Emergency

Question 1

Whats a traumatic brain injury?

Answer 1

Traumatic brain injury (TBI) is an injury that causes a disruption in the normal function of the brain due to a bump, blow or jolt to the head or a penetrating head injury.

Question 2

What are common causes of TBI?

Answer 2

• motor vehicle accidents
• sporting or recreational accidents
• falls
• violence/assault

Question 3

Who is most at risk for a TBI?

Answer 3

The most at risk groups include children under five years old, adolescent& young adult malesand the elderly.

Question 4

How is TBI categorized as?

Answer 4

blunt/closed TBI

penetrating/open TBI

Question 5

What is a blunt/closed TBI?

Answer 5

blunt/closed TBI: skull & dura mater remainintactand brain is NOT exposed to external environment

Question 6

What is a penetrating/open TBI?

Answer 6

penetrating/open TBI: penetration or damageof skull & dura mater occurs and the brain is exposed to the external environment

Question 7

What is a primary injury when speaking about a TBI?

Answer 7

Tissue damage that occurs at the moment of trauma.

This includes damage to tissue via penetration or compression andshearing forces associated with blunt trauma.

Question 8

What is secondary injury when speaking about a TBI?

Answer 8

occurs in the hours to days after the primary injury and involves the inflammation, oedema and bleeding that occurs in response tothe primary injury.

Secondary injurycan include metabolic & electrolyte imbalances, neurotransmitter excitotoxicity, mitochondrial dysfunction, apoptosis and/or ischemia.

Secondary injury is going to have an impact on intracranial pressure (ICP) and can be even more detrimental than the primary injury in some cases.

Question 9

What scale is used commonly to assess TBI?

Answer 9

Glascow coma scale

Question 10

What is a mild, moderate and severe TBI GCS score

Answer 10

• Mild TBI: score 13-15
• Moderate TBI: score 9-12
• Severe TBI: score 3-8

Question 11

What is a major component of TBI treatment?

Answer 11

• Monitoring and management of intracranial pressure (ICP) and cerebral perfusion pressure (CPP).
• Monitoring ventilation and blood pressure
• Affected/damaged tissue may need to be removed
• Antibiotic treatment with penetrating TBI

Question 12

how can ICP be monitored?

Answer 12

ICP can be monitored through invasive measures and interventions to reduce ICP and maintain adequate CPP may be implemented if ICP gets too high or CPP gets too low (e.g. induced coma, surgical decompression).

Question 14

What is a focal brain injury?

Answer 14

A focal brain injury occurs when the injury is localized to a specific region, or regions, of the brain.

Question 15

What types of trauma can result in focal brain injury?

Answer 15

Either blunt (closed) or penetrating (open) TBI can result in focal injury.

Question 16

What are the two possible outcomes of focal brain injury?

Answer 16

• Contusion: injury to brain tissue
• Intracranial hematoma: accumulation of blood (clotted) within the cranium

Question 17

How does a contusion occur in blunt (closed) trauma?

Answer 17

Contusion occurs due to the impact of the brain against the skull.

Question 18

What is a coup injury?

Answer 18

Coup injury is the injury occurring at the initial point of forceful impact.

Question 19

What is a contrecoup injury?

Answer 19

Contrecoup injury is the injury occurring in areas of the brain opposite from the site of initial impact due to rebound effect.

Question 20

What are the two components of brain contusion?

Answer 20

• Coup injury
• Contrecoup injury

Question 21

What are the types of intracranial hemorrhage/hematoma?

Answer 21

• Epidural (extradural) hematoma
• Subdural hematoma
• Subarachnoid hemorrhage
• Intracerebral hemorrhage

Question 22

Where does an epidural hematoma occur?

Answer 22

Between the skull and outer layer of the dura mater.

Question 23

What type of blood loss is most common in epidural hematoma?

Answer 23

Arterial blood loss.

Question 24

What is a subdural hematoma?

Answer 24

Blood accumulation between the dura mater and arachnoid mater; may be acute or chronic.

Question 25

What is a subarachnoid hemorrhage?

Answer 25

Bleeding within the subarachnoid space between the arachnoid and pia mater.

Question 26

What is an intracerebral hemorrhage?

Answer 26

Bleeding into the brain.

Question 27

What is the consequence of intracranial hemorrhage and hematoma?

Answer 27

An increase in intracranial pressure (ICP), leading to compression of the brain and possible herniation.

Question 28

What characterizes diffuse brain injury?

Answer 28

More widespread damage to neurons throughout the brain.

Question 29

What range of injuries does diffuse brain injury encompass?

Answer 29

* Concussion (mild form of TBI) * Severe diffuse axonal injury (DAI) with coma

Question 30

What occurs during diffuse axonal injury (DAI)?

Answer 30

Majority of neurons fire action potentials simultaneously, leading to release of glutamate and excitotoxicity.

Question 31

What are the effects of abnormal ion transport in neurons?

Answer 31

Disrupts mitochondrial function and ATP production, reducing the neurons' ability to generate and propagate action potentials.

Question 32

What causes diffuse axonal injury (DAI)?

Answer 32

Shearing forces generated within the brain at impact.

Question 33

What is the nursing assessment for TBI regarding pupils?

Answer 33

PERRLA: Pupils are Equal, Round, and Reactive to Light and Accommodation.

Question 34

What does 'Equalization' refer to in TBI assessment?

Answer 34

Equality of strength in left vs right arms and legs.

Question 35

What does 'Drift' assess in TBI evaluation?

Answer 35

Can arms stay up for a count of 10 seconds, legs for 5 seconds.