Head Injury

Question 1

What is the lowest total GCS score?

Answer 1

3 - No response to E/V/M

Question 2

what is the highest total GCS score?

Answer 2

15

Question 3

GCS score parameters

Answer 3

Eye opening
Verbal response
Motor response

Question 4

Highest score for each GCS parameters

Answer 4

E - 4
V - 5
M - 6

Question 5

Head Injury GCS classification

Answer 5

Minimal - 15, with NO LOC
Mild - GCS 13-15
Moderate - GCS 9-13
Severe - GCS 3-8

Question 6

Head Injury Sx

Answer 6

1. Pain in the head or neck
2. Loss of consciousness or drowsiness
3. Confusion or amnesia (memory loss)
4. Seizures
5. Vomiting
6. Changes to vision or hearing
7. Neurological Sx: weakness, sensory changes, ataxia or difficulty speaking

Question 7

Head Injury clinical presentations

Answer 7

External: Scalp lacerations or haematoma
Retinal haemorrhages/papilloedema
Unequal/Unresponsive pupils
Down/out gaze: CN III palsy

Question 8

Basal Skull Fracture presentation

Answer 8

• Periorbital haematomas
• Clear discharge from ear/nose (CSF leakage)
• Battle’s sign: mastoid bruise
• blood behind TM: Haemotypanum

Question 9

Cushing’s Traid

Raise ICP presentations

Answer 9

HTN, Bradycardia, SOB

Question 10

Airways Mx for GCS <8

Answer 10

Maintain Airways: Intubation/Ventilation

Question 11

Head Injury choice of imaging

Answer 11

non-contrast CT head

Question 12

Head Injury Acute Mx

Answer 12

1. IV flud: Hypotensive
2. O2: for low O2 sat
3. Pain Mx: for Raised ICP
4. Tranexamic acid: for GCS <12
5. Reverse anticoagulation
6. Maintain normoglycaemia: insulin/dextrose

how

Question 13

GCS Eye opening scale

Answer 13

4 - Spontaneous
3 - Sound
2 - Pressure
1 - No response

Question 14

GCS Verbal response scale

Answer 14

5 - Orientated
4 - Confusion
3 - Words
2 - Sound
1 - non verbal

Question 15

GCS Motor scale

Answer 15

6 - Obeys commands
5 - Moves to localised pain
4 - Flex to withdraw from pain
3 - Abnormal flexion
2 - abnormal extension
1 - No response

Question 16

1h CT head scan criteria for Head Injury

Answer 16

1. GCS <13 on initial assesment OR GCS <15, 2h after injury
2. > 1 vomiting
3. Post-traumatic seizure
4. Focal neurology deficit
5. Open/Depressed fracture
6. Signs of basal skull fracture

Question 17

8h CT head scan criteria for Head Injury

Answer 17

On an anti-coagulant, or they have suffered LOC / memory loss AND
1. age 65 or over
2. any current bleeding or clotting disorders
3. dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of more than 1 m or 5 stairs)
4. more than 30 minutes’ retrograde amnesia of events immediately before the head injury.

Question 18

Raised ICP Mx in head injury

Answer 18

1. Pain analgesia
2. Mannitol or Hypertonic saline

Question 19

Define Head injury

Answer 19

A patient who has sustained any form of trauma to the head, regardless of whether they have any symptoms of neurological damage

Question 20

Define Traumatic Brain Injury

Answer 20

Evidence of damage to the brain as a result from trauma to the head, represented with a reduced GCS or presence of a focal neurological deficit

Question 21

Time frame for assessing patient with evidence head injury

Answer 21

examined within 15 mins of arrival to assess brain / spine injury

Question 22

which other part of the body needs to be assess during a head injury

Answer 22

Cervical spine - consider immobilisation

Question 23

A in Head injury

Answer 23

GCS <8 - on-call anaesthetic team
Suspected C-spine injury - jaw thrust

Question 24

Airway Mx for basal skull fracture

Answer 24

1. Oropharyngeal Airway (OPA): does not pass through the nose and avoids potential complications associated with a basal skull fracture
2. Edotracheal intubation

Question 25

Airway Mx contraindicated in **basal skull fracture** and why

Answer 25

Nasopharyngeal airways (NPA) - Risk of Inserting the **NPA into the Brain or Cranium** (further damage, particularly concerning if there is **CSF** leakage) - Compromised Nasal Structures: Basal skull fractures can result in damage to the nasal passages and sinuses, and inserting an NPA may exacerbate bleeding - Increased Risk of Infection: NPA could introduce bacteria into the cranial cavity, increasing the risk of meningitis or other infections

Question 26

basal skull fracture complications

Answer 26

- CSF leakage - damage to cranial nerves - increased risk of infection (e.g., meningitis)

Question 27

Head injury RED FLAGS

Answer 27

- Impaired consciousness level - **Dilated pupils** which **do not respond to light** **(“fixed and dilated”)** - Signs of basal skull fracture - Focal neurological deficit or visual disturbances - Seizures or amnesia - Significant headache or nausea and vomiting

Question 28

Raised ICP Sx

Answer 28

Worsening headaches dull / localised frontal pain Bilateral papillodeama

Question 29

Raised ICP gold standard Ix

Answer 29

Lumbar puncture (LP) is the gold standard for diagnosing raised intracranial pressure (ICP)

Question 30

Raised ICP CSF feature

Answer 30

elevated CSF pressure