Traumatic Brain and Head Injury Flashcards
(38 cards)
What groups are at a higher risk of a traumatic brain injury?
- Young men (due to risk taking)
- Elderly (risk of falling)
- Previous head injuries
- Residents of inner cities
- Alcohol and drug abuse
- Low-income
What are the main mechanisms of brain/head injury?
- Assault
- Falls
- *BOTH CAN BE DUE TO ALCOHOL**
- Road traffic collisions
- Sports
What laws have the government put in place in order to prevent traumatic brain injury?
- Seatbelt laws
- Drink driving testing
- Helmets on motorbikes/ bicycles
- Air bags
What medication should we as doctors be aware of prescribing if a patient is at risk of falling and causing a brain injury?
Anticoagulants
need to weigh up risk (fall and brain injury) and benefits (AF - stroke prevention
Why do elderly patients tear a lot of their scalp during a head injury?
it is thin and therefore peels away easily during injury
At what intervals after a brain/head injury are most patients likely to die or deteriorate?
1st Peak: Most dead within 1st hour “Golden Hour”
2nd Peak: 7 hours later patients deteriorate due to secondary effects of injury
3rd Peak: Medical complications cause deterioration
How are patients with traumatic brain or head injury first managed?
Airway (and C spine control)
Breathing
Circulation
intubate, ventilate
How should a patient be further assessed after the Primary ABCDE survey?
- Glasgow Coma Scale
- Pupil Reactivity
- Secondary survey ABCDE
- History
What are the 3 main components of the Glasgow Coma Scale?
Eye opening
Motor
Verbal
What patients require a CT within ONE HOUR?
- GCS<13 on initial assessment
- GCS <15 2 hours after injury
- Suspected skull fracture/ basal skull fracture
- Post traumatic seizure
- Focal Neurological Deficit
- > 1 episode vomiting
- Suspicion of NAI
What patients should get a CT scan if there has been any evidence of unconsciousness of amnesia since the injury?
- Age >65
- Patients with a Coagulopathy
- Dangerous mechanism of injury
What clinical signs can indicate a base of skull fracture?
“Raccoon Eyes” - Periorbital haematoma
Battle’s sign - bruising over mastoid
Blood or CSF coming out of ear
Which of the sections of the glasgow coma scale is most important in telling us the status of a patient?
Motor section
Describe how an extradural haematoma appears on a scan
Doesn't cross any suture lines Biconvex shape (Lemon)
How do patients present when they have developed an extradural haematoma?
- Initial loss of consciousness after injury
- Recover for a period of time “lucid interval”
- *often present to ED in this state^**
- THEN rapid progression and deteriorating GCS
- hemiparesis
- Unilateral fixed and dilated pupil
How does a subdural haematoma appear on a scan?
- Banana shape on scan
- hyperdense as blood has usually clotted before visualisation
What patients are most likely to get subdural haematomas?
- elderly (as brain volume has shrunk)
- bridging veins more susceptible to damage when they fall etc
What are the two different types of intracerebral haemorrhage?
focal
contusion (bruising across majority of brain)
What two factors of injury increase the risk of developing a haematoma?
Skull fracture and loss of consciousness
What occurs during diffuse axonal injury?
- axons can be sheared, stretched, twisted or compressed
- More ions and water allowed into neuronal cell bodies
=> brain swells
Where does most diffuse axonal injury occur and why?
- Grey/white matter junction
- due to different matter densities rubbing against each other, injury creates enough force in this movement to break axons
What secondary injury insults do doctors wish to prevent?
- Hypoxia
- Hypotension
- Mass lesions
- Controlling ICP and Cerebral perfusion pressure
What should be considered before transferring patients to surgery?
Are they elderly?
Are they haemodynamically stable?
Are they on anticoag/antiplatelets?
Do they have a raised ICP?
How does the ICP normally rise in the brain due to injury?
Brain compensates for a period of time then rise is exponential
