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Flashcards in TBI Deck (47):
1

What is implied by dorsal pontine haemorrhages?

Severe diffuse axonal injury

2

Why do you get a PCA infarct with raised ICP?

Due to the PCA being compressed against the tentorium

3

What are the histological features of DAI?

Gliding / shearing forces cause disruption of axoplasmic transport resulting in retraction balls **

4

What is the grading of DAI?

**

5

What is chronic traumatic enchephalopathy?

Repeat head injuries resulting in a neurodegenerative tau pathology (tauopahty) affecting the deep sulci

6

What is the incidence of TBI?

250 per 100,000 population based on TBI hospital admissions

7

Define TBI

Alteration in brain function or evidence of brain pathology caused by an external force

8

What is the weight of the brain?

1.3-1.5Kg

9

What is elastance?

Elastance = dPressure / dVolume

10

What is compliance?

Compliance = dVolume / dPressure

11

What are the indications for ICP monitoring?

GCS

12

What is the conversion between cmH20 and mmHg?

10cmH20 = 7mmHg

13

What are Lundberg waves?

A waves = plateau waves B waves =

14

What is Pouseille's equation?

**

15

Where does autoregulation occur? CO2 reactivity?

Pial arteries Pial small vessels

16

What are Duret haemorrhages?

**

17

What is the Marshall classification?

** Diffuse 1 = normal CT Diffuse 2 = visible basal cisterns Diffuse 3 = compression of the basal cisterns Diffuse 4 = signs of raised ICP + shift Mass lesion = mass lesion / ICH >25 cc fill in the rest!

18

Decision tree of Marshall classification?

Abn yes / no Mass yes / no (mass requiring evacution yes / no) cisterns yes / no midline shift yes / no

19

How do you classify the mechanisms of TBI?

Closed, penetrating, crush and blast. There is overlap

20

What are the tiers of treatment for raised ICP?

Tier 1 - HOB, sedation / analgesia, intermittent ventricular drainage, repeat CT Tier 2 - Hyperosmolar therapy, PCo2, paralysis Tier 3 - DHC, barbiturates (hypotherapy in rescueICP has worse outcome)

21

When should orthopaedic patients be performed in TBI?

Delay for 48 hours until ICP is stable

22

When should clexane be given in TBI?

Within 72 hours (prophylactic IVC filter can be placed if big contusions etc) Note - 20% of TBI will have a VTE

23

How should you treat an elderly patient on anticoagulation with ASDH?

Consider it to be similar to EDH as the elderly patient will have minimal brain injury if surgery is performed earlier

24

Which penetrating injuries carry a very low prognosis?

Transventricular and multilobar path / injury

25

ww.tbiclickandlearn.org

**

26

What is the evidence for abx in penetrating head injury?

Look up

27

How do you remove a penetrating foreign body?

Look up

28

How extensive do you debride a penetrating head injury?

Minimal debridement

29

What are the principles of management for penetrating head injury?

Antibiotics Full exposure Control of vascular components Minimal debridement Water tight dural closure (depending on ICP)

30

What are the complications of penetrating head injury?

Infection Sinus - mucocoele Pseudo-aneurysm ..

31

How do you manage a pseudo-aneurysm?

Vessel sacrifice

32

What is the relationship between ICP and volume?

Exponential

A image thumb
33

How is CBF affected by CO2?

Rising CO2 affects ICP with a sigmoidal relationship

A image thumb
34

What are the reversible factors of raised ICP?

Pyrexia

Seizure

Raised MAP

Low Na

Low protein

Pain

Sedation / paralysed

35

Which study showed no difference with using ICP monitoring?

BEST:TRIP (Chestnut et al 2012)

36

What are the outcomes of DECRA?

Decompressive craniectomy worsens outcome even though ICP was lower

Early decompression at ICP 20mmHg

More people had blown pupils in the surgery group

37

What are the outcomes of RescueICP?

Overall survival is increased with decompressive hemicraniectomy but they are made vegetative

High proporion of bifrontal craniectomies

Cranioplasty side-effects were not counted

38

What BP do you aim for in TBI?

Look up

39

What does cerebral microdialysis measure?

Mitochondrial dysfunction: Lactate to pyruvate ration

40

What is brain tissue oxygenation monitoring?

How does it work?

look up

41

Explain the rational of jugular venous saturation

Look up

42

What does Xe-CT show?

CBF measurement

43

How does near infrared spectroscopy work?

Look up

Different wavelengths correspond to HbO2 etc so able to monitor the response to treatment

44

Does gender affect TBI outcome?

No

45

When would you place a brain tissue monitor?

...Variable, most would place with any depressed GCS

46

What threshold would you treat at brain tissue oxygenation?

Brain trauma foundation recommend >15 but more recent evidence suggests 20.

47