Head Trauma Flashcards
(51 cards)
What is the definition of head trauma?
Injury to scalp, skull, or brain
What is the definition of a traumatic brain injury (TBI)?
Injury to brain tissue / vessels with any change in mentation, no matter how brief, following head trauma
What mechanism of action (MOI) is the most common cause of TBI?
Falls (28%)
What are the three main components of the Glasgow Coma Scale (GCS)?
Eye Opening, Verbal Response, Motor Response
What is the point breakdown for Eye Opening in the GCS?
4 = Spontaneous 3 = To voice 2 = To pain 1 = None
What is the point breakdown for Verbal Response in the GCS?
5 = Normal conversation
4 = Disoriented conversation
3 = Words, but not coherent ("word salad")
2 = No words, only sounds
1 = NoneWhat is the point breakdown for Motor Response in the GCS?
6 = Normal 5 = Localizes to pain 4 = Withdraws to pain 3 = Decorticate posture 2 = Decerebrate posture 1 = None
Describe Decorticate posture
Flexor, arms like “Cs”, moves toward the “Cord”
Problems with cervical spinal tract or cerebral hemisphere
Describe Decerebrate posture
Extensor, arms like “e”
Problems within midbrain or pons
What is the following patient’s GCS score?
42 y/o M, eyes open after a car accident, slightly confused about events of accident (repetitive questioning), follows commands.
14 (loses point for verbal)
What is the following patient’s GCS score?
Will not open eyes to pain, moaning, when stimulated pulls arms to chest and becomes rigid
6 (1 for eyes, 2 for verbal, 3 decorticate posture = 6 GCS, pt will likely go to trauma center and be intubated, highly likely cerebral hemisphere/cortical spinal tract injury w/ high mortality)
A mild TBI is defined as a GCS of ____-____. Moderate TBI GCS? Severe TBI GCS? What type is the most common?
Mild 13-15 (most common)
Moderate 9-12
Severe 8 or less
What rules or criteria can be followed to determine if a pt requires a CT scan following a mild TBI? (children vs adults)
Canadian CT Head Rule
PECARN Pediatric Criteria
According to the Canadian CT Head Rule, what are the high risk findings that would indicate that a CT head is indicated in a pt with a minor head injury? (hint: 5)
- GCS score < 15 at 2 hours post-injury
- Suspected open or depressed skull fx
- Any sign of basal skull fx
- Vomiting > or = 2 episodes
- Age > or = 65 y/o
According to the Canadian CT Head Rule, what are the medium risk findings that would indicate that a CT head is indicated in a pt with a minor head injury? (hint: 2)
- Amnesia before impact > or = 30 min
2. Dangerous mechanism
What are considered signs of basal skull fx?
Hemotympanum, “raccoon eyes”, CSF otorrhea/rhinorrhea, Battle’s sign
What are examples of “dangerous mechanism”?
Pedestrian struck by vehicle, occupant ejected, fall from >2x height/3ft/or 5 stairs
What is Battle’s sign?
Mastoid ecchymosis
PECARN is the largest study ever done in emergency medicine in children, and there is one rule for kids under ___ y/o and one for kids over ___ y/o
2 y/o
T/F All pts with a moderate or severe TBI get a CT scan performed
True
T/F All pts with a moderate or severe TBI are admitted for observation (why or why not?)
True, high potential for decompensation
Diffuse axonal injury (DAI) occurs most frequently during what type of injury mechanism?
Deceleration injury
What are some examples of impact injuries?
Cerebral or brainstem contusions
Cerebral lacerations
Immediate hematomas
Diffuse axonal injury (DAI)
What are some examples of secondary injuries?
Intracranial hematoma
Edema
Ischemia
