Traumatic Brain Injury Flashcards Preview

Neuro Module > Traumatic Brain Injury > Flashcards

Flashcards in Traumatic Brain Injury Deck (48)
Loading flashcards...
1

Definition of traumatic brain injury

damage to brain resulting from external mechanical forces

2

Epidemiology of traumatic brain injury

trauma most common cause of death 1-45 yo; 50% are deaths from head injury

20% of head injuries cause brain injury

3

Etiology of traumatic brain injury

direct impact, rapid acceleration, blast waves, penetration by projectile (bullets, knifes, etc.)

4

intra-axial vs extra-axial brain injury

intra-axial = acceleration/deceleration injury (shearing, coup/countrecoup); in brain parenchyma

extra-axial = direct force; in epidural, subdural, subarachnoid

5

coup-countrecoup

- head strikes fixed object, causing brain to collide with inside of skull at impact site and opposite side of site
- result in cerebral contusions (bruising)

6

Primary vs secondary traumatic brain injury

Primary: immediate injury effects

Secondary: molecular cascade of neurochemical reactions in brain post-injury; last for hours to days

7

epidural injury mechanism

direct trauma, usually with skull fracture, min to hours

8

Important history information with traumatic brain injury

mechanism, LOC, HA, visual changes, focal neural complaints, neck pain, seizures

9

Leading cause of brain injuries

falls

10

where contusions likely to occur?

basilar temporal area

11

subdural injury mechanism

lower force (eg. fall), less likely skull fracture, veins, hrs to days

12

subarachnoid injury mechanism

spontaneous/high force, small vessels rupture, secs-mins

13

Secondary brain injury can result in

neuronal cell death, cerebral edema, increased ICP

14

PE of traumatic brain injury

Neuro exam
Glasgow Coma Scale
External findings (hematoma, depressions, lacerations)
Signs of increased ICP
Signs of basilar skull fracture

15

Signs of increased ICP

fixed/dilated pupils
decorticate/decerebrate posturing
Cushing response (bradycardia, HTN, less respiratory drive)

16

Signs of basilar fracture

- Battle sign
- Raccoon eyes
- Hemotympanum, otorrhea, rhinorrhea (may be CSF)

17

galea

periosteum on top region of skull

18

decorticate vs decerebrate posturing

decorticate is abnormal flexion rigidity and decerebrate is abnormal extension rigidity

19

Glasgow Coma Scale classes

Mild = 13-15
Mod = 9-13
Severe = 8 or less

20

Tx according to Glasgow Coma Scale?

GCS < 8 = intubate
GCS 14 or less = CT

21

What does Glasgow scale 3 or less indicate?

70-100% mortality

22

First line diagnostic studies for head injury

1) CT
2) Lumbar Puncture

23

ER tx and dx of traumatic brain injury

1. Maintain vitals
2. Neuro exam GCS
3. Assess for systemic trauma
4. Check labs (CBC, lytes, glucose, coags, etoh, urine drug screen)

For severe TBI - head elevation, Mannitol or IV hypertonic saline

24

What greatly effects accuracy of Glasgow Coma Scale?

alcohol

25

Different ways to treat increased ICP

Mannitol, hyperventilation, sedation

26

Why monitor glucose?

too high - osmotic (water to brain, worsening edema)

too low - seizures

27

Definition of concussion

trauma-induced alteration in mental status

28

Definition of mild TBI

- injury to brain caused by contact and/or acceleration/deceleration forces
- GCS score 13-15 measured at ~30 min post-injury

29

Etiology of mild TBIs

most common MVA and falls

others - occupational accidents, recreation accidents, assaults

30

Hallmark sx of concussion

confusion, amnesia, +/- LOC