Level 4 Exam 4

Traumatic Brain Injury

Traumatic Brain Injury (TBI) refers to any trauma to the skull, brain, or scalp that disrupts brain function. The severity of TBIs ranges from mild (e.g., concussion) to severe (e.g., minor brain injury, coma, and death).

Types of Head Injury

Scalp Lacerations
  • Characteristics: Significant bleeding due to the highly vascular nature of the scalp.
  • Risks: High risk for infection.
Skull Fractures
  • Linear Fracture: A simple break in the skull.
  • Depressed Fracture: A fracture where the bone is pressed inward.
  • Comminuted Fracture: Involves multiple fragments of the skull.
  • Basilar Fracture: A fracture at the base of the skull, associated with severe complications such as:
      - Raccoon Eyes: Bruising around the eyes.
      - Battle’s Sign: Bruising behind the ears.
      - CSF Leak: Leakage of clear fluid from the nose or ears. Testing for glucose or the halo sign is crucial, as it indicates a high risk for meningitis, necessitating preventive antibiotics.

Head Trauma

Concussion
  • Definition: A brief disruption in level of consciousness (LOC).
  • Symptoms:
      - Headache
      - Retrograde amnesia
      - Typically short duration of symptoms.
      - Possible loss of total consciousness or not.
Contusion
  • Definition: Bruising of brain tissue.
  • Potential complications include bleeding and swelling.
Coup-Contrecoup Injury
  • Description: Occurs when an impact causes injury both at the site of impact (coup) and on the opposite side (contrecoup). Contrecoup injuries are typically more severe.
Diffuse Axonal Injury
  • Definition: A widespread damage to axons, often resulting in severe impairments.
  • Clinical Implications: Can lead to decreased LOC, coma; symptoms may develop over 12 to 24 hours.
Hematomas
  • Epidural Hematoma: Arterial bleeding between dura mater and the skull; is a medical emergency with rapid deterioration.
  • Subdural Hematoma: Venous bleeding under the dura; presents with a slower onset and can be classified as acute, subacute, or chronic.
  • Intracerebral Hematoma: Bleeding within brain tissue.

Common Causes of TBI

  • Most common cause: Falls
  • Other causes include:
      - Motor vehicle accidents.
      - Violence (e.g., gunshot wounds, assaults).
      - Sports injuries.
      - Military blasts.
  • Gender statistics: Men are twice as likely to sustain a TBI.

Clinical Manifestations of TBI

  • Altered LOC (earliest sign of increased ICP).
  • Headaches.
  • Nausea/vomiting.
  • Seizures.
  • Pupillary changes (e.g., unequal, sluggish, fixed).
  • Posturing: indicates severity of brain injury with decorticate (flexion) being milder compared to decerebrate (extension).
  • CSF leakage from the nose.
  • Respiratory changes.
Mortality Points Post-Injury
  1. Immediately after injury.
  2. Within 2 hours following injury.
  3. Around 3 weeks post-injury.

Note: Use of a Nasogastric (NG) tube is contraindicated in TBI patients.

Diagnostic Tests

  • CT Scan: The best imaging modality for assessing head trauma.