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Questions and Answers

What is the target cerebral perfusion pressure (CPP) in managing traumatic brain injury?

  • 50 mmHg
  • 60 mmHg (correct)
  • 80 mmHg
  • 70 mmHg

    • What is the Glasgow Outcome Scale score for a patient who is dead?

  • 2
  • 3
  • 4
  • 1 (correct)

    • Which of the following is a cognitive symptom of post-concussive syndrome?

  • Balance difficulties
  • Tiredness
  • Difficulty concentrating (correct)
  • Headaches

    • What is the target intracranial pressure (ICP) in managing traumatic brain injury?

    <p>&lt; 20 mmHg</p> Signup and view all the answers

    Which healthcare professional is part of the multidisciplinary team in managing traumatic brain injury?

    <p>Occupational therapist</p> Signup and view all the answers

    What is a potential complication of traumatic brain injury?

    <p>Post-traumatic seizures</p> Signup and view all the answers

    What is the normal value of ICP?

    <p>20 mm Hg</p> Signup and view all the answers

    What is the goal of cerebral perfusion pressure management?

    <p>To increase mean arterial pressure</p> Signup and view all the answers

    What is post-concussive syndrome?

    <p>A group of symptoms that occur after a head injury</p> Signup and view all the answers

    What is the Glasgow Coma Scale used for?

    <p>To assess the severity of head injury</p> Signup and view all the answers

    What is the primary goal of the multidisciplinary team in head injury management?

    <p>To improve patient outcome</p> Signup and view all the answers

    What is an indication for CT scan in a patient with a head injury?

    <p>All of the above</p> Signup and view all the answers

    What is an indication for observation at home in a patient with a head injury?

    <p>All of the above</p> Signup and view all the answers

    What is a complication of head injury?

    <p>All of the above</p> Signup and view all the answers

    What is the normal range for Brain Tissue Oxygen Tension (PbtO2) monitoring?

    <p>20 - 35 mmHg</p> Signup and view all the answers

    What is the formula for calculating Cerebral Perfusion Pressure (CPP)?

    <p>CPP = MAP - ICP</p> Signup and view all the answers

    What is the targeted value for Cerebral Perfusion Pressure (CPP) in brain injury patients?

    <p>60 mmHg</p> Signup and view all the answers

    What is the indication for ICP monitoring in brain injury patients?

    <p>GCS ≤ 8</p> Signup and view all the answers

    What is the definition of Post-Concussive Syndrome?

    <p>A syndrome characterized by headaches, dizziness, and cognitive impairment after a concussion</p> Signup and view all the answers

    What is the role of the multidisciplinary team in managing brain injury patients?

    <p>To provide comprehensive care involving medical, surgical, and rehabilitation teams</p> Signup and view all the answers

    What is the Glasgow Outcome Scale used for?

    <p>To predict outcome in brain injury patients</p> Signup and view all the answers

    What is the age group with the greatest potential for survival and recovery in brain injury patients?

    <p>Younger patients</p> Signup and view all the answers

    Study Notes

    Motorbike Crashes

    • GCS < 8 indicates coma or severe head injury
    • ICP > 45 indicates poor outcome
    • Hypotension increases mortality by 50% with a single episode
    • Hypoxia is defined as PO2 < 60 mmHg or Sats < 90%

    Glasgow Outcome Scale

    • 1: Dead
    • 2: Vegetative state
    • 3: Severe disability
    • 4: Moderate disability
    • 5: Mild disability

    Late Complications

    • Post-traumatic seizures
    • Hydrocephalus
    • Infections
    • Post-concussive syndrome

    Post-Concussive Syndrome

    • Somatic: headaches, dizziness, anosmia, hearing difficulties, balance difficulties
    • Cognitive: difficulty concentrating, dementia, impaired judgment
    • Psychosocial: emotional problems, personality changes, loss of libido, tiredness, difficulty sleeping

    Multidisciplinary Team

    • Physiotherapists
    • Occupational therapists
    • Psychologists
    • Social workers
    • Nurses
    • Doctors

    Key Points

    • 2 mechanisms of brain injury: impact injury and secondary injury
    • GCS < 8 indicates coma or severe head injury
    • CT imaging is the study of choice in acute head injury assessment
    • Operative and non-operative strategies aim to reduce mass effect and ICP
    • ICP < 20 mmHg, CPP = 60 mmHg

    Autoregulation and Herniation

    • Autoregulation: volume-pressure curve
    • Herniation: point of decompensation, volume of mass

    Classification of Head Injury

    • Glasgow Coma Scale

    Clinical Scenario

    • 20-year-old male in MVA, intubated, GCS 8T

    Approach to Head Injury

    • History: mechanism of injury, loss of consciousness, vomiting, seizures, intoxicants, post-traumatic amnesia
    • Clinical examination: dilated non-reactive pupils, hemiplegia/hemiparesis, aphasia/dysphasia, facial weakness, cranial nerve palsy, papilloedema

    Investigations

    • Skull X-ray: only detects skull fracture, wastes time in trauma setting
    • Cervical spine injury: C-spine X-ray, CT scan
    • Indications for CT: GCS ≤ 14, focal neurological deficits, deteriorating GCS, penetrating head injuries, post-traumatic seizures, loss of consciousness and amnesia, multiple trauma, skull fracture, intoxicated patients, patients on anticoagulant therapy, mechanism of injury (e.g., motorbike injuries)

    Pathology

    • Primary injury: acute extradural hematoma, acute subdural hematoma, contusion/intracerebral hematoma, diffuse cerebral injury, skull fracture, gunshot injuries, penetrating stab injuries
    • Secondary brain injury: prevention, conservative management, surgical management, ICU management, medical management

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