Head Injury & Neuro

Question 1

A systolic BP of atleast… mmHg is desired in patients with isolated severe TBI

Answer 1

100 mmHg

Question 2

Agents to reduce ICP include

Answer 2

Osmotic diuretics and hypertonic crystalloid

Question 3

For severe brain injury, management to ensure neuroprotective care includes

Answer 3

Systolic BP > 100 mmHg and < 150 mmHg
Sp02 >94%
ETCO2 4 - 4.5kpa
BM - normal
Temp - normothermia
TXA if GCS >13 within 3hrs of injury

Question 4

Head injury is the most common cause of death in people aged less than

Answer 4

40 years old

Question 5

Head injury severity is classified into what three categories?

Answer 5

Minor GCS 14-15
Moderate GCS 9-13
Major 8 or less

Question 6

Hemorrhage can occur in the brain tissue itself and in the

Answer 6

Subdural, extra-dural or intercranial

Question 7

How does mannitol work?

Answer 7

Reduces ICP by reducing blood viscosity (immediate effect) and increasing serum osmolarity (delayed effect)

Note, it’s diuretic effect will exacerbate hypovolemia

Question 8

Hyperacute head injury is?

Answer 8

The collective term for describing the immediate physiological effects seen after a concussive brain injury

Question 9

Hypertonic saline solutions work by

Answer 9

Increasing serum osmolarity, moving fluid from the intracellular space to the extracellular compartments

Question 10

Hyperventilation to manage ETCO2 is no longer recommended because?

Answer 10

Cerebral ischaemia is worsened

Question 11

Hypotension in the patient with severe head injury is not always due to hypovolemia, what else should you consider?

Answer 11

A neuro-cardiogenic component if no sign of bleeding, high-normal ETC02 or poor contractility on echo

Question 12

In patients with a mild HI, perform a CT within 8hrs of head Injury for the following

Answer 12

Age 65 or older
Hx of clotting/ bleeding disorder
Dangerous MOI
More than 30min of retrograde amnesia of events immediately before the injury

Question 13

In patients with severe head injuries, try t0 maintain a cerebral perfusion pressure (CPP) of?

Answer 13

60-70mmHg

Question 14

In the ventilated patient, how should cerebral drainage be optimised?

Answer 14

Loosen tube ties
Loosen c-spine collar
Place patient at 30 degrees head up

Question 15

Indications for PHEA in head-injured patients

Answer 15

The cardiac injury and subsequent cardiogenic failure resulting from a severe concussive force to the brain.

Myocardial cells are damaged by the local release of norepinephrine from myocardial sympathetic nerve terminals around the base of the heart.

The patient can present with arrythmia/ heart failure and/ or cardiogenic shock

Question 16

Neuro-ventilatory syndrome describes what?

Answer 16

A period of apnea and dysventilation that results from concussive force to the Pre-Botzinger complex within the Medulla Oblongata

Question 17

Neurogenic stunned myocardium (NSM) presents how on ecocardiogram?

Answer 17

Reverse-Takusbo picture (intact apical contraction/ impaired heart base contractility)

Question 18

Primary brain injury occurs …. and includes injuries such as?

Answer 18

Occurs at the point of injury and includes I juries such as subdural and extradural haematoma, cerebral contusions and axonal injury

Question 19

Secondary brain injury is characterised by

Answer 19

Impaired regulation of cerebral blood flow & metabolism

Question 20

Severe head injury is associated with what mortality rate?

Answer 20

High mortality rate (30%-50%)

Question 21

Three layers of meninges (inner to outer)

Answer 21

Pia mater
Arachnoid mater
Dura mater

Question 22

Three main areas of the brain

Answer 22

Cerebrum
Cerebellum
Brain stem

Question 23

When completing GCS, what is the more important? Eyes, Voice or Motor

Answer 23

Motor