Trauma - head and face Flashcards
(49 cards)
What is the leading cause of death and disability worldwide?
Traumatic brain injury
Traumatic brain injury is a significant public health issue affecting individuals globally.
What are the two main types of damage associated with traumatic brain injury?
Initial traumatic insult and secondary damage due to hypoxia and hypovolaemia
Secondary damage can exacerbate the effects of the initial injury.
How are traumatic brain injuries classified?
By severity, type, and mechanism
This classification helps in treatment and understanding the injury’s impact.
What scale is used to assess the severity of traumatic brain injury?
Glasgow Coma Scale
The Glasgow Coma Scale provides a score out of 15.
Which factor in Glasgow Coma Scale is the best predictor of level of consciousness?
Best motor score, best predictor
What are the components of and scores for the eye opening section of the GCS?
Nil eye opening 1
Eye opening to pain 2
Eye opening to voice
3
Eye opening spontaneous 4
What are the components of and scores for the verbal response section of the GCS?
Nil 1
Groans 2
Words 3
Disorientated 4
Orientated 5
What are the components of and scores for the motor response section of the GCS?
Nil 1
Extensor 2
Flexor 3
Withdrawal 4
Localise 5
Obey command 6
In addition to GCS, TBI is also classified as mild, moderate and severe. How are each of these categories defined?
- Mild TBI GCS 13-15, brief LOC, PTA <1hr, normal brain imaging
- Moderate TBI: GCS 9-12, LOC < 24 hrs, PTA 1-24hrs, abnormal imaging
- Severe TBI: GCS 3-8, loss of consciousness >24hrs, PTA >24hrs, abnormal imaging
What type of injury involves a collision force acting directly on the skull and underlying tissue?
Focal injuries
Focal injuries cause a wide range of lesions including contusion, epidural/subdural, subarachnoid, and intraparenchymal injuries.
What is the most common cause of diffuse brain injury?
Deceleration, most common in MVA
Diffuse brain injury leads to Diffuse Axonal Injury (DAI) and severe cerebral oedema.
What percentage of head injuries are blunt head injuries?
75%
Blunt head injuries are associated with an increased risk of skull fractures and underlying bleeds.
How much does an associated skull fracture increase the risk of underlying bleed?
400x
An associated skull fracture greatly increases the risk of serious complications.
What is the outcome for patients with low GCS and penetrating injury?
Poor outcome
Penetrating injuries are associated with a significantly worse prognosis.
What characterizes the primary brain injury stage?
Direct tissue damage and impaired regulation of cerebral blood flow and metabolism
This stage causes an ischaemia-like pattern.
What can excessive release of neurotransmitters and apoptosis lead to?
Secondary brain injury
This occurs following the primary injury due to subsequent hypoxia, hypotension, or hypoperfusion.
What is a consequence of secondary brain injury?
Increased area of injury
This includes areas that were previously thought to be reversible.
Fill in the blank: The initial stages of injury in TBI are characterized by _______.
direct tissue damage
This is part of the primary brain injury phase.
What is the primary focus of management in traumatic brain injury (TBI)?
Preventing secondary brain injury
Secondary brain injury can result from factors such as hypotension and hypoxia.
What should be the target for systolic blood pressure (SBP) in TBI management?
Keep SBP >90mmHg
Maintaining adequate SBP is crucial to prevent hypoperfusion.
What is the minimum recommended partial pressure of oxygen (pO2) in TBI management?
Keep pO2 >60mmHg
What does the ‘Cushing effect’ indicate in isolated head trauma?
Hypoperfusion is compensated by increasing SBP
How is cerebral perfusion pressure (CPP) calculated?
CPP = MAP - ICP
What is the target range for cerebral perfusion pressure (CPP) in TBI?
CPP to aim for is 60 to 70 mm Hg
