TBI Quiz: Test Your Knowledge of Traumatic Brain Injury

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Questions and Answers

What is the main consequence of disruption of the blood-brain barrier in Traumatic Brain Injury?

Improved microcirculatory flow and decreased blood viscosity

Elevated intracranial pressure and poor neurologic outcomes (correct)

Local inflammation and altered cellular metabolism

Increased cerebral perfusion pressure

What is the goal of ICP management in Traumatic Brain Injury?

Achieve a CPP of 80-90 mmHg

Maintain a GCS score of 8-10

Maintain a CPP of 60-70 mmHg (correct)

Maintain an ICP of 25-30 mmHg

What is the primary mechanism of action of Mannitol in reducing ICP?

Decreasing blood viscosity

Increasing microcirculatory flow

Increasing MAP and decreasing ICP simultaneously

Creating an osmotic gradient (correct)

What is a predictor of poor outcomes in Traumatic Brain Injury?

Elevated ICP and absent cough and gag reflexes Signup and view all the answers

What is the advantage of Hypertonic Saline over Mannitol?

Increased MAP and decreased ICP simultaneously Signup and view all the answers

What is the recommended duration for seizure prophylaxis in Traumatic Brain Injury?

Not recommended Signup and view all the answers

What type of hemorrhage occurs between the dura and arachnoid mater?

Epidural hematoma (EDH) Signup and view all the answers

What is the primary goal of Hyperosmolar Therapy?

Decrease intracranial pressure Signup and view all the answers

What is a common adverse effect of Mannitol therapy?

All of the above Signup and view all the answers

What is the most significant risk factor for early posttraumatic seizures within 7 days of injury?

GCS < 10 Signup and view all the answers

Which antiepileptic medication is commonly used for preventing seizures in TBI patients, despite having a lower safety profile?

Phenytoin Signup and view all the answers

What is the recommended duration of antiepileptic therapy for TBI patients?

7 days post-TBI Signup and view all the answers

Which of the following is NOT a predictor of DVT in TBI patients?

GCS < 10 Signup and view all the answers

What is the mechanism of action of Propofol in reducing ICP?

Decreased cerebral metabolism Signup and view all the answers

What is a potential complication of Propofol infusion?

Propofol-related infusion syndrome (PRIS) Signup and view all the answers

When is Pentobarbital typically used in TBI patients?

Elevated ICP refractory to other agents Signup and view all the answers

What is the benefit of Levetiracetam in TBI patients?

All of the above Signup and view all the answers

What is the timing of VTE prophylaxis in TBI patients?

Within 24-48 hours from stable head CT Signup and view all the answers

Study Notes

Traumatic Brain Injury (TBI)

Alteration in brain function or evidence of brain pathology caused by an external force

Types of Hemorrhage

Extra-axial hemorrhage: Epidural hematoma (EDH), Subdural hematoma (SDH), Subarachnoid hemorrhage (SAH)
Intra-axial hemorrhage: Diffuse axonal injury (DAI), Intraventricular hemorrhage (IVH), Intracerebral hemorrhage (ICH)

Primary and Secondary Injury

Primary injury: Initial injury caused by external force
Secondary injury: Result of subsequent cellular and molecular responses

Predictors of Poor Outcomes

Elevated ICP
Herniation
Absent cough and gag reflexes
Low GCS scores
Over breathing the ventilator

Hyperosmolar Therapy

Goals: Maintain cerebral perfusion pressure (CPP), provide adequate blood flow to brain
CPP = MAP – ICP, Goal CPP: 60-70 mmHg, Goal ICP: < 22 mmHg

Mannitol and Hypertonic Saline

Mannitol: Osmotic diuretic, decreases blood viscosity, increases microcirculatory flow
Adverse effects: Hypernatremia, Hypovolemia, Renal dysfunction
Hypertonic Saline: Increases MAP, decreases ICP, improves CPP
Monitoring: serum sodium levels, renal function
Adverse effects: Hypernatremia

Comparison of Mannitol and Hypertonic Saline

ICP reduction onset: Mannitol < 5 min, Hypertonic Saline 15-30 min
ICP reduction duration: Mannitol up to 12 hrs, Hypertonic Saline 1.5-6 hrs
Rebound effect: Mannitol none, Hypertonic Saline possible
Diuretic effect: Mannitol none, Hypertonic Saline yes, ↓MAP

Early Seizure Prophylaxis

Recommended to prevent early post-traumatic seizures within 7 days of injury
Risk factors: GCS < 10, Immediate seizures, Subdural, epidural, or intracerebral hematoma, Post-traumatic amnesia lasting longer than 30 mins, Cortical contusion, Linear or depressed skull fracture, Age < 65 years, Penetrating head injury, Chronic alcoholism

Antiepileptic Therapy

Phenytoin: Most data to support its use, not used as often, Monitoring: dose titrated based on phenytoin levels, not as well tolerated as levetiracetam, more sedating
Levetiracetam: Used more commonly, shown to be as effective as phenytoin in preventing seizures, benefits: improved safety profile, easy administration, few DDI, safe in pregnancy, no drug monitoring required, 1:1 IV to PO conversion

Duration of Therapy

7 days post TBI

VTE Prophylaxis

Background: High risk for VTE due to hypercoagulable state from primary brain injury, periods of prolonged immobilization, focal motor deficits
Predictors of DVT: Age, SAH, ISS > 15, Extremity injury
Agents: Compression devices (SCDs), graduated compression stockings, LMWH or low-dose UFH
Timing: LMWH or UFH within 24-48 hr from stable head CT

Other Agents

Propofol: Sedative of choice in TBI patients, decreases ICP, rapid onset, short duration, possible neuroprotective effects, no mortality benefit, no effects on neurological improvement
Monitoring: Triglyceride levels, Propofol related infusion syndrome (PRIS)
Pentobarbital: Not a 1st line agent, elevated ICP refractory to other agents, barbiturate coma, concern

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Description

Test your knowledge of traumatic brain injuries, including types of hemorrhages, predictors of poor outcomes, and more. This quiz covers the basics of TBI, primary and secondary injuries, and symptoms to look out for.

Traumatic Brain Injury (TBI) Quiz

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