3.4- TBI Flashcards
What percentage of TBI are mild?
What percentage are severe?
TBIs affect what population the most?
mild- 80%
severe- 42% of 20% that aren’t mild
Men>Women 2:1
15-24 year olds, but high incidents with infants, children, and elderly
What are the 5 most common causes of TBI?
MVA Car/pedestrian accidents Falls Assaults/Crime Sports/Recreation
What 3 factors influence the outcome of TBI?
What are the 2 types/classifications of TBI?
- Amount of immediate danger
- Cumulative effects of secondary damage
- Premorbid status/family support
- Open injury
- Closed or Intercranial Injury
What is an open injury?
What is a closed or intercranial injury?
penetrating wounds (gunshots, stabbings)
neural tissue is damaged w/o penetration
Because damage follows path of entry and exit with an open injury, _____ can complicate and effect the CNS.
infections
What are the 3 types of closed or intercranial injury?
- Concussion
- Contusion
- Hematoma
What is a concussion?
momentary loss of consciousness/reflexes
no direct structural damage to brain tissue, but synapses are disrupted due to shearing
What are the two types of amnesia? How are they different?
- Retrograde amnesia- loss of memory prior to injury
2. Post traumatic amnesia- unable to remember or learn new information
What is a contusion?
What are the 2 types of lesions?
bruising of surface of the brain at impact
- Coup lesion
- Countercoup lesion
_____ lesion occurs on the same side as impact.
Coup lesion
_____ occurs on the opposite side as trauma due to deceleration.
- ______ lobes most commonly affected
- shearing force causes axons to become disrupted within the sheath
Countercoup lesion
Frontal and parietal lobes
Coup lesion occurs on same side as _____.
Countercoup lesion occurs opposite side as trauma due to ______.
impact
deceleration
What is a hematoma?
What are the 2 types of hematomas?
vascular hemorrhage
- Epidural hematoma
- Subdural hematoma
What type of hematoma forms between the dura mater and skull due to a ruptured artery?
It is commonly due to ________.
epidural hematoma
blow to hear or MVA
Subdural hematoma forms between the dura and arachnoid due to _______.
What type of hematoma happens quickly?
rupture of a vein
epidural hematoma
What type of hematoma???
- due to a ruptured artery
- often seen in elderly after fall w/ blow to head
- symptoms fluctuate & can resemble CVA
- immediate surgery is required
- epidural hematoma
- subdural hematoma
- subdural hematoma
- epidural hematoma
What symptoms will an EMT see with an epidural hematoma?
initially patient is unconscious, becomes alert, and then rapidly deteriorates as the hematoma enlarges
What symptoms will an EMT see with a subdural hematoma?
symptoms fluctuate and can resemble CVA- decreased consciousness, pupil dilation same side, hemiparesis opposite side
What may occur within an hour or up to several months after TBI (normally 1st week)?
secondary cerebral damage
Secondary problems after a TBI can cause what 3 problems?
What problem is the most common?
- increased intercranial pressure- common- as much as 80% of patients in a coma
- anoxic injury
- post traumatic epilepsy
Define:
Increased intercranial pressure
*Usually 1st week, but must watch closely b/c it can occur up to 1 month later.
adult skull cannot expand- can’t accommodate increase in fluid due to edema or hemorrhage
increased pressure can compress brain tissue and cause herniation
________ - brain tissue requires 20% of body’s O2- if not adequate can cause diffuse damage
anoxic injury
TBI patients have an increased risk for developing _____- about 5%. They may develop _____ after injury. They are more common with open head injury.
seizures
several years
What are the 6 symptoms of increased cranial pressure?
What is the treatment for increased intercranial pressure?
- decreased responsiveness
- loss of consciousness
- severe headache
- vomiting
- papilledema- edema of optic disc
- change in vital signs- increased BP, decreased HR
Rx: monitoring/drugs, shunt if necessary
What are the 2 types of seizures/post traumatic epilepsy?
How are seizures treated?
- absence seizures (was petit mal)
- tonic-clonic (was grand mal)
Treated with meds- dilantin
Which type of seizure is a loss of consciousness with convulsions?
Tonic-Clonic (was Grand mal)
Which type of seizure is usually in children, only momentary loss of consciousness with blank empty stare?
Absence Seizures (was Petit mal)
What scale is used to determine level of arousal and cerebral function- very good predictor of outcome?
Glasgow Coma Scale
Glasgow Coma Scale-
higher score = _________
Score of 3-4 = _________
Score of 8 or less = _______
higher scale= less severe damage w/ better chance of survival
3-4= often don’t survive
8 or less= in coma/severe TBI (most have permanent deficits)
Glasgow Coma Scale-
Score of 9-12 = ________
Deficits may be _________.
Score of 13 or higher with loss of consciousness less than 20 min = _____
9-12= moderate TBI
Deficits may be…
- unable to answer questions
- may have permanent deficits
13 or higher= mild TBI
*awake upon arrival at ER
