MDT closed head injury to include aneurysm Flashcards
(46 cards)
most common demographic for TBI
Young (15-34), male, and drunk are most accident prone
What is
Coup-contrecoup
Injury will be present at site of impact as well as opposite side from rebound
motion
Concussion is _____ subset of traumatic brain injury (TBI)
Mildest
Concussion Hallmarks are ____ and _____
confusion and amnesia
Amnesia almost always includes the _______ itself, but may also extend to events _______ trauma
traumatic event
before and after
Concussion periodicity of symptoms
Headache, dizziness, vertigo, imbalance, nausea, vomiting
Early symptoms (minutes to hours)
Concussion periodicity of symptoms
Mood/cognitive disturbance, light/noise sensitivity, sleep disturbance
Delayed symptoms (hours to days)
Common signs of what?
1) Vacant stare (befuddled facial expression)
2) Delayed verbal expression (slower to answer questions)
3) Inability to focus attention (easily distracted)
4) Disorientation (walking in the wrong direction, not A&O)
5) Slurred or incoherent speech (making disjointed statements)
6) Gross observable incoordination (stumbling)
7) Emotionality out of proportion to circumstances (appearing distraught, crying
for no apparent reason)
8) Memory deficits
Concussion
If seizures occur within _____ of head injury, much more likely to be related to ___ than epilepsy. Occurs in 5% of TBI patients.
one week
TBI
What type of concussion?
(a) Any concussion with concomitant hemorrhage
(b) May present as acute, subacute or chronic
(c) Usually arterial in origin
(d) Treat based on complication
Complicated concussion
MACE exams are completed on patients within that timeframe
48 hours
Acute Evaluation of concussion
Focus on ______ exam to detail extent of damage
neurologic exam
Management of concussion
(a) Direct observation for____
(b) Awaken the patient every _____ to ensure normal alertness
(c) ________ for 24 hours after injury
(d) No alcohol, sedatives, or pain relievers other than NSAIDs should be given for ________
a. 24 hours
b. two hours
c. Low level of activity
d. 48 hours
Concussion criteria for what?
(a) Inability to awaken the patient
(b) Severe or worsening headaches
(c) Somnolence or confusion
(d) Restlessness, unsteadiness, or seizures
(e) Difficulties with vision
(f) Vomiting, fever, or stiff neck
(g) Urinary or bowel incontinence
(h) Weakness or numbness involving body part
Immediate Referral/MEDEVAC
What complication of concussion?
1) Diffuse cerebral swelling that can develop in setting of a second concussion
2) Occurs when patient symptomatic from the 1st concussion and sustains 2nd concussion
3) Rare but potentially fatal complication
Second impact syndrome
What complication of concussion?
Headache, dizziness, cognitive impairment, psych symptoms that develop in the first few days after mild TBI and resolve in weeks to months
Postconcussion syndrome
25-78% of patients experience _______ headaches within 7 days of the event
Posttraumatic headaches
What complication of concussion?
Excessive daytime somnolence, increased sleep need, insomnia, sleep fragmentation
Sleep disturbances…….
What complication of concussion?
Repeated concussions can lead to cumulative neuropsychologic deficits
a) Behavior changes, personality changes, depression, increased suicidality
b) Parkinsonism
c) Speech and gait abnormalities
Chronic traumatic encephalopathy (CTE)
In an open skull fracture what should you look for?
Look for CSF leakage
The skull is difficult to break, but is thin in several areas what two?
1) Temporal region
2) Nasal sinuses
Theses are signs for_____
1) Battle sign
2) “Raccoon” eyes
3) Hemotympanum(blood behind TM)
4) CSF rhinorrhea/otorrhea
5) Cranial nerve deficits
basilar skull fracture (base of skull)
If an open basilar skull fracture is suspected what type of airway might be more appropriate
Orogastric tube
Acute Management of skull fracture
treatment
Oxygen, C-spine precautions and MEDEVAC ASAP
(ultimately needs Head CT and Neurosurgeon)
