Flashcards in Brain Injury Deck (58):
Traumatic Brain Injury?
damage to the brain from external mechanical forces
Traumatic brain injury epidemiology?
trauam is the most common cx of death 1-45yo - 50% head injury
Head vs brain injury?
Head: laceration of the head, scalp
brain: the BRAIN is injured
Traumatic brain injury cx?
direct impact (car accident and hit your head through the windshield)
rapid acceleration or deceleration (brain sloshing around but not hitting the head anything)
blast waves (military)
Traumatic brain injury classification?
TBI - YA cx? Adults cx?
YA - MVA
Primary injury: Intra-axial injury?
-shearing: axonal injury (the gray and white matter shear from going different directions)
-Coup/countrecoup: cerebral contusion (head injury from hitting the skulls: front and back)
Primary - extra-axial injury?
Direct for injury
-epidural: high impact --> fx --> arterial injury (min to hrs) --> lenticular shape --> recovery is ok b/c brain is separated
-subdural: lower force --> no skull fx --> injury to the vein --> crescent shape --> recovery is not so ok b/c brain is not separated
-subarachnoid: spontaneous or high force --> small vessels/Death Star --> THUNDERCLAP
Traumatic brain injury - hx?
mechanism (did they fall from the stairs, rug on the carpet, etc)
LOC - loss of consciousness (long or short?)
HA (secondary from brain trauma)
focal neural complaints
neck pain (comes in together w/ brain injury)
Secondary traumatic brain injury?
molecular injury mechanisms that start from the beginning of the trauma but lasts for hrs or days
leads to neuronal cell death and cerebral edema and ICP to worsen brain injury
Traumatic brain injury - what PE do you do?
glasgoow coma scale
Traumatic brain injury - what are you looking for/PE?
external findings -hematomas, depresison, lacertions
signs of ICP
signs of basilar skull fx
Signs of ICP?
Cushing response (bradycardia, HTN, dec respiratory drive)
DEC: heart and respiratory (parasympathetic tries to cancel out sympathetic)
HTN (sympathetic runs first - so HTN)
Basilar skull fracture?
*blood mixed w/ CSF
TBI - dx studies?
CT scan (GCS<14, detects skull fractures, intracranial hematomas, cerebral edema)
Lumbar puncture (detect blood in CSF, if CT is questionable for subarachnoid)
Traumatic brain injury- what can you use to estimate pt's consciousness?
Glasgow coma scale
TBI - tx prehospital?
prevent hypotension and hypoxia (can cx secondary injury)
- isotonic crystalloids (normal saline)
-intubtion for GCS <8
TBI - tx ED?
1) maintain vitals (BP 90, 02 greater 60)
2) neuro exam w/ GCS
3 assess systemic trauma
4) check labs (CBC - not hemorrhaging GI, lytes, glucose, coags - pt on warfarin? BAD, ETOH-messes up GCS -> auto CT, DAS)
Severe TBI tx?
osmotic therapy (mannitol for hypertonic saline)
TBI -tx ICU?
-maintain vitals (BP 90, 02 60)
-increased ICP (osmotic tx, hyperventilation, sedation)
limit secondary brain injury (seizure - phenytoin, fever - hypothermia, glucose - insulin therapy, coag - vitamin K, FFP)
TBI tx - surgery?
TBI - prognosis?
severe - most likely to die
mild - good recovery
Severe TBI survivors?
25% functional independence (GCS <8)
5-15% are vegetative state and 50% wake up in a yr
trauma induced alteration in mental status
TBI - epidemiology of mild?
Mild TBI - cx? - GCS?
injury d/t contact or acceleration/deceleration froces
resulting in GCS 13-15
30min post injury
Mild TBI - etiology?
occupation accident 10%
Recreational accident (sports) 10%
Mild TBI - primary?
shearing forces in mild axonal injury
Mild TBI - patho?
1)Structure - TBI but mild
2)Function - shear strain
-lactic acid accumulation
-decreased blood flow
TBI mild - secondary?
free rdiacl release --> brian metabolism disruption
Mild TBI - hx/sx?
hallmark: confusion and amnesia
Mild TBI - early sx?
lack of awareness
min to hours
Mild TBI - late sx?
mood and cognitive disturbance
sensitivity to light and noise
hours and days
Mild TBI - PE?
evaluate head for hematomas, lacerations
Mild TBI - assessment?
SAC - mostly used
SCAT - sports
imPACT-screening before starting sports (baseline)
Mild TBI - dx testing?
CT - first line
MRI - persistent sequelae (secondary injury)
Decision to CT head injury?
Canadian CT rule
New Orleans criteria (ONLY FOR GCS 15)
loss conscious, N&V, altered mental status, worst HA ever, hematoma, ETOH
Concussion grading scale?
Grade 1 (mild), 2 (mod), 3 (severe) based on consciousness or not
(confused, amnesia >15min)
BUT loss of consciousness DOES NOT have ANYTHING
Concussion of Mild TBI - discharge criteria?
GCS = 15
Concussion and mild TBI - admit?
no responsible caregiver
Concussion and mild TBI - sx care?
sx resolve over 7-10days
DO NOT TAKE NSAIDS-GIVE THEM TYLENOL!!!
Concussion and mild TBI - discharge instruction?
physical and cognitive rest for 24-48 hrs (bed rest)
slowly return back to work (5 days)
Concussion and mild TBI - return to ED?
cannot wake pt (when they're sleeping randomly)
somnolence or confusion
vomit more than 1x
urinary and bowel incontinence
CAN INDICATE INC ICP
Concussion - sport players tx?
NO return to play if symptomatic
no return to play for 24 hrs
Complication of concussion and mild TBI?
post concussion sx (sx that resolves over wks, mo)
chronic traumatic encephalopathy
post traumatic HA, epilepsy
Post concussion syndrome?
common symptom complex sequelae of mild TBI
Post concussion sx patho?
Post concussion sx-structural/biochem patho?
white matter abnormality - scarring
Post concussion sx - psychogenic patho?
sx similar to somatization in psychiatric disorders
lack of sleep, mood, irritability --> internally pain turns into physical pain
Post concussion sx - sx?
concussion like- but lasts longer
Post concussiosn sx - dx test?
CT scan- first line, abnormality found
Post concussion sx - tx?
Simple reassurance - 3mo
symptomatic approach (insomonia, dizziness, etc)
eduation - pt, family teacers, employers, attornes, insurance companies (let them be aware b/c it can all affect work, school, etc)
Post concussion sx - prognosis?
first 7-10 days: sx and disabilities the greatest
1 mo: sx are improved
3 mo: largely recovered
1yr: 10-155 ongoing sx (post traumatic HA)
Chronic traumatic encephalopathy-epidemiology?
combat related blast injuries
CTE - PE?
cognitive impairment - memory loss, dementia
neurosychological sx - behavior, personality changes, depression, suicidality
neurodegenerative sx - parkinsonims, speech and gait abnormalities
radiopharmaceutical that binds to tau proteins --> MRI/PET