Head Injury and Coma

Question 1

“Any trauma to the brain or scalp”???

Answer 1

Head Injury

Question 2

“Damage to the brain, which occurs after birth and is not related to a congenital or a degenerative disease”

Answer 2

Acquired Brain Injury

Question 3

• Stroke
• Tumour
• Infection
• Anoxia

are examples of ???

Answer 3

Non-Traumatic Brain Injury

Question 4

“A non-degenerative, non-congenital insult to the brain

from an external mechanical force”

Answer 4

Traumatic brain injury

Question 5

What % of TBI’s are Males?

Answer 5

70%

Question 6

what % of TBI’s are children under 15 years of

age?

Answer 6

33-50%

Question 7

Who’s at higher risk of TBI?

Answer 7

• young males
• previous head injuries
• Alcohol an drug abuse history
• Low- income

Question 8

Which is the most common?

A. Crushed head injurys
B. Open or Penetrating head wounds
C. Closed head injuries

Answer 8

C.

Question 9

Crush injuries often damage…?

Answer 9

The base of skull and nerves of brain stem rather than brain itself

Question 10

-cerebral oedema
-seizures
-haematoma
-increased intracranial pressure (ICP)
are examples of…?

Answer 10

Secondary damage:

Damage that evolves over time after trauma.

Question 11

What does ATLS stand for?

Answer 11

Advanced Trauma Life Support

Question 12

In ATLS what does ABCDE stand for?

Answer 12

• Airway maintenance and Cervical Spine Protection
• Breathing and Ventilation
• Circulation and haemorrhage control
• Disability – neurological status: GCS, pupils
• Exposure – undress the patient

Question 13

If someone is scored 10 on the GCS what catagory would that place them in?

Answer 13

‘moderate’

Question 14

If someone is scored 4 on the GCS what catagory would that place them in?

Answer 14

‘critical’

Question 15

-An area of localized injury that may cause pressure
within the brain.
-Sometimes called ‘mass lesions’.

what is this?

Answer 15

Focal Injuries

Question 16

What are the two main types of focal injuries?

Answer 16

Traumatic Haematoma or Contusion

Question 17

A. • Collection of blood in ‘potential’ space between
skull and outer protective lining that covers the brain.
B. • Collection of blood in space between dura mater and arachnoid mater

Which one describes a Subdural Haematoma?

Answer 17

B.

Question 18

• Blood vessel within brain bursts, allowing blood to leak inside brain
• Sudden increase in pressure can cause damage to surrounding brain cells

What is this?

Answer 18

Intracerebral Haematoma

Question 19

Which of the following is not typical of Contusions?

A. Comparable to bruises in other parts of the body - areas of injured or swollen brain mixed with blood that has leaked out of arteries, veins, or capillaries.

B. Caused by small blood vessel leaks, usually most evident on scans after 24 hours

C. • May occur with or without an associated focal injury

D. Most commonly seen at the base of the front parts of the brain, but may occur anywhere

Answer 19

C. - that’s typical of diffuse axonal injuries

Question 20

“Results from brain moving back and forth in skull as a result of acceleration or deceleration”
“One of the most common types of brain injuries, also one of the most devastating”

What is this?

Answer 20

Diffuse axonal injury

Question 21

With head injury – what injury should be assumed until proven otherwise?

Answer 21

Cervical Spine Injury

Question 22

If a fracture extends into the sinuses, there may be leakage of what from the nose or ears?

Answer 22

CSF (Cerebro-Spinal Fluid)

Question 23

• A build-up of fluid inside the skull that leads to brain swelling
• A build up of blood inside the skull that leads to brain swelling
• A blockage inside the skull that leads to brain swelling

which of these describes Hydrocephalus?

Answer 23

A build-up of fluid inside the skull that leads to brain swelling….

…It puts pressure on the brain pushing the brain up against the skull and damaging brain tissue

Question 24

Why can Hydrocephalus occur?

Answer 24

• The flow of CSF is blocked.
• The fluid isn’t properly absorbed into the blood.
• Overproduction of the fluid

Question 25

How can raised IntraCranial Pressure be managed medically?

Answer 25

▪ Sedation ▪ Maximise Venous Drainage of Brain ▪ CO2 control ▪ CSF release

Question 26

Why might a External Ventricular Drain be used?

Answer 26

* to relieve raised intracranial pressure * to divert infected CSF * to divert bloodstained CSF following neurosurgery * to divert the flow of CSF

Question 27

A• Small holes drilled in the skull and a tube is inserted to drain the haematoma and relieve pressure B• An operation where a disc of bone is removed from the skull to allow access to the underlying brain. • After the surgery the bone is replaced C• If the brain is very swollen the bone isn’t replaced until the swelling decreases, which may take several weeks. Which describes Craniotomy?

Answer 27

B.

Question 28

A• Small holes drilled in the skull and a tube is inserted to drain the haematoma and relieve pressure B• An operation where a disc of bone is removed from the skull to allow access to the underlying brain. • After the surgery the bone is replaced C• If the brain is very swollen the bone isn’t replaced until the swelling decreases, which may take several weeks. Which describes Burr Holes?

Answer 28

A.

Question 29

A• Small holes drilled in the skull and a tube is inserted to drain the haematoma and relieve pressure B• An operation where a disc of bone is removed from the skull to allow access to the underlying brain. • After the surgery the bone is replaced C• If the brain is very swollen the bone isn’t replaced until the swelling decreases, which may take several weeks. Which describes Craniectomy?

Answer 29

C.

Question 30

* GCS 8 or less * Inability to eye open, verbalise or obey * No sleep / wake cycle * No voluntary movements What is this?

Answer 30

A coma.

Question 31

What two systems regulate and control consciousness?

Answer 31

1. The Cerebral Cortex | 2. The Reticular Activating System

Question 32

What are functions of the Cerebral Cortex?

Answer 32

* Perception * Sensation (via thalamus) * Movement * Vision * Thought

Question 33

What does the Reticular Activating system control?

Answer 33

- Arousal - Sleep - Awakening

Question 34

What does the Pons (brainstem) do?

Answer 34

-Contains nuclei that relay signals from the forebrain to the cerebellum -nuclei that deal primarily with sleep, respiration, swallowing, bladder control, hearing, equilibrium, taste, eye movement, facial expressions, facial sensation, and posture

Question 35

which part of the brainstem is associated with vision, hearing, motor control, sleep/wake, alertness, and temperature regulation?

Answer 35

The Midbrain.

Question 36

Which part of the brainstem contains the cardiac, respiratory, vomiting, and regulate involuntary functions such as breathing, heart rate, and blood pressure?

Answer 36

The Medulla.

Question 37

Which cause of coma has a better prognosis? - Hypoxia/Ischaemia - Haemorrhage/Stroke

Answer 37

neither are good prognosis. -Hypoxia/ Ischaemia has a better prognosis however (<10% chance of recovery) (Haemorage has a <5% chance of recovery)

Question 38

after over 24 hours coma, whats the % prognosis?

Answer 38

10% chance of recovery

Question 39

prognosis after 7 days in coma?

Answer 39

3% chance of recovery

Question 40

Whats the difference between brain death and a vegitive state?

Answer 40

- When someone is brain dead they have no arousal or awareness - when someone is in a vegitive state they have no awareness but do have arousal

Question 41

* Unconscious and no response to outside stimulation * Heartbeat and breathing can only be maintained using a ventilator * Clear evidence that serious brain damage has occurred and it can't be cured what diagnosis might be made from this?

Answer 41

Brain stem death.