TBI Basics
This type of penetrating or open head injury occurs when an object like a bullet or shrapnel pierces the skull and directly enters the brain tissue.
What is a penetrating (or open) brain injury?
This is the minimum SpO2 target in TBI
What is > 94%?
As the uncus presses on the third cranial nerve, this hallmark, eye-related physical sign is an immediate red flag for herniation.
What is ipsilateral fixed and dilate pupil?
These are the three components of the GCS, or Glascow Coma Scale and their relative values.
What is Eye (4), Verbal (5), and Motor (6).
Cushing's triad is an ominous clinical sign because it indicates the imminent danger of this permanent and fatal neurological complication.
What is brain herniation?
This is bleeding between the tough outer membrane surrounding the brain and the skull, typically caused by a tear in an artery.
What is an Epidural hematoma?
This is the minimum SBP target for TBI in resuscitation.
What is >110mmHg?
These are considered among the first warning signs for rapid neurologic deterioration in severe TBI.
What is rapid decline in consciousness (2point drop in GCS), pupil changes and severe headache.
A GCS score of this would be classified as severe TBI,
What is 3-8?
This first hallmark sign of Cushing's triad is a reflex elevation in systolic blood pressure, which creates a larger gap between the top and bottom numbers.
Question: What is widened pulse pressure (or systolic hypertension)?
The Joint Trauma System recommends monitoring serum sodium levels and strictly avoiding free water/hypotonic fluids to prevent this secondary complication of a severe TBI.
What is cerebral edema (brain swelling)
For severe TBI patients, providers must closely control end-tidal CO2 within this range?
A severe, unrelenting headache, projectile vomiting, and progressive sleepiness are classic early indicators of this pressure-related shift.
What is increased intracranial pressure (ICP)?
To test this motor response (scoring a 5), the patient must reach above the clavicle to push away a painful stimulus applied to their core
What is Localizes Pain?
The body mounts this triad of responses as a desperate final measure to maintain this vital metric above the rising intracranial pressure, ensuring blood flow to the brain tissue.
What is Cerebral Perfusion Pressure (CPP)?
This type of blast injury is caused by flying shrapnel and debris that pierces the skull and brain tissue.
What is secondary blast injury?
This is the ICP pressure target in TBI management?
What is < 20mmHg?
When the brain shifts downward, pressure on the motor tracts causes this ominous symptom, characterized by rigid extension (arms out, toes pointed) or abnormal flexion (arms to core).
What is abnormal posturing (decerebrate or decorticate)
The patient groans and moans during a painful sternal rub, but does not articulate any recognizable words, resulting in this verbal response score?
What is 2?
As the blood pressure shoots up, baroreceptors send signals via the vagus nerve to trigger this second hallmark of Cushing's triad.
What is bradycardia?
This widespread, microscopic damage results from the brain's rapid acceleration and deceleration inside the skull, heavily contributing to loss of consciousness and coma.
What is diffuse axonal injury?
To prevent brain swelling, the target serum sodium level for severe TBI patients is slightly above normal, between this range?
What is 145-164mmol/L?
These are the classic "H" bombs TBI management aims to limit to mitigate secondary brain injury in addition to elevated ICP.
Hypoxia, Hypo/Hypercarbia, Hypoglycemia, Hypotension
Your patient only opens their eyes to pain, speaks in inappropriate, random words, and withdraws their limb quickly away from a painful stimulus, resulting in this GCS score.
What is 10?
Because the increased ICP begins to physically compress the brainstem, the patient's breathing becomes abnormal—often presenting as a pattern of deep, rapid breaths alternating with periods of apnea.
What are irregular respirations (Cheyne-Stokes breathing)?