Traumatic Brain Injury Flashcards
(43 cards)
what are the most common age groups of TBI
0-4
15-19
75+
what are the major causes of TBI
falls
road traffic accidents
assaults
what is the commonest cause of death and disability in 1-40 years
head injury
which gender is is it more common in
men 1.5
what are traumatic brain injuries
external forces causing damage
mild-moderate-severe
what is primary brain injury
the instant injury
-happens at the instant of trauma
-pattern and extent of damage depends on nature of impact
-not treatable
-TARGET PREVENTION (PUBLIC HEALTH)
-there is more happening around that area
what is shaken baby syndrome
occurs when a baby or toddler gets shaken violently
they have very flexible necks
brain hits skull at each movement due to hyperextension and hyperflexion
what is coup contrecoup injury
“blow” and “counterblow”
two separate brain injury occur at same incident
coup- directly under first impact (hit dashboard)
countercoup- (hit headboard)
what is the early management of head injury
-manage at site
-assessment in EandR
-investigating pre-emtive investigations (eg. ct)
who gets sent to hospital (this is post ABC)
under 5 years, over 65 years
amnesia
loss of consciousness
high energy injury
vomiting
seizure
bleeding/clotting disorders
what to do when in contact with TBI patient straight away
ABC
Disability: GCS
Optimise oxygenation
why do you need to optimise oxygenation in TBI patients
50% patients pre admission have SpO2 <90%
the airway should be open BUT could have cervical spine injury– stabalise while intubating and mobilising
why do you do GCS
to find out degree of consciousness
differentiate mild, moderate, severe injury
what are the different levels of GCS in regards to mild moderate and severe
mild– 13-15
moderate– 9-12
severe– 8 or less
what is secondary brain injury
secondary processes which occur at the cell and molecular level to EXACERBATE neurological damage
what happens in secondary brain injury
once inflammation occurs after primary injury
NT release (glutamate)
oedema- increases intracranial pressure
free radical generation
calcium mediated damage
mitochondrial dysfunction
inflammatory response
ischaemia, excitotoxicity
neuronal death cascades
how can you minimise secondary brain injury
stop bleeding
optimise oxygenation
optimise cerebral perfusion
blood glucose- dont want hypoglycaemia trying to stop hyperglycaemia
hypocapnia/hypercapnia
HYPERTONIC solution to reduce oedema and intracranial pressure
body temperature control- every degree increase increase metabolic rate– give paracetamol if pyrexic
what is the monro kellie doctrine/ PRINCIPAL
there is a balance in the skull between
1. venous/arterial volume of blood
2. volume of brain
3. volume of csf
the sum of these three components remain constant, if one increases all other areas have to decrease
intracrainial bleeding
increase intracranial pressure
csf squished out of brain to compensate
compensatory mechanisms wont last long– therefore uncompensated phase
different stages:
-NORMAL BRAIN
-COMPENSATED BRAIN
-UNCOMPENSATED AND RAISED ICP
what is a physiological principle (not monro-kellie doctrine)
CPP=MAP-ICP
cerebral perfusion pressure
mean arterial pressure
intracranial pressure
MAP= diastolic pressure + 1/3 pulse pressure
or
MAP= DP + 1/3 (SP-DP)
identify some features that suggest risk of intracranial mass
history:
high impact injury
significant retrograde amnesia
history of coagulopathy
post traumatic seizure - increase metabolic rate
exam:
GCS
-12/15 or less
-13/15 or 14/15 and failing to improve within two hours of injury
-clinical signs of skull fracture
-leaking fluid from nose or ears
rhinorrhoea, otorrhea
what are some red flag to not discharge
-loss of consciousness, drowsiness, confusion, fits
-painful headache which doesnt settle, vomiting, visual disturbance
-rhin/otorrhea (to check if CSF do glucose test or beta 2 transferrin)
-problems understanding or speaking, loss of balance, walking difficulties, weakness in arms or legs
what do you do in hospital in regards to breathing
administer oxygen
monitor SpO2
monitor ABGs
GCS <8 INTUBATE
What is the investigation of choice
X-ray
often CT cervical spine
what drug should you use to control bleeding
Tranexamic Acid (CRASH-3 trial)
stops fibrinolytic activity
