Brain Injury Flashcards
1
Q
Highest risk for TBIs with 0-4 years old
A
- Large heads compared to rest of body with weak necks/poor motor control so fall a lot
2
Q
Highest risk for 15-19 year olds
A
- Body is too strong/mature for their brais (frontal lobe not fully developed)
3
Q
Highest risk for older adults
A
Falls
4
Q
Most common causes of TBIS
A
- Falls
- Unknown/other
- MVA
- Struck by motor vehicle
5
Q
Mild brain injury
A
- GCS >/= 13
- Known as a concussion
- Symptoms improve over 1-3 months
6
Q
Moderate brain injury
A
- GCS 9-12
- Loss of consciousness followed by few days/weeks of confusion
7
Q
Severe brain injury
A
- GCS </=8
8
Q
Primary brain injuries
A
- Skull fracture
- Contusions
- Hematoma/Hemorrhage
- Lacerations
- Diffuse axonal injuries
9
Q
Secondary damage
A
- Influx of Ca2+
- Efflux of K+
- Reduced magnesium related to decreased energy metabolism and correlated with neurological deficits
- Rise in oxygen free radicals causing secondary to cell death and damage
5 .Cerebral edema - Intracranial hematoma
- Cerebral hypoxia and ischemia
- Brain herniation
- Increased intracranial pressure
10
Q
Evaluation of a Coma
A
- Eye movements (pupillary light, conjugate eye movement, VOR, Doll’s head, Caloric response)
- Movement patterns
- Breathing patterns
- Glasgow coma scale
- Coma recovery scale
- Rancho Los Amigos Levels of Cognitive Function
11
Q
Cheyne-Stokes
A
- Periods of hyperventilation alternating with periods of apnea
- Caused by damage to cortex
12
Q
Central Neurogenic Hyperventilation
A
- Continuous, regular, rapid respirations/consistent hyperventilation
- Damage to midbrain and upper pons
13
Q
Apneustic Respiration
A
- Prolonged inspiration with pause before expiration, has period of apnea
- Caused by damage to lower pons
14
Q
Ataxia respirations
A
- Chaotic with irregular phases; normally leads to cessation of breathing
- Damage to medulla
15
Q
Glasgow Coma Scale
A
- Uses eye movement, motor response, and verbalization to score coma
16
Q
Coma recovery scale
A
- Identifies different levels of consciousness (coma, vegetative state, persistive vegetative state, minimally conscious state, brain death)
17
Q
Rancho Los Amigos Levels of Cognitive Function
A
- 8 levels with more detailed descriptions and a more functional scale
18
Q
Consciousness
A
- Complete and normal content of consciousness depends on many systems (Memory, emotion, drive, language, executive function, arousal systems, sensory processing)
- Depends on awake and awareness
19
Q
Coma
A
- A state of unarousable unresponsiveness in which there is no evidence of self-awareness or environmental awareness
- Not awake or aware
- Absence of spontaneous eye opening
- No sleep wake cycles
- Behavior is limited to reflexive activity indicating failure of reticular activating system and integrated cortical activity
- Eyes continuously closed
- Purposeful responses to environmental stimulation cannot be elicited
- No evidence of discrete localized responses
- No evidence of language comprehension or expression
20
Q
Vegetative State
A
- Awake but not aware
- The recovery of eye opening with continued absence of observable signs of cognitively mediated behavior signals transition to VS
- AAN 3 diagnostic criteria (all must be met): 1. No evidence of sustained, reproducible purposeful or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli; 2. No evidence of language comprehension or expression; 3. Intermittent wakefulness manifested by presence of sleep/wake cycles (periodic eye opening)
- May experience sleep-wake cycles or may be constant state of wakefulness
- Can exhibit some behaviors that can be seen as partial consciousness: grinding teeth, swallow, smile, crying, grunting, moaning, screaming, orienting behavior
21
Q
Permanent vegetative state v. persistent vegetative state
A
1 year; 4 weeks
22
Q
Minimally conscious state
A
- Awake with fluctuating awareness
- Clear and reproducible evidence of one of the four categories: 1. Follow simple commands; 2. Gestures or verbalizes yes/no; 3. Intelligible verbalization; 4. Movement or affective behavior that occur in response to environmental stimulation that are not reflexive (crying, smiling, laughter, gestures, vocalization, reaching for objects, visual pursuit, sustained fixation)
23
Q
Brain death
A
- No clinical evidence of brain function upon physical examination
- No response to pain
- No cranial nerve reflexes
- No pupillary response (fixed pupils)
- No oculocephalic reflex (Doll’s Head)
- No corneal reflex
- No caloric reflex test
- No spontaneous respirations
- Flat EEG (not necessary in US to certify brain death)
- Confirmed by exam of 2 independent physicians
- 2 EEG’s, 24 hours apart
- Must be differentiated from conditions where recovery may be possible
- Barbiturate intoxication, alcohol intoxication, sedative overdose, hypothermia, hypoglycemia, coma, or chronic vegetative states
- This will be when patient is on life support and harvest organs
- Only difference between brain dead and dead is your heart is beating
24
Q
Treatment Guidelines for Reducing Brain Edema
A
- A more direct approach to monitoring and managing increased intracranial pressure and maintaining steady perfusion of brain tissue
- Use of intracranial pressure monitors in ventricles
- Ability to tap off cerebrospinal fluid (CSF) if pressure rises to dangerous levels
- Normal intracranial pressure (ICP) is 7-10 mmHg
- If ICP rises above 20 mmHg then shunt is put in place
- ICP > 25 mmHg is life threatening (above 60 mmHg, uniformly lethal)
- Maintain BP (systolic BP > 90 mmHg) for adequate perfusion of tissue
- Cerebral perfusion pressure (CPP) maintained > 70 mmHg
- CPP = mean arterial pressure – ICP
- MAP = [(2 * diastolic) + systolic]/3
- Treatment has significant effect on outcome
- In cases where acute, elevated ICP cannot be lowered sufficiently, hyperventilation, barbiturates, and diuretics may be used judiciously in combination with ICP management
25
Factors of Prognosis (better vs. worse)
- Damage is focal vs. diffuse
- Damage is superficial vs. deep
- Damage is unilateral vs. bilateral
- Score on 24 hour GCS is better than 8
- Loss of consciousness (LOC) is less than 2 weeks
- Post-traumatic amnesia (PTA) is less than 2 months
- Anterograde – how much people can remember since accident
- There was a lucid interval prior to LOC (less chance of DAI)
- No secondary injury like brain herniation or ischemia
- Younger than 40 years old
- Premorbid psychosocial factors (drug/alcohol free)
26
PTA
- Anterograde episodic amnesia
- Cannot recall events since trauma
- Associated with confusional state
- Length of PTA is a standard measure of severity of injury
- Length of PTA is correlated with length of LOC
