Approach to Traumatic Brain Injury

Traumatic Brain Injury Quick Notes:

Definition: alteration in brain function or evidence on imaging of brain pathology, caused by an eternal force.

External forces:

-       Object striking the head

-       Foreign body penetrating the brain

-       Head striking an object

-       Acceleration/deceleration of brain within the skull

-       Force of blast or explosion

Population:

-       Young children

-       Teenagers

-       Elderly

-       Male sex

-       Intoxications

-       Neurologic or psychiatric conditions

-       Functional impairment

-       Lower SES

Causes:

-       Falls (45%)

-       Traffic-related injuries (25%)

-       Interpersonal violence (9%)

-       Other (sports-related, explosions, etc.) (9%)

Classification:

-       Mild – GCS 13-15

-       Moderate – GCS 9-12

-       Severe – GCS 3-8

Imaging findings:

-       Skull fracture

-       EDH

-       SDH

-       SAH

-       ICH

-       Cerebral contusion

-       IVH

-       Cerebral edema

-       Axonal injury

Management:

-       Maintain euvolemia

-       Avoid hypoxia

-       Target SBP > 100 (patients 50-69 yrs) and > 110 (patients 15-49, or >70 yrs)

-       Consider prophylactic AEDs in first 7 days

-       Normoglycemia

-       Normothermia

-       Transfusion targets > 90

-       ICP monitor if GCS < 9 or no reliable neuro exam