Brain Trauma

Brain Trauma

1. Anatomy of the brain stem

   • Physiology of the brain stem and consciousness
     • Consciousness refers to different levels of awareness of one’s thoughts and feelings
     • SLEEP
       • REM sleep, a stage of sleep characterized by rapid eye movements, a high level of brain activity, a deep relaxation of the muscles and dreaming
       • NREM sleep. This stands for non-rapid eye movement and is the other type of sleep.
   • Blood Supply
     • Types of traumatic brain injury
       • Clinical Presentation and radiology
         • Glasgow Coma Scale
           • practical method to assess the impairment in the level of conscious in response to specific stimuli
             • It classifies traumatic brain injury (TBI) into:
               • Severe (3-8)
               • Moderate (9-13
               • Mild (14-15
         • Cushing Reflex
           • occurs in response to increase in the intracranial pressure.
             • It is a triad of hypertension, bradycardia, and irregular breathing (Apnea)
               • indicates that brain herniation and death is imminent, so it is an emergency situation
         • Managements
           • Pharmacology
           • General
             • Check the ABC’s. if necessary, begin rescue breathing and CPR
               • Stop any bleeding by firmly pressing a clean cloth on the wound. If blood soaks the cloth, place another cloth over it (don’t remove).
                 • adequate airway, breathing and circulation during the initial period of resuscitation and evaluation
                   • maintenance of balance between CDO2  (cerebral oxygen delivery ) and CMRO2 (cerebral metabolic rate of oxygen=cerebral oxygen consumption
           • Surgery
             • INDICATIONS A sudden (acute) subdural hematoma An ongoing (chronic) subdural hematoma Certain kinds of brain cancer Buildup of pus around the meninges  Hydrocephalus
               • Complications Bleeding Infection Blood clots Brain injury Another surgery required
       • Complications
       • Contusion
         • -Localized injury
           • -Macroscopic
             • Changes in cognition such as alterations in personality, or reductions in intelligence.
               • Difficulty understanding speech. Memory challenges
         • Contusion: Seizures Increased ICP Cerebral herniation Loss of memory Infections—if followed by a skull fracture
       • Concussion
         • -Widespread injury
           • -Microscopic
             • Changes in behavior, attention, or memory. An intense headache, feeling of fullness, or pressure in the head. Loss of consciousness.
               • Sleepiness, confusion, Dizziness. Ringing in your ears.
         • Concussion: Epilepsy Post-concussion Syndrome Second-impact Syndrome Post-traumatic headaches and vertigo

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