TBI (Adult) CPG Notes Flashcards
(18 cards)
What are the care objectives in managing TBI?
Optimise airway patency, oxygenation, ventilation, and cerebral perfusion pressure (CPP)
* Triage high-risk patients to neurosurgical centres
* Transport moderate risk patients to ED for CT or observation
* Refer low-risk patients into the community with self-care advice
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Who does this guideline apply to?
Patients aged ≥16 years with a potential traumatic head injury.
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What makes a TBI high risk?
Moderate to severe TBI (GCS < 13)
* Penetrating head injury
* High risk features:
* LOC > 5 minutes
* Skull fracture
* Vomiting more than once
* Neurological deficit
* Seizure
* Worsening signs and symptoms
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What are the management priorities for high-risk TBI?
Follow CPG A0810 Major Trauma
* Airway: maintain patency, consider RSI
* Breathing: maintain normal SpO₂ and ETCO₂
* Circulation: maintain normo- or supranormal BP
* Supportive care: elevate head of stretcher by 10–15°
* Transport per CPG A0105 Trauma Triage
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What is the difference between primary and secondary brain injury?
Primary = occurs at the time of injury
* Secondary = caused by physiological changes (e.g. hypoxia, hypotension) post-injury
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What is cerebral perfusion pressure (CPP) and why is it important?
CPP = MAP - ICP. It represents the pressure needed to perfuse the brain. Maintaining adequate CPP is crucial to prevent secondary brain injury.
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What is the target MAP and CPP in TBI?
MAP: ~70–100 mmHg
* ICP: ~5–10 mmHg
* Target CPP: ~60–90 mmHg
* If ICP ↑ or MAP ↓, CPP will fall → risk of hypoperfusion
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Why is penetrating head injury considered high risk even if GCS is normal?
These patients may rapidly deteriorate; even mild wounds can mask serious intracranial damage.
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What signs are suggestive of a basal skull fracture?
Haemotympanum
* CSF leakage from nose or ears
* Battle sign
* Raccoon eyes
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What features indicate moderate TBI risk?
Altered mental status
* Dangerous MOI (e.g. MVA >30 km/h, ejection, fall >3m, explosion)
* Amnesia ≥ 30 mins
* Intoxication
* Age ≥ 65
* Coagulopathy or anti-platelet (not aspirin)
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What is the disposition for moderate risk patients?
CT-capable hospital preferred
* If not available, hospital observation for ≥ 4 hours
* Consider VVED if age/coagulopathy are only risk factors
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Why are older adults and anticoagulated patients higher risk for TBI?
Brain atrophy → more movement in skull → ↑ shearing forces
* Symptoms may take longer to appear
* Coagulopathy → increased risk of intracranial bleeding
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Is aspirin a moderate risk factor?
No. Other antiplatelets like clopidogrel are.
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What is VVED’s role?
To support nuanced decision-making and shared care planning.
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What defines a low risk patient?
No high/moderate risk features
* Competent adult available to monitor for 4 hours
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How should you manage a low-risk TBI with concussion symptoms?
Rest (limit activity and screen time)
* Paracetamol for headaches
* Avoid alcohol, sedatives, driving for 24h
* Safety netting: monitor for deterioration
* GP follow-up in 2–3 days
* Provide health information sheet
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What symptoms prompt urgent reassessment (safety net)?
Increasing headache
* Repeated vomiting
* Altered mental state
* Seizures
* Weakness or altered limb sensation
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What monitoring should be done for transported TBI patients?
Pupil exam every 15 minutes
* Baseline vitals as per CPG A0101
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