What are the three points in time after TBI that death can occur?
- Immediately after the injury (from direct head trauma or from massive hemorrhage and shock)
- Within 2 hours after the injury (by progressive worsening of the head injury or internal bleeding)
- 3 weeks after the injury. (from multisystem failure)
It is any injury or trauma to the scalp, skull, or brain
Head injury
What are the two most common cause of TBI?
falls and motor vehicle accidents
What are the causes of TBI?
Motor vehicle collisions Falls Firearm-related injuries Assaults Sports-related injuries Recreational accidents War-related injuries
Females are twice likely to sustain TBI than males. True or False.
False. Males are twice likely to sustain TBI than females.
What are the types of TBI?
Scalp lacerations and skull fractures
What are scalp lacerations?
- They are external head trauma
- easily recognized
- scalp is highly vascular with poorly constricting blood vessels
- cause profuse bleeding
- complications - blood loss and infection
What are the different types of skull fractures?
- linear (break in continuity of bone - low velocity injury )
- depressed (inward indentation - powerful blow)
- simple (fracture without fragments or serious lacerations - low to moderate impact),
- comminuted (multiple linear with many fragments of bone - direct high momemtum impact)
- compound (depressed skull + scalp laceration= severe head injury)
- can be closed or open
The clinical manifestations of skull injury is determined by the _____ of the fracture.
location
What are the complications of skull fracture?
intracranial infections, hematoma, meningeal and brain tissue damage
The ____ and ____ of a skull fracture depend on the velocity, momentum, direction and shape (blunt or sharp) of the injuring agent, and site of impact.
type and severity
postauricular ecchymosis is also called ___’s ___.
Battle’s sign
periorbital ecchymosis is also called ___ ____
raccoon eyes
In cases where a basal skull fracture is suspected, a nasogastric or oral gastric tube should be inserted under ____ (x-ray or fluroscopy).
fluoroscopy
A basilar skull fracture is a specialized type of _____ fracture that occurs when the fracture involves the base of the skull.
linear
CSF leakage from the nose
Rhinorrhea
CSF leakage from the ear
otorrhea
The risk of meningitis is ___ (high or low) with a CSF leak, and ______ should be administered to prevent the development of meningitis.
high; antibiotics
What are the two methods of testing fluid from ear or nose for CSF?
- Test fluid with Dextrostix or TesTape Strip for glucose. CSF is positive for glucose, mucous is not.
- Let the fluid drip on a white gauze pad. In a few minutes as the blood coalesces into the center, and a yellowish ring encircles the blood, halo or ring sign, if CSF is present
(Note: Both methods can give false positive so the color, appearance, and amount of leaking fluid must be observed)
It is alright to insert NG tube in a patient with basilar skull fracture. True or false.
False. NG tube should NEVER be inserted instead an orogastric (OG) tube should be inserted.
What are the different categories of brain injury?
- Diffuse (generalized - cannot be localized to a particular area. Eg. concussion, diffuse axona injury)
- Focal (localized, contusion, lacerations, hematoma)
How are brain injuries classified?
- Minor (GCS 13-15)
- Moderate (GCS 9-12)
- Severe (GCS 3-8)
It is a sudden transient mechanical head injury with disruption of neural activity and a change in the LOC that usually last a short duration.
concussion
Concussion is considered a ____ (minor or major) diffuse head injury?
minor. Patient may or may not lose consciousness.
