TBI

Question 1

types of head injury (3)

Answer 1

Open head injury
closed
diffuse axonal injury

Question 2

what is diffuse axonal injury

Answer 2

shaking or strong rotation of the head causing tearing of brain tissue​

Question 3

mechanism of TBI (3)

Answer 3

penetrating
crush
acc/deceleration injury

Question 4

what is Open head injury

Answer 4

dura is punctured

Question 5

primary brain damage

Answer 5

result of the direct trauma to the brain tissue​

Question 6

2nd brain damage

Answer 6

result of the complications arising from the primary causes​

Question 7

concussion, contusion, lacerations - what are they as a group?

Answer 7

primary mechanisms

Question 8

definition of concussion

Answer 8

Brief state of unconsciousness with no lasting damage to the brain

Question 9

what is contusions

Answer 9

bruising of brain tissue; below or opposite site of injury

Question 10

what is lacerations

Answer 10

tearing

Question 11

what lead to ICP

Answer 11

haemorhage, oedema

Question 12

intracranial haemorrhage
cerebral oedema
tentorial herniation (coning)

Answer 12

examples of 2nd mechanism

Question 13

As a result of increasing ICP or unresolving haematoma, the brain tissue is compressed and pushed downwards through the foramen magnum. The brain stem compression leads to a stopping of vital functions​

Answer 13

coning; tentorial herniation

Question 14

3 cardinal features of brainstem death

Answer 14

Coma/unresponsiveness​

Absence of brain stem reflexes​

Apnoea

Question 15

what is apnoea

Answer 15

breathing stops and starts while you sleep.

Question 16

3 components in the skull

Answer 16

brain tissue, blood, cerebrospinal fluid (CSF)

Question 17

ways to regulate ICP (3)

Answer 17

Autoregulation – blood flow​

Compliance - tolerate an increase in intracranial volume​

Shunting of CSF

Question 18

Normal resting ICP
on coughing
on sneezing

Answer 18

10
30
100 mmHg

Question 19

Signs and symptoms of raised ICP (7)

Answer 19

Headache​

Nausea​

Papilloedema – swelling of optic disc​

Neck stiffness​

Vomiting​

Decrease in conscious level​

Pupil dilation

Question 20

Cerebral ischaemia/hypoxia - 2nd mechanism

Answer 20

impaired blood flow to the brain.
due to hypotension

Question 21

• Prolonged state of unconsciousness
• No eye opening​
• No response even to painful stimuli​
• May have some non-purposeful movements​ = ?

Answer 21

coma

Question 22

GLASGOW COMA SCALE range

Answer 22

3-15

Question 23

purpose of GCS

Answer 23

to determine severity of brain injury

Question 24

GCS category

Answer 24

severe (7 or less), ​
moderate (8-12) or mild (13-15).

Question 25

mild/moderate/severe TBI? Loss of consciousness brief if apparent at all (seconds / minutes).​ Testing / scans of brain may appear normal.​ Diagnosed only when there is change in mental status at the time of injury.​ Symptoms usually temporary with full recovery after 1 year

Answer 25

Mild

Question 26

mild/moderate/severe TBI? Loss of consciousness lasts from a few minutes / hours.​ Confusion can last days to weeks.​ Physical, cognitive and / or behavioural impairments can last months or be permanent. ​ Patients generally make a good recovery via rehabilitation or learning to compensate for their deficits.​

Answer 26

Moderate TBI

Question 27

mild/moderate/severe TBI? Prolonged unconscious state lasting days, weeks or months (coma).​ Minimal or no response to stimulus.​ Can develop PVS.​ Patients can make significant improvements but are left with permanent physical, cognitive and / or behavioural impairments.

Answer 27

severe TBI

Question 28

Visual Agnosia​ Figure/ground discrimination​ Position in Space​ Spatial Relationships​ Unilateral Neglect​ Apraxia​ are examples of ?

Answer 28

Perceptual Problems​

Question 29

personality and emotional changes attention memory planning & problem solving' are examples of?

Answer 29

cognitive problems

Question 30

(full) Visual field​ Colour agnosia​ Word blindness

Answer 30

Visual defects​ problems

Question 31

Dysphagia​ Insomnia, sleep apnoea​ Vertigo, balance​

Answer 31

Brain stem issues​

Question 32

Rest via ventilation and sedation​ positioning​ diuretics to reduce fluid – Mannitol​ steroids to reduce swelling?​ ventricular drainage if hydrocephalus​

Answer 32

tx of raised ICP

Question 33

3 stages of TBI MGT

Answer 33

acute - unconscious/conscious ICU pts sub-acute - rehab chronic - post discharge