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Flashcards in Brain Injury Deck (58):
0

Traumatic Brain Injury?

damage to the brain from external mechanical forces

1

Traumatic brain injury epidemiology?

trauam is the most common cx of death 1-45yo - 50% head injury

2

Head vs brain injury?

Head: laceration of the head, scalp
brain: the BRAIN is injured

3

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)

4

Traumatic brain injury classification?

Primary
Secondary

5

TBI - YA cx? Adults cx?

YA - MVA
Adults- falls

6

Primary injury: Intra-axial injury?

acceleration-deceleration 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)

7

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

8

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)
visual changes
focal neural complaints
neck pain (comes in together w/ brain injury)
seizures

9

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

10

Traumatic brain injury - what PE do you do?

neuro exam
glasgoow coma scale

11

Traumatic brain injury - what are you looking for/PE?

external findings -hematomas, depresison, lacertions
signs of ICP
signs of basilar skull fx

12

Signs of ICP?

fixed/dilated pupils
decorticate/decerebrate
Cushing response (bradycardia, HTN, dec respiratory drive)

13

Cushing response?

DEC: heart and respiratory (parasympathetic tries to cancel out sympathetic)
HTN (sympathetic runs first - so HTN)

14

Basilar skull fracture?

battle sign
raccoon eyes
hemotympnum
otorrhea
rhinorrhea
*blood mixed w/ CSF

15

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)

16

Traumatic brain injury- what can you use to estimate pt's consciousness?

Glasgow coma scale
TBI classes
general rules

17

TBI - tx prehospital?

prevent hypotension and hypoxia (can cx secondary injury)
- isotonic crystalloids (normal saline)
-intubtion for GCS <8
backboard (Cspine)

18

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)

19

Severe TBI tx?

head elevation
osmotic therapy (mannitol for hypertonic saline)

20

TBI -tx ICU?

monitor ICP
-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)

21

TBI tx - surgery?

Burr hole
Craniotomy

22

TBI - prognosis?

severe - most likely to die
mild - good recovery

23

Severe TBI survivors?

disabled
25% functional independence (GCS <8)
5-15% are vegetative state and 50% wake up in a yr

24

Concussion?

trauma induced alteration in mental status

25

TBI - epidemiology of mild?

75-95%

26

Mild TBI - cx? - GCS?

injury d/t contact or acceleration/deceleration froces
resulting in GCS 13-15
30min post injury

27

Mild TBI - etiology?

MVA 20-45%
Falls 30-38%
occupation accident 10%
Recreational accident (sports) 10%
Assaults 5-17%

28

Mild TBI - primary?

shearing forces in mild axonal injury

29

Mild TBI - patho?

1)Structure - TBI but mild
-primary
-secondary
-complicated
2)Function - shear strain
-neuronal depolrization
-lactic acid accumulation
-decreased blood flow

30

TBI mild - secondary?

free rdiacl release --> brian metabolism disruption

31

Mild TBI - hx/sx?

hallmark: confusion and amnesia
with/out LOC

32

Mild TBI - early sx?

HA
dizziness
lack of awareness
N&V
min to hours

33

Mild TBI - late sx?

mood and cognitive disturbance
sensitivity to light and noise
sleep disturbances
hours and days

34

Mild TBI - PE?

evaluate head for hematomas, lacerations
neck injuries

35

Mild TBI - assessment?

SAC - mostly used
SCAT - sports
imPACT-screening before starting sports (baseline)

36

Mild TBI - dx testing?

CT - first line
MRI - persistent sequelae (secondary injury)

37

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

38

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

39

Concussion of Mild TBI - discharge criteria?

GCS = 15
no sx
normal exam
normal CT
no bleeding

40

Concussion and mild TBI - admit?

GCS <15
seizures
abnormal CT
aogulopsthy
no responsible caregiver

41

Concussion and mild TBI - sx care?

sx resolve over 7-10days
DO NOT TAKE NSAIDS-GIVE THEM TYLENOL!!!
NO narcotics

42

Concussion and mild TBI - discharge instruction?

physical and cognitive rest for 24-48 hrs (bed rest)
slowly return back to work (5 days)

43

Concussion and mild TBI - return to ED?

cannot wake pt (when they're sleeping randomly)
worsening HA
somnolence or confusion
restlessnes
gat probs
seizures
vision
vomit more than 1x
fever
stiff neck
urinary and bowel incontinence
weakness/numbness
CAN INDICATE INC ICP

44

Concussion - sport players tx?

NO return to play if symptomatic
no return to play for 24 hrs

45

Complication of concussion and mild TBI?

post concussion sx (sx that resolves over wks, mo)
chronic traumatic encephalopathy
post traumatic HA, epilepsy

46

Post concussion syndrome?

common symptom complex sequelae of mild TBI

47

Post concussion sx patho?

structural/biochemical
psychogenic

48

Post concussion sx-structural/biochem patho?

global atrophy
white matter abnormality - scarring

49

Post concussion sx - psychogenic patho?

sx similar to somatization in psychiatric disorders
lack of sleep, mood, irritability --> internally pain turns into physical pain

50

Post concussion sx - sx?

cognitive
thinking
emotional
concussion like- but lasts longer

51

Post concussiosn sx - dx test?

CT scan- first line, abnormality found
MRI
neurophyscological

52

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)

53

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)

54

Chronic traumatic encephalopathy-epidemiology?

prof boxers
NF
combat related blast injuries

55

CTE - PE?

cognitive impairment - memory loss, dementia
neurosychological sx - behavior, personality changes, depression, suicidality
neurodegenerative sx - parkinsonims, speech and gait abnormalities

56

CTE-dx?

autopsy
radiopharmaceutical that binds to tau proteins --> MRI/PET

57

CTE- prevention?

helmets