Unit 2: CONCEPTS for Traumatic Brain Injury

Question 1

Damage to the brain from an external force not caused by neurodegenerative or congenital conditions

Answer 1

Traumatic Brain Injury

Question 2

A force produced by a blow to the head is a ____ injury.

Answer 2

Direct injury (GSW, blow to the head, fall)

Question 3

A force applied to another body part with a rebound effect to the brain is an ______ injury.

Answer 3

Indirect injury
(whiplash, rear-ended MVC, Shaken baby syndrome)

Question 4

A ______ brain injury occurs at the time of injury and results from the physical stress (force) within the tissue caused by blunt or penetrating force.

Answer 4

Primary brain injury

Question 5

Primary brain injuries can be further classified into four categories. What are they?

Answer 5

Opened or Closed
Focal or Diffuse

Question 6

A ____ brain injury is characterized by damage throughout many areas of the brain.

Answer 6

Diffuse brain injury
(Typically microscopic + may not be seen on imaging until necrosis occurs)

Question 7

An ____ brain injury occurs when the skull is fractured or pierced by a penetrating object.

Answer 7

Open brain injury

Question 8

A _____ brain injury occurs when the integrity of the skull is intact, but damage to the brain tissue still occurs due to ICP.

Answer 8

Closed brain injury (contusion, cerebral laceration)

Question 9

A ____ brain injury is confined to a specific brain area and causes localized damage.

Answer 9

Focal brain injury
(often detected w/ a CT or MRI)

Question 10

A ______ brain injury occurs after the initial injury resulting from physiologic, vascular, &/or biochemical events.

Answer 10

Secondary brain injury

Question 11

The severity of a TBI can be classified in three ways…

Answer 11

Mild, Moderate, and Severe

Question 12

_______ is a type of mild TBI caused by a blow to the head and may or may not result in some period of unconsciousness.

Answer 12

Concussion

Question 13

The most common secondary injury from a mild TBI (concussion) is ________ syndrome where Sxs continue to occur for weeks to months after initial TBI.

Answer 13

Postconcussion syndrome
(HA, impaired cognition, dizziness/vertigo)

Question 14

The most common secondary injury from a moderate or severe TBI result from (4)

Answer 14

1. Hypotension (MAP <65)
2. Hypoxia (PaO2 <80 mmHg)
3. ICP (NR: 10-15 mmHg; neurons die at >20 mmHg)
4. Cerebral edema

Question 15

Secondary TBI:
Hypotension may be r/t (2)

Answer 15

Shock or clot formation

Question 16

Secondary TBI:
Hypoxia may be r/t (3)

Answer 16

Respiratory failure, asphyxiation, loss of airway/impaired ventilation

Question 17

Secondary TBI
Cerebral edema may be r/t (2)

Answer 17

Low blood flow (perfusion) + hypoxemia

Question 18

Which Secondary TBI has the poorest prognosis?

Answer 18

Cerebral Hypoxia!

Question 19

As ICP increases, cerebral ______ decreases leading to tissue ischemia and edema.

Answer 19

cerebral perfusion

Question 20

If cerebral edema isn’t treated, the brainstem may ..

Answer 20

HERNIATE! eeeeeek!!

Question 21

Is a cerebral hematoma a big deal?

Answer 21

OH yeah! all are considered potentially life-threatening → space-occupying lesion surrounded by edema

Question 22

What are the 5 S/S associated with a Basilar skull fracture?

Answer 22

1. CSF leakage (ears, nose)
2. Hemotympanum (blood behind tympanic membrane or external ear if ruptured)
3. Ecchymosis (behind ear or periorbital area)
4. Loss of smell + hearing (immediate)
5. Impaired facial nerve function (immediate or delayed)

Question 23

Ecchymosis found behind the ear is called

Answer 23

Battle sign

Question 24

Ecchymosis found behind the periorbital area is called

Answer 24

Raccoon eyes

Question 25

A “Halo sign” is indicative of

Answer 25

CSF leakage!

Question 26

If you suspect a brain hemorrhage, what and how often should you assess your patient?

Answer 26

Monitor q 5-10 min for changes in Neuro status!
Call provider or Rapid Response if any changes occur

Question 27

A loss of consciousness from an epidural hematoma is considered …

Answer 27

a NEUROSURGICAL EMERGENCY!
Bleeding will occur suuuuper fast (pg. 913)

Question 28

What Sxs might we see for a pt with a Mild TBI (aka concussion) and when do they usually resolve?

Answer 28

Sxs usually resolve w/in 72 hours
1. +/- unconsciousness for = 30 min
2. Impaired cognition (memory, thinking; dazed, disoriented)
3. Post-traumatic HA
4. Post-traumatic vertigo
5. No brain damage evident on imaging

Question 29

Cerebral Perfusion Pressure (CPP) =

Answer 29

CPP = MAP - ICP

Question 30

A Cerebral Perfusion Pressure (CPP) <__ is considered an indicator of a poor prognosis r/t a TBI.

Answer 30

CPP <70

Question 31

Hypercarbia can cause cerebral vasodilation and contribute to increased ___, whereas hypocarbia caused by hyperventilation can lead to ______.

Answer 31

Hypercarbia → Increased ICP
Hypocarbia → Ischemia

Question 32

A TBI can result in “Autoregulation impairment?” What does this mean?

Answer 32

the ability of cerebral vasculature to modify systemic pressure such that blood flow to the brain is sufficient.

Question 33

What type of Herniation am I?
Shift of temporal lobe leading to pressure on the oculomotor nerve which causes DILATED, nonreactive pupils.

Answer 33

Uncal Herniation

“Uncle D!”

Question 34

What type of Herniation am I?
Shift downward toward the brainstem resulting in hemodynamic instability, Cheyne-Stokes respirations, and PINPOINT, nonreactive pupils.

Answer 34

Central Herniation
“Pin the donkey in the Center”

Question 35

What should we suspect if our pt develops intense thirst and extreme urination?

Answer 35

Diabetes insipidus
-too little Antidiuretic hormone

Question 36

What should we suspect if our pt has electrolyte imbalances, low Na+ levels, and urinary retention?

Answer 36

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
-too much Antidiuretic hormone

Question 37

Criteria for Brain Death (4)

Answer 37

1. Coma for known cause
2. Normal body temperature
3. Normal blood pressure > 100
4. Neuro exam- 2 providers