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Flashcards in TBI Deck (19):

How many injury-related deaths are due to TBIs? 75% of TBIs are what kind? What are the most common causes of concussions? 

CDC Stats:

~TBI is a contributing factor 1n a third (30.5%) of all injury-related deaths in the United States.

~About 75% of TBIs that occur each year are concussions or other mild TBI

~The most common causes of concussions are Bicycling, Football, Playground Activities, Basketball and Soccer.

~Risk of Motor Vehicle Accidents is highest among 16-19 year olds


What are the most common causes of TBIs?

#1 Falls

#2 Motor Vehicle Accident

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Who is most at risk for TBI?


  • ¡Kids? not as coordinated (falls), sshaken baby syndrome
  • ¡Teens? Drunk, boys, risky taking behaviors
  • ¡Adults?
  • ¡Seniors? Dementia, frail (falls) 
  • ¡Men vs.  Women?
  • ¡Boys vs. Girls? Girl athletes less padding and equipment, neck not as muscular, girls report more 


  • Children 0-4
  • Adolescents 15-19
  • Older adults 75+
    •   Highest mortality rate



What are mechanisms of injury for TBI?

Don't have to hit your head.

  • Closed Head Injury (CHI)
    • Impact to the head (head strikes solid object, solid object strikes head)
    • Acceleration/Deceleration injury  (“Whiplash” injury)
    • Blast injury
  • Penetrating Head Injury
    • Moving projectile penetrates the skull and enters the brain


Describe closed head injury: impact. WHat type of impact happens? What impacts severity?

  • Impact occurs when head strikes solid object or a solid object strikes head
  • Mass of the object and speed both impact severity
  • ¡Examples: balls, windshield, falls, helmet to helmet


Describe closed head injury: acceleration/deccelaration. What is another name for it? When can it occur?


  • ¡“Whiplash” injury
  • ¡No direct impact to the head
  • ¡Can occurs any time the head suddenly accelerates or suddenly decelerates. something stops moving body abruptly
  • ¡Examples: car crash, rollercoaster, football


Discuss closed head injury: blasts, primary injury. What is it caused by? What are factors that influence the severity? 


  • ¡Primary Injury or “blast wave” injury
  • ¡caused by the intense pressure wave created by explosion.  Pressure compresses organs, especially air filled and fluid filled cavities.
  • ¡Factors influencing severity:
    • ¡Peak pressure of the initial blast wave
    • ¡Duration of blast wave
    • ¡Environment in which the explosion occurs (confined space or open area)
    • ¡Distance from the source of the explosion


Describe closed head injuries: blasts, secondary injury. What are they caused by? What may this cause? What type of injury might this be similar to?

  • ¡Secondary injuries
  • ¡Caused by flying shrapnel and other objects.
  • ¡May cause a penetrating head injury
  • ¡May cause injury similar to “Impact injury”


Describe closed head injuries, blasts, tertiary injury. When does this happen? What kind of injury can this cause?

¡Tertiary Injuries
¡Sustained when the body is physically thrown from the blast.
¡Can cause impact type injury or whiplash type injury


Describe penetrating head injury. What is it? What is the survival rate?

¡Anytime an object breaks through the skull and enters the brain
¡Survival rate is ~10%


What happens in the brain after injury?


  • ¡Coup-Contrecoup Injury
  • ¡Rotational forces
  • ¡Diffuse Axonal Injury (DAI) “Sheering” injury
  • ¡Edema
  • ¡Neurometabolic cascade
  • ¡Neurotransmitter Dysfunction
  • ¡Migraine= depolarizing event
  • ¡Seizures


Describe Coup- Contrecoup injury (linear forces). Where is the injury (directions)? What additionally happens?


  • ¡Injury to two opposite sides of the brain.
    • ¡One in the direction of the momentum
    • ¡One in the opposite direction
  • ¡Injury is often frontal and occipital
  • ¡But can occur in any direction depending on the direction of the momentum
  • ¡Additionally, the brain compresses contributing to Diffuse Axonal Injury


What else can coup-countercoup injuries lead to?


  • ¡Brain is roughly the consistency of jello
  • ¡Brain is floating in cerebrospinal fluid
  • ¡Boney projections on the inside of the skull contribute to risk of
    • ¡Contusions
    • ¡Hematomas


Describe rotational forces. When does this happen? What does this contribute to? What has an impact on severity?


  • ¡Caused when the brain rotates within the skull
  • ¡Contributes to Diffuse axonal injury
  • ¡Injury may be more diffuse than Linear injury
  • ¡Angular acceleration and duration of rotation seem to have an impact on severity of injury - more rotational - more diffuse.


Describe Diffuse axonal injuri (DAI). What happens to the axons? What does this result in?

  • ¡Diffuse Axonal Injury (DAI) “Sheering” injury
  • ¡Axons (white matter) gets
    • ¡Stretched,
    • ¡Twisted
    • ¡Torn
  • ¡Results in cell death and decrease connectivity in the brain


Describe edema. What is it? What does it increase? How can it be managed?


  • ¡Swelling/ inflammation of the brain after injury
  • ¡Increases intracranial pressure
  • ¡Can be life threatening
  • ¡May be medically managed with a craniectomy


Describe craniectomy. When is it performed? What is removed? What allows brain to swell?


  • ¡Surgical procedure performed as a life-saving measure due life threatening intracranial pressure
  • ¡Bone from skull is removed and placed on ice or in patients abdomen.
  • ¡Soft tissue of the scalp allows brain to swell with less risk of death


Describe neurometabolic cascade. 


  • Abrupt Neuronal Depolarization (Ca/K)
  • Release of excitatory neurotransmitters (glutamate)
  • Metabolic Crisis characterized by low brain Glucose (gluc)
  • Altered cerebral blood flow (CBF)
  • uses glucose very quickly - decrease in glucose

Migrane depolarization theory - similar process to brain injury?

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Describe seizures. What increases the risk of seizures? What are most patients on? What are the side effects of seizure medication?


  • ¡Brain injury increases risk of post-traumatic seizures
  • ¡Many patients are on preventative seizure medications after a TBI, even if they have not had a seizure
  • ¡Seizure medication has many side effects, including
    • ¡Sleepiness or fatigue.
    • ¡Worsening of balance.
    • ¡Lightheadedness or dizziness.
    • ¡Double vision.
    • ¡Confusion.