BRADDOM - Acceleration/deceleration = shearing injury to brain

tissue, disruption of blood vessels, and retinal bleeding

TRAUMATIC BRAIN INJURY Military TBI
- alteration in brain function/evidence of brain - Blast plus: < 1 one type of injury at a time
pathology caused by an external force
- open/closed Pathophysiology
- suspected/indicated 1. Primary injury
 significant blow to the head and/or alteration or loss of  Conjunction c mechanical forces that cause disruption
consciousness at the time of injury to the brain issue
- head injury  Contact forces: head is prevented from moving after it
 blow to the head/laceration that may occur s causing is struck
injury to the brain  Inertial forces: head is set into motion and results in
acceleration
Glasgow Coma Scale (GCS)  C angular acceleration = DAI
- gold standard  Angular acceleration- brain’s
- levels center of gravity moves over a
 mild= 13-15 center of angulation, or fulcrum,
 moderate= 9-12 located in the lower to middle
 severe= 3-8 cervical region
- Pediatric Glasgow Coma Scale (PGCS)  DAI
o Corpus callosum often
Posttraumatic Amnesia affected
- Loss of memory for events surrounding the injury, o Associated c loss of
disorientation, confusion, and significant cognitive consciousness and coma
impairment  C translation acceleration= contusion
 Cortical contusion
Violence o often occur in gyral crests
- Firearm use: leading cause of death from TBI (frontal & anterior
Child abuse temporal lobes)
- Shaken baby syndrome and inflicted childhood
neurotrauma
 Contusion
o Coup: under the impact site
o Countercoup: remote from the injury site and
opposite of the impact
o DAI and focal contusions = neuronal disconnection or
diaschisis
o Hematomas
o Epidural hematoma (EDHs)
 Local impact and subsequent laceration
of underlying dural veins and arteries
 Meningeal artery (common source)
o Subdural hematomas (SDHs)
 Inertial forces and tearing of bridging
veins
o Traumatic subarachnoid hemorrhage (SAH)
 Angular acceleration shears vessels
located in subarachnoid space
2. Secondary injury
o Disruption of cerebral blood flow and
metabolism, massive release of
neurochemicals, cerebral edema, and
disruption of ion homeostasis
o Brain swelling =  ICP and CPP
o After TBI, excess EAAs present in extracellular
microdialysate and CSF
 Trigger influx of sodium and chloride 
acute neuronal and astrocytic swelling
 Intracellular calcium influx and release
of Ca++  cellular death
Concomitant injury
Military Blast Injury
o Primary: direct effects of overpressure blast
o Secondary: penetrating trauma
o Tertiary: effects of structural collapse and person being
thrown by the blast wind
o Quaternary: asphyxia, and exposure to toxic inhalants
Mild TBI
- At least once of the ff:
 Confusion
 Disorientation
 Loss of consciousness < 30 mins
 PTA < 24hr or other transient focal
neurologic abnormalities
 GCS: 13-15 after 30 mins or
presentation to a health care facility
- Cantu Colorado concussion scales
Acute Medical Management of Moderate to Severe TBI
- Elevated ICP= 20-25mmHg
- Maneuvers to ICP: elevating the head of the bed 30
degrees, tx of hyperthermia, mannitol, sedation, and
brief hyperventilation
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