Nabeel Kouka, MD, DO, MBA brain101

2. Brain Injuries THIS SLIDE SHOWSHOW DIFFERENT TYPES OF BRAIN INJURIES ARE CLASSIFIED THE TYPE OF INJURY WE WILL FOCUS ON TODAY IS TRAUMATIC BRAIN INJURYTHIS SLIDE SHOWSHOW DIFFERENT TYPES OF BRAIN INJURIES ARE CLASSIFIED THE TYPE OF INJURY WE WILL FOCUS ON TODAY IS TRAUMATIC BRAIN INJURY

3. What is a TBI? Sudden damage to the brain due to an external force. 2 Types Closed Head Injury- Occurs when the head forcefully collides with another object (for example the windshield of a car) but doesn't fracture or penetrate the skull. Open Head Injury- Occurs when an object (for example a bullet) fractures the skull and debris enters the brain and rips the soft brain tissue in its path.

6. TBI in the United States (by Cause) Falls were the leading cause of traumatic brain injury (28%), followed by motor vehicle-traffic (20%) and assaults (11%). Falls were the leading cause of traumatic brain injury (28%), followed by motor vehicle-traffic (20%) and assaults (11%).

7. Two types of TBI TRAINER: WE WILL LOOK AT TWO TYPES OF TRAUMATIC BRAIN INJURIES THAT CAN OCCUR FROM AN EXTERNAL PHYSICAL FORCE OPEN-HEAD INJURIES INCLUDE THOSE WHERE THE SKULL HAS BEEN PENETRATED INJURIES THAT INVOLVE PENETRATION OF THE SKULL AND BRAIN CAN BE MORE LOCALIZED CLOSED HEAD INJURIES AND INJURIES OF A NON-TRAUMATIC NATURE (I.E. STROKE OR ANOXIA FROM NEAR DROWNING) CAN CAUSE MORE DIFFUSE OR GLOBAL DAMAGETRAINER: WE WILL LOOK AT TWO TYPES OF TRAUMATIC BRAIN INJURIES THAT CAN OCCUR FROM AN EXTERNAL PHYSICAL FORCE OPEN-HEAD INJURIES INCLUDE THOSE WHERE THE SKULL HAS BEEN PENETRATED INJURIES THAT INVOLVE PENETRATION OF THE SKULL AND BRAIN CAN BE MORE LOCALIZED CLOSED HEAD INJURIES AND INJURIES OF A NON-TRAUMATIC NATURE (I.E. STROKE OR ANOXIA FROM NEAR DROWNING) CAN CAUSE MORE DIFFUSE OR GLOBAL DAMAGE

8. Two Classes of Brain Injury PRIMARY THE INJURY IS MORE OR LESS COMPLETE AT THE TIME OF IMPACT SKULL FRACTURE CONTUSION/ BRUISING OF THE BRAIN HEMATOMA/BLOOD CLOT ON THE BRAIN DIFFUSE AXONAL INJURY SECONDARY THE INJURY EVOLVES OVER A PERIOD OF HOURS TO DAYS AFTER THE INITIAL TRAUMA BRAIN SWELLING/EDEMA INCREASED INTRACRANIAL PRESSURE INTRACRANIAL INFECTION EPILEPSY HYPOXEMIA (LOW BLOOD OXYGEN) HIGH OR LOW BLOOD PRESSURE ANOXIA/HYPOXIA (LACK OF OXYGEN TO THE BRAIN)

9. TBI Severity Levels Mild- Only when there is a change in the mental status at the time of the injury; concussion. Moderate- Loss of consciousness last for minutes to hours; confused for days or weeks. Impairments can be temporary or permanent. Severe- Unconscious state for days, weeks, or months. Impairments are permanent.

11. Brain Rates of Development TRAINER: #1: THE GREATES PERCENT OF BRAIN MATURATION OCCURS IN THE EARLY YEARS, BIRTH THRU AGE 5. WE LEARN MORE DURING THIS TIME THAN AT ANY OTHER TIME IN OUR LIFE LEARNING TO WALK/RUN (P-O), SPEAK/USE LANGUAGE(T), BONDING EMOTIONALLY WITH FAMILY, ETC. DESPITE MYTHS THAT INJURY DURING THIS TIME IS OF LITTLE CONSEQUENCE, WE NOW KNOW THATTBI DURING THIS TREMENDOUS STAGE OF BRAIN DEVELOPMENT CAN BE DEVASTATING CHILDREN WITH DAMAGE TO THEIR FRONTAL LOBES FROM TBI BEFORE AGE 5 FREQUENTLY HAVE LIFELONG CHALLENGES WITH SOCIAL AND BEHAVIORAL ISSUES #2: CAN HANDLE SEPARATION (C), WRITING(P-O),FOLLOWING DIRECTIONS & IMPULSE CONTROL (F-T) #3: BECOMING MORE COORDINATED(P-O) (ex)playing team sports #4: LEARNING 2ND LANGUAGE, COMMUNICATE SOCIALLY W/PEERS & ADULTS, REMEMBERING MORE ACADEMIC INFO(T); EMOTIONS BECOMING MORE ADULT-LIKE(C) #5: ACCEPTING MORE RESPONSIBILITY, PLANNING LIVES(F-T)TRAINER: #1: THE GREATES PERCENT OF BRAIN MATURATION OCCURS IN THE EARLY YEARS, BIRTH THRU AGE 5. WE LEARN MORE DURING THIS TIME THAN AT ANY OTHER TIME IN OUR LIFE LEARNING TO WALK/RUN (P-O), SPEAK/USE LANGUAGE(T), BONDING EMOTIONALLY WITH FAMILY, ETC. DESPITE MYTHS THAT INJURY DURING THIS TIME IS OF LITTLE CONSEQUENCE, WE NOW KNOW THATTBI DURING THIS TREMENDOUS STAGE OF BRAIN DEVELOPMENT CAN BE DEVASTATING CHILDREN WITH DAMAGE TO THEIR FRONTAL LOBES FROM TBI BEFORE AGE 5 FREQUENTLY HAVE LIFELONG CHALLENGES WITH SOCIAL AND BEHAVIORAL ISSUES #2: CAN HANDLE SEPARATION (C), WRITING(P-O),FOLLOWING DIRECTIONS & IMPULSE CONTROL (F-T) #3: BECOMING MORE COORDINATED(P-O) (ex)playing team sports #4: LEARNING 2ND LANGUAGE, COMMUNICATE SOCIALLY W/PEERS & ADULTS, REMEMBERING MORE ACADEMIC INFO(T); EMOTIONS BECOMING MORE ADULT-LIKE(C) #5: ACCEPTING MORE RESPONSIBILITY, PLANNING LIVES(F-T)

16. Brain Concussion Impaired function (varying time frame) No structural damage to speak of directly Can lead to degradation over time Extreme variance in severity LOC Diffuse

26. Intracranial Haematomas Epidural arterial bleeding quick onset less common Subdural venous bleeding wide range of onset time can build on each other without symptoms

31. Management The specific goals in the acute management of severe traumatic brain injury are: 1. Protect the airway & oxygenation 2. Ventilate to normocapnia 3. Correct hypovolaemia & hypotension 4. CT Scan when appropriate 5. Neurosurgery if indicated 6. Intensive Care for further monitoring and management

32. Significant Head Injuries Signs of increased intercranial pressure Visual difficulties Vomiting Dyspnea Decreased pulse

34. Glascow Coma Scale