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TBI Part I
Terms in this set (20)
What is the definition of a traumatic brain injury?
a delivered force to the head that causes transient or permanent loss of neurologic function
Describe the current classification system for traumatic brain injuries.
Based on Glasgow Coma Scale Score: Mild = 13-15, Moderate = 9-12, Severe < or = 8
True or false: the diagnosis of a concussion requires a head CT.
List the indications for immediate need to be transferred to the ER following a head injury.
headaches that have worsened, seizures, focal neurological signs, decreased level of consciousness or loss of consciousness, vomiting, slurred speech, failure to recognize people/place, confusion/irritability, neck pain, unusual behavior changes
The best way to determine if someone has had a brain injury following a blow to the head is to compare their performance on a standardized assessment tool prior to their injury with their performance after an injury. Often, though, this is not possible. How is the diagnosis of mild traumatic brain injury made if it is not possible?
Glasgow Coma Scale Score, presence of concussion symptoms, findings on neurologic examination.
List the physical symptoms of a concussion.
headache, pressure in head, nausea, vomiting, balance problems, dizziness, fuzzy or blurry, vision, fatigue, sensitivity to light or noise
List the cognitive symptoms of a concussion.
feeling mentally foggy, feeling slowed down, difficulty concentrating, difficulty remembering, don't feel right
List the emotional symptoms of a concussion.
irritability, sadness, more emotional, anxiety
List the sleep symptoms of a concussion.
drowsiness, sleeping more than usual, sleeping less than usually, trouble falling asleep
If you have a loss of consciousness following a blow to the head have you had a mild traumatic brain injury? Have you had a concussion?
List the questions to ask informants regarding the patient's behavior after a blow to the head.
did he lose consciousness, did he appear dazed/stunned, answer questions slowly, was he confused, move clumsily, repeat questions, or acted differently
List the medical problems that lead to an increased risk of having prolonged symptoms after a concussion.
past head injuries, personal or family headache history, past developmental problems such as ADHAD or learning disability, past psychiatric problems, all especially if < 18 yo
In the setting of a head injury, it is important to know what medications the patient is on. What is the MOST important question you should ask with respect to medications?
Are they on anticoagulants?
True or False: People with head injuries are at increased risk of having had a cervical spine injury at the same time.
List the well-validated reasons for performing a head CT in a person with a mild traumatic brain injury. What question are you trying to answer with the head CT?
GCS<15, suspected open or depressed skull fracture, basilar skull fracture, two or more episodes of vomiting, neuologic deficit, bleeding diathesis, seizure, age > or = 60 yo, retrograde amnesia > 30 mins, high impact injury; looking for intracranial hemorrhage or skull fracture
List 4 different presentations of a basilar skull fracture.
racoon eyes, hemotympanum (blood behind the tympanic membrane), CSF oto- or rhinorrhea, battle sign (bleeding over mastoid process)
True or false: Patients with a basilar skull fracture should have a CT scan.
List the indications for admission following a normal head CT in the setting of a traumatic brain injury.
GCS<15, bleeding diathesis, seizure, recurrent vomiting, no responsible caregiver at home
What percentage of patients with a concussion are symptom-free within 3 months?
List the possible mood, behavior, cognitive and motor findings in a patient with presumed chronic traumatic encephalopathy.
depression, irritability, hopelessness, suicidality, impulsivity, explosivity, agression, memory impairment, executive dysfunction, dementia, Parkinsonism, ataxia, dysarthria
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