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Cumulative > TBI & Concussions > Flashcards

TBI & Concussions Flashcards

1
Q

Cause of TBI

A
  • head injury usually d/t contact, acceleration/deceleration force (MVA, falls)
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2
Q

Complications of a TBI

A
  • brain contusions, localized ischemia, edema, focal neuro signs, evolving hematoma/hemorrhage
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3
Q

Diagnostic testing for TBI

A

CT/MRI without contrast to look for bleeding

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4
Q

Characteristics of a concussion/Mild TBI

A
  • trauma induced alteration in mental status +/- LOC
  • direct force or brain being slapped against intracranial surfaces (contre-coup)
  • axonal damage
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5
Q

Symptoms of a concussion/mild TBI

A
  • confusion and amnesia +/- LOC
  • headache, dizziness, n/v, visual disturbances, mood change, photosensitivity, sleep disturbance
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6
Q

Diagnostic testing for concussion/mild TBI

A

GCS for medically trained
SAC, ACE, SCAT-5 for non-medically trained

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7
Q

Return to play guidelines following a concussion

A

complete resolution of all symptoms
- return of memory and concentration
- no symptoms after testing
- 6 step process

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8
Q

What are the Canadian Head CT Rules

A

Minor head injury presenting with GCS 13-15 after witnessed LOC, amnesia, confusion

High risk for neurosurg
- GCS <15 at 2 hrs post injury
- suspected open/depressed skull fx
- sign of basal skull fracture
- vomiting 2+ times
- age 65+

Medium Risk
- amnesia 30+ mins before incident
- dangerous mechanism

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9
Q

What are the signs of basal skull fracture

A
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10
Q

What is the GCS score for a moderate TBI

A

GCS 9-13 within 48 hours

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11
Q

What is the GCS score for a severe TBI

A

GCS 3-8 within 48 hours

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12
Q

Describe the primary and secondary injuries related to moderate-severe TBIs

A

Primary = occurs at moment of trauma
- skull fx
- hematoma
- auditory symptoms

Secondary = occurs immediately after trauma and produces long term effects
- excitatory AA
- increased ICP

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13
Q

What are the characteristics of moderate to severe TBI

A

permanent or temporary impairment of cognitive, physical, and psychosocial functions

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14
Q

What is the treatment for moderate TBI

A

tranexamic acid, avoid hypotension and hypoxia

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15
Q

What is the treatment for severe TBI

A
  • neuro trauma center
  • prevent hypotension and hypoxia
  • treat ICP
  • intubation if GCS <9
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16
Q

What are some treatments for increased ICP

A

mannitol, keppra, decompressive craniectomy, extraventricular drain

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17
Q

What is one of the most life threatening complications of a TBI

A

subarachnoid hemorrhage

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18
Q

Define a subarachnoid hemorrhage

A

rupture of small cortical arteries/veins bleeding into the subarachnoid space
- worst headache of life, thunderclap, meningeal signs

19
Q

Diagnostic testing for SAH

A
  • CT without contrast may show bleeding following circle of willis, “star of death”
  • lumbar puncture may show presence of RBCs and xanthochromia
20
Q

SAH treatment

A
  • calcium channel blocker to prevent vasospasm (Nicardipine)
  • phenytoin
  • neurosurg consult for potential aneurysm clip or coil
21
Q

Define post concussive syndrome

A

prolonged symptoms related to initial head injury
- headache, dizziness, memory loss, loss of libido, ataxia, difficulty sleeping, fatigue

22
Q

Define second impact syndrome

A

Fatal brain swelling occurring after minor head trauma, occurs in pts <20
- headache, neck pain, n/v
- get head CT and treat with hyperventilation and osmotic agents

23
Q

Define chronic traumatic encephalopathy (CTE)

A

progressive degenerative dz beginning months-years after last brain trauma, results from repetitive trauma
- progressive dementia, confusion, judgement, aggression, impulsive

24
Q

Signs and symptoms of an impending cerebral herniation

A
  • increase in ICP d/t CSF, brain tissue, blood shift in the skull
  • significant pupillary asymmetry
  • cushing triad
  • decorticate/decerebrate
  • respiratory depression
25
Q

Describe the cushing triad

A

Increased ICP
- bradycardia
- irregular respiration
- widened pulse pressure

26
Q

How to treat an impending cerebral herniation

A

-intubate
-head of bed elevation
-hypertonic saline or mannitol
-seizure prophylaxis

27
Q

Describe blunt cerebrovascular injury

A

Injury to carotid/vertebral arteries with skull base or vertebral fracture
- Dx with CBC, BMP, coags, EtOH
- Tx with 81mg ASA qd

28
Q

What are the components of the glasgow coma scale

A
  • Eye opening response
  • Verbal response
  • Motor response
29
Q

List the components and points of the Eye Opening response of the GCS

A

4 pts - spontaneous eye opening and blinking at baseline

3 pts - open to verbal stimuli, command, speech

2 pts - open to pain only (not on face)

1 pt - no response

30
Q

List the verbal response components of the GCS

A

5 pts - oriented

4 pts - confused conversation but able to answer questions

3 pts - inappropriate words

2 pts - incomprehensible speech

1 pt - no response

31
Q

List the motor response components of the GCS

A

6 pts - obeys commands for movement

5 pts - purposeful movement to painful stimulus

4 pts - withdraws in response to pain

3 pts - flexion/decorticate response to pain

2 pts - extension/decerebrate response to pain

1 pt - no response to pain

32
Q

What is the GCS for a mild TBI

A

13-15 30 mins after the injury, 14-15 48 hours after

33
Q

Primary injuries in TBIs

A
  • skull fracture (vault, basal)
  • Epidural hematomas (tear in mid meningeal artery)
  • subdural hematomas (cortical vein injury)
  • coup/contrecoup contusion
  • diffuse axonal injury
  • audiovestibular dysfunction
34
Q

Secondary injuries in TBIs

A
  • excitatory amino acids
  • increased ICP
  • apoptosis
  • etc.
35
Q

Describe

A

frontal cerebral contusion

36
Q

Describe

A

traumatic subdural hematoma

37
Q

Describe

A

diffuse axonal injury

38
Q

Describe

A

traumatic epidural hematoma

39
Q
A
40
Q
A
41
Q
A
42
Q
A
43
Q
A

E2 V4 M4 = GCS 10

Cumulative (162 decks)

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