Traumatic Brain Trauma

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

245

Pages:

5
Author:

Mariam A. A.

Traumatic Brain Trauma Epidemiology Bimodal distribution Young adult males Elderly Causes Falls Most common cause MVA accidents Most common cause of TBI deaths Violence Industrial accidents Sport Classification Primary Secondary Hours to days after Due to further cellular damage from the effects of primary injuries Happens at time of incidents Most common Mechanisms Impact loading – collision of head with a solid object Free oxygen radicals Can lead to: Seizures Hypoxia Impulsive loading – sudden motion without physical contact Hypotension Static loafing Neuroinfection Hydrocephalus Hypo/hypercapnia Leads to neuronal degeneration and poor outcomes Types of Injury Skull fracture Subdural hematoma Most common Epidural hematoma SAH Cerebral contusions Diffuse axonal injury Grading of Injury Grade Description GCS of 13 to 15 Brief LOC Mild Nausea Cognitive, behavioural or emotional disturbances Moderate GCS of 9 to 12 after non-surgical resuscitation Severe GCS of less than 8 after a non-traumatic surgical resuscitation Clinical features Worsening headache Confusions Dizziness Fatigue Nausea and vomit LOC Seizure Clear fluid draining from nose/ears Cognitive deficits E.g. memory loss or mood changes Investigations/diagnostic work up History Skull examination Neurological exam CT Initial investigation MRI Management ABCDE assessment ICP management Elevate head to 30 degrees Hyperosmolar therapy hypertonic saline or mannitol Sedation if agitated If severe injury ICP monitor Continuous monitoring Oxygen support Intubate if cannot support own airway or of GCS is 8 or less Maintain cerebral perfusion pressure Avoid hyperthermia Blood pressure support IV fluids Vasopressors Analgesia If features of anaemia present Manage ASAP to prevent hypoxia If neck injury – secure with a c-collar + immobilise spine Hemodynamically stable: CT Then manage as per cause and seek urgent neurosurgery advice Seizure prophylaxis for 7 days Hemodynamically unstable Urgent surgery Options: Mass evacuation Craniectomy Decompressive craniectomy Depressed skull fracture surgical repair Diffuse axonal injury mainly supportive rarely need surgery Rehabilitation/follow up Physiotherapy OT Speech therapy Neurocognitive support Family counselling Red Flags Worsening GCS Neurological deficits Pupillary changes Persistent vomiting or severe headache Complications Cerebral oedema Long term neurological deficits Cognitive impairment Death Functional limitations Chronic traumatic encephalopathy