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Ppnp 3 > head injury > Flashcards

head injury Flashcards

(51 cards)

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1
Q

how many types of brain injury are there?

A

2, primary and secondary

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2
Q

explain primary HI

A
  • caused by impact or initial insult
    Include diffuse axonal injury and the focal lesions of laceration, contusion
    and hemorrhage
    ○ Focal / Polar / Diffuse
    ○ Intracranial hematomas
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3
Q

what is focal in primary HI>

A

particular spot in the brain

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4
Q

what is polar in primary HI?

A

brain shift within the skul and meninges, injuries at 2 opposite poles

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5
Q

what is diffuse in primary Hi?

A

widespread neuronal damage

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6
Q

examples of intracranial haemorrhage in primary HI

A

➢ Epidural, Subdural Subarachnoid

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7
Q

explain secondary HI

A

Progressive damage resulting from a physiologic response to an initial insult
○ Damage results from the subsequent brain swelling, infection, and cerebral hypoxia.
○ Often diffuse or multifocal, including concussion, infection, and hypoxic brain injury

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8
Q

what causes brain injury? (5)

A

Trauma, tumours, stroke, metabolic derangements, degenerative disorders

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9
Q

explain the different score band for GCS

A

3 - 8: Coma
9 - 12: Moderate head injury
15: fully conscious
Score >11: 85% chance of recovery

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10
Q

what are the symptoms of HI?

A

Changes in level of consciousness - may fluctuate; RAS
dependent
○ Confusion, delirium, obtundation, stupor, coma
● Alterations in sensory & motor functions
● Alterations in cranial nerve reflexes

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11
Q

what is RAS?

A

Reticular Activating System

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12
Q

what is obtundation?

A

less than full alertness with decrease interest, slower reaction to stimulus

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13
Q

what is stupor?

A

near unconsciousness

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14
Q

what is decorticate posture? score 3 for motor

A

Abnormal flexor response of arms and wrist
➢ Leg and feet extend and internally

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15
Q

what is decerebrate posture (score 2 for motor)

A

extensor

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16
Q

what parts of the brain does the pupil reflex test, tests on

A

Function of the brainstem and CN II & III

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17
Q

what does it indicate if the patient’s pupil reflex test is abnormal?

A

of brain herniation

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18
Q

how does increasing ICP affect the eye?

A

Increasing ICP may impair eye movements controlled by CN III, IV, VI

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19
Q

what does the oculovestibular reflex test on. how do u do it?

A

brainstem dysfunction.

caloric water test or dolls eye. test/

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20
Q

what is the corneal reflex?

A

test if u blink to stimulus.

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21
Q

what does abnormal result in corneal reflex test indicates?

Study These Flashcards
A

Absence of blink response, indicator of severely impaired brain function

22
Q

how many types of primary injury are there?

Study These Flashcards
A
  1. focal, polar, diffuse, intracranial hematomas
23
Q

what is a characteristic of linear fracture?

Study These Flashcards
A

Lucent lines, it indicate bone separation and dense lines, overlap

24
Q

what does linear fracture cause?

Study These Flashcards
A

● Causes rupture of meningeal vessels

25
how many types of depressed fracture are there? please list them
3 in total ● Stellate: ● Eggshell: ● Open fractures associated with infections
26
how do you identify a stellate fracture? what does it mean?
starburst shaped, multiple fracture points that radiate outward from a central point.impact by blunt objects. Underlying brain injury
27
how do u identify eggshell fracture and in which scenarios is it commonly seen?
fine delicate cracks in thin brittle bones such as elderly and children, child abuse
28
is it easy to identify eggshell fracture on xray?
no :(
29
how many types of skull fracture are there in terms of category?
3, linear depressed, basal skull fracture
30
is it easy to detect basal skull fracture?
DIFFICULT in view of irregular dense bones
31
how do you identify a basal skull fracture without the use of diagnostic machines? (4)
1) hemotympanum - blood in middle ear 2)CSF rhinorrhea and otorrhea 3)postauricular ecchymoses ( battle's sign) 4) periorbital ecchymoses ( raccon's eyes)
32
what are the usual symptoms associated with a HI?
scalp wound lOC fracture swelling, bruising nasal discharge stiff neck
33
what are fractures at the base of skull associated with.
cranial nerve injuries. anosmia, nystagmus, partial loss of vision, facial palsy vertigo
34
how many types of intracranial lesions are there?
6 concussions, contussion extradural haematoma subdural haematoma subarachnoid haematoma intracerebral haematom
35
what is concussion?
immediate transient LOC - dazed, star struck situation
36
what are the causes of a concussion?
Rotation of the cerebral hemispheres on the relatively fixed brainstem ➢ Electro-physiological dysfunction of the reticular activating system ➢ No structural lesion & residual sequelae
37
what are the clinical features of concussion? (3)
Amnesia may occur after injury ➢ Retrograde amnesia ● Memory loss for events before the injury ● May indicate severity of the lesion ➢ Antegrade amnesia ● For events after, very brief
38
how many types of amnesia are there?
2 retrograde ● Memory loss for events before the injury ● May indicate severity of the lesion antegrade ● For events after, very brief
39
what is contussion?
Head injury resulting in haemorrhage into brain tissue
40
what are the causes of contussion?
➢ Due to deceleration of the brain against the skull rupturing the blood vessels on the surface of the brain ➢ Frontal and occipital poles affected ➢ Coup injury ● Directly under point of impact ➢ Contrecoup injury ● At a point opposite to the point of impact
41
what is coup injury?
● Directly under point of impact
42
what is contrecoup injury?
At a point opposite to the point of impact
43
what are the clinical features of contussion? (5)
Hemiparesis or gaze paralysis may occur with frontal injuries ➢ Visual defect in occipital injuries ➢ Cranial nerve dysfunction - commonly olfactory ➢ More severe injury causes cerebral edema, decorticate or decerebrate rigidity ➢ If cerebral lesions are bilateral ⇒ coma
44
what is extradural haematoma?
Bleeding is between skull & dura Due to direct trauma causing # temporal bone and damage to middle meningeal artery ➢ As the bleeding is arterial, there is rapid worsening of the patient’s condition
45
what is the clinical features of a extradural haematoma? (4)
➢ Brief LOC (due to concussion) followed by a short "lucid interval" then, coma again (progressive neurological deterioration due to herniation) ➢ Carries a bad prognosis ➢ Usually requires surgical evacuation ➢ Untreated: decerebrate rigidity, coma, death
46
how does the duration of LOC differes between extradural haematoma and acute SDH?
EDH is short, SDH is long
47
what is SDH
Bleeding is between dura mater and arachnoid membrane May not be associated with any surface injuries on the scalp ● Follows severe head injury – change in velocity ● Due to rupture of surface cerebral veins that join the dural venous sinuses ● Twice as common as extradural hematoma
48
what are the symptoms of SDH (4)
Brief LOC (due to concussion) followed by a relatively longer "lucid interval" then, coma again (progressive neurological deterioration due to herniation) ● Carries a bad prognosis if associated with cerebral injury due high velocity ● Usually requires surgical evacuation ● Untreated: decerebrate rigidity, coma, death
49
what are the causes of chronic SDH?
➢ Cause ● Common in elderly > 60 y/o ● minor injuries which may not be remembered ● Due to shrinking of the brain coupled with fragility of blood vessels
50
what are the clinical features of chronic SDH? (7)
Signs & symptoms appear months to years after trivial injury ● Due to slow accumulation of venous blood around atrophied brain ● Symptoms and signs may be absent, non-specific, non-localising ● Commonly experience minor headaches over a period of time because of slow bleeding ● Other symptoms: personality changes, fluctuating drowsiness, confusion, weakness, seizures ● Can be confused with stroke, dementia ● Potentially treatable
51
what should u assess for HI patients? (7) and not do.
● Vital signs – ABC ● Secure airway and IV line ● Protect cervical spine in collar ● No morphine or depressants! ● Hourly vital signs, GCS ● Arrange for urgent CT scan head ● Neurological assessment for severity of head injury

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