.
What does hyperventilation cause to happen in patients with TBI's?
Causes vasoconstriction which decreases cerebral blood flow.
What is the preferred method for ventilating patients with a TBI?
RSI - other intubation may worsen outcomes by increasing secondary injury and increasing intracranial pressure.