Traumatic Brain Injury

Question 1

Closed traumatic injury vs open/penetrating traumatic injury

Answer 1

closed: bump on the head

open/penetrating: gunshot wound

Question 2

Risk factors for TBI

Answer 2

Males

0-4 years old: learning to walk, top heavy

15-19 years old: driving, experimenting with drugs/alcohol

Question 3

Primary causes of TBI

Answer 3

Falls, MVCs, assaults (lower socioeconomic areas have higher crime rates)

Question 4

How are head injuries diagnosed and classified?

Answer 4

using the GCS

mild: 13-15
moderate: 9-12
severe: 3-8

Question 5

Important to manage in TBI patients

Answer 5

Blood Pressure is extremely important to manage

Hypotension decreases cerebral perfusion and leads to ischemia

Hypertension leads to vasogenic edema and increases ICP

Question 6

Complications of skull fractures

Answer 6

increased risk for hematoma, infection, cranial nerve injury

Can cause HA, bleeding, restlessness, neuro changes

Question 7

Basilar skull fractures

Answer 7

S/S: battle sign (bruising behind ears), raccoon eyes, runny nose

NO NG TUBES bc they can go into the brain

Question 8

Treatment of skull fractures

Answer 8

linear fracture: observation
comminuted/depressed fracture: surgery
basilar fracture: no surgery unless persistent CSF leakage

Question 9

Medications for skull fractures

Answer 9

Dexamethasone: steroid to decrease inflammation
Antibiotics for infection
Pain meds: don’t overmedicate with narcotics bc they can mask true neuro status

Question 10

What is diffuse axonal injury (DAI)?

Answer 10

twisting of the brain and axons causes axons to break

S/S: petechial hemorrhage on CT/MRI, decreased LOC, increased ICP, posturing (extending or flexing), global cerebral edema

Question 11

Types of intracranial hemorrhage

Answer 11

Classified by location

subdural hematoma, epidural hematoma, intracerebral hematoma

Question 12

Subdural hematoma

Answer 12

usually a venous bleed so it occurs slower; people tend to deteriorate over time (bleeds over months)

Seen in older people

Question 13

Treatment of subdural hematoma

Answer 13

Monitor patient; sometimes requires no intervention

Question 14

Epidural hematoma

Answer 14

develops between the dura and the skull

Usually caused by a tear in the middle meningeal artery (arterial bleed = rapid deterioration)

“Talk and die syndrome”: these patients go from being totally awake to crashing quickly

Question 15

Treatment of epidural hematoma

Answer 15

Go to the OR stat to relieve pressure and stop the bleed

Question 16

Intracerebral hematoma

Answer 16

bleeding into the brain tissue: most common in the frontal or temporal lobes

usually caused by a closed head injury or hemorrhagic stroke

Question 17

Treatment of intracerebral hematoma

Answer 17

not necessarily any surgical intervention that we can do

Question 18

Explain coup countercoup injury

Answer 18

coup: initial impact/trauma
countrecoup: secondary injury caused by whiplash of the brain on the opposite side of impact

Question 19

Cerebral edema

Answer 19

causes: trauma, obstruction of venous outflow, damage to the blood-brain barrier, mechanical failure of Na, K, and water regulation

swelling = tissue compression and increased ICP

leads to neuro deficits and herniation