TBI

Question 1

injury that occurs at the time of trauma

Answer 1

TBI primary injury

Question 2

what is the pathogenesis of TBI primary injuries?

Answer 2

diffuse axonal injury d/t coup and counter-coup

Question 3

injury that is initiated at the time of initial trauma and continues for hours or days

Answer 3

TBI secondary injury

Question 4

what does TBI secondary injury lead to? (3)

Answer 4

neuron death
cerebral edema
increase ICP

Question 5

what kind of injuries will result in greater axonal damage? (2)

Answer 5

assault
falling object

Question 6

unable to remember things that happened after the injury

Answer 6

anterograde amnesia

Question 7

unable to remember what happened right before the injury

Answer 7

retrograde amnesia

Question 8

a patient opens their eyes when spoken to, can have a conversation but is disoriented, and makes withdrawal movements to pain. what is their GCS?

Answer 8

11

Question 9

a patient opens their eyes when you walk in the room, grunts, and follows motor commands. what is their GCS?

Answer 9

12

Question 10

a patient only opens their eyes when you pinch their skin, says inappropriate words, and uses extensor posturing to pain. what is their GCS?

Answer 10

7

Question 11

what is the classification of TBI if GCS is 13-15?

Answer 11

mild

Question 12

what is the classification of TBI if LOC is over 30 mins and GCS is 9-12?

Answer 12

moderate

Question 13

what is the classification of TBI if LOC is over 24 hours and GCS is 3-8?

Answer 13

severe

Question 14

in which patients is hospital admission recommended? (4)

Answer 14

GCS < 15
abnormal CT
seizures
underlying coagulopathy

Question 15

what is the management for moderate/severe TBIs? (3)

Answer 15

monitor for ischemia, cerebral edema, increased ICP
monitor for coagulopathy (PT/INR)
monitor for seizures (EEG)

Question 16

what can we give for increased ICP in moderate/severe TBI? (2)

Answer 16

mannitol
normal saline
elevate head of bed

Question 17

what should be avoided in patients with moderate/severe TBI?

Answer 17

glucocorticoids

Question 18

what is the hallmark of concussions/mild TBIs? (3)

Answer 18

confusion
amnesia
+/- loss of consciousness

Question 19

according to the AAN, what is classified as a grade 3 or severe concussion/mild TBI?

Answer 19

loss of consciousness

Question 20

according to the AAN, what is classified as a grade 2 or moderate concussion/mild TBI?

Answer 20

symptoms that last over 15 mins

Question 21

when is a recurrent concussion more likely to occur?

Answer 21

within 10 days after a prior concussion

Question 22

what is not necessary in sports-related concussions to be diagnosed?

Answer 22

CT imaging

Question 23

what is the management for mild TBI/concussion? (3)

Answer 23

cognitive and physical rest
NSAIDs for pain
follow up

Question 24

what is the return to play precaution for a concussion?

Answer 24

patient must be asymptomatic without medication