Applied physiology:The Clinical Management of Head Injury Flashcards
(54 cards)
How many head injury attendances are there per year in Scotland?
100,000
What is the male to female ratio of head injuries?
2:1
What age groups are most frequently affected by head injuries?
- Early 20s and early 80s
What percentage of those who turn up to AandE with a head injury are admitted?
15% (children make up a 1/3, more challenging to assess)
What is the leading cause of death in under 45s?
Trauma (50% head injury)
What percentage of adult head injuries involve alcohol?
65%
What is a primary brain injury?
- Occurs at the moment of impact
- Pattern and extent of damage depends on nature of impact
- Not treatable
- Target prevention (public health issue)
What is a secondary brain injury?
- Secondary processes after primary brain injury which occur at the cell and molecular level to exacerbate neurological damage
What is done to minimise the impact of secondary brain injury?
- Optimise oxygenation
- Optimise cerebral perfusion
- Blood glucose
- Hypo/hypercapnia - maintain normal CO2
- Body temperature - maintain
What gene increases the risk of brain injury?
ApoE4
What processes can cause secondary brain injury?
- Lactic acid increased ATP depleted
- Membrane pump failure causing glutamate release
- Free radical generation
- Calcium mediated damage
- Inflammatory response
- Mitochondrial dysfunction
- Early gene activation
What 2 things cause a rise in intracranial volume in traumatic brain injury?
- Oedema (of specific cells or organ itself)
- Haematoma
What does secondary brain injury involve?
- Ischaemia, excitotoxicity, and cellular energy failure
- Neuronal death cascades
- Cerebral oedema
- Inflammation
How does primary brain injusry lead to secondary?
- Activation of biomeolecular mediators of injury
- Neuronal damage
- Cytotoxic oedema
- Cerebral vessel damage, opening of BBB
- Increased interstitial fluid and tissue pressure
- Vasogenic oedema
- Decreased Cerebral perfusion pressure
- Vasodilation
- Increased cerebral blood volume
- Increased intracranial pressure
What procedure is most commonly done to asses a head injury?
CT scan
What head imjury patients should be sent to hospital?
- Extremes of age
- Amnesia for events before or after injury
- Any loss of consciousness
- High energy injury
- Vomitting
- Seizure (previous neurosurgery)
- Bleeding/clotting disorder
What are the different scorings for eyes in the GCS?
- 4 - eyes open spontaneously
- 3 - eyes open to speech
- 2 - eyes open in response to pain
- 1 - eyes do not open
Record NT If patient is unable to open eyes due to bandages, swelling etc.
What are the different scorings for verbal response in the GCS?
- 5 - Orientated
- 4 - Confused
- 3 - Inappropriate words
- 2 - Incomprehensable sounds
- 1 - No response despite verbal and physical stimuli
Record NT if dysphasic, record T if intubated
What are the different scorings for motor response in the GCS?
6 - Obeys commands 5 - Localises to central pain 4 - Normal flexion towards source of pain 3 - Abnormal flexion 2 - Extension to pain 1 - No response to painful stimuli
What are the different degrees of injury according to the GCS?
- Minimal = 15
- Mild 13-15
- Moderate 9-12
- Severe 8 or less
What is considered a coma on the GCS?
GCS of 8 or less
What is the mortality for a severe brain injury (GCS of 8 or less)
23% (over half have substantial disability at total recovery)
What signs mean you should request a CT scan immeadiately in adult patients?
- GCS <13 on initial assessment in AandE
- GCS <15 2 hors after injury
- SUspected open or depressed skull
- Any sign of basal skull
- Post traumatic seizure
- 1 or more episode of vomitting (3 in kids)
- Amnesia for events more than 30 mins before impact
What are red flags (don not discharge) ?
- Loss of consciousness, drowsiness, confucion, fits
- Painful headache which doesn’t settle, vomitting or visual disturbances
- 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
