Chapter 31: Trauma Induced Conditions Flashcards
Post-trauma continuum of care
ICU-acute-inpatient-outpatient
Post-trauma OT interventions
Preparatory methods
Purposeful activity/occupation based
Education
Pediatric SCI incidence
1.99 times per 100,000 children
1455 new injuries per year
Pediatric SCI gender discrepancy
Boys are twice as likely to experience SCI than girls
- Risk takers, fast drivers, more likely to be impulsive
Causes of SCI
Traumatic (motor vehicle accident, violence (guns), falls, sports injury)
Medical (spinal tumor, spinal procedure, disease process)
Children are more likely to have what type of SCI and why?
Upper cervical (C1-C3) due to having a larger head in proportion to their body and weak ligaments
What level of SCI allows a child to use an adapted environmental control?
C6
What is the major muscle innervated by C7 that is a major help with ADLs?
Triceps
- Provides extension movement
What is the main focus of intervention for a child with a SCI?
Play
Community mobility
Emotional aspects
Social interaction
Self care
Bowel-bladder control
Pediatric TBI incidence
Approximately 1.7 million people per year
Ages most likely to incur TBI
Young children: 0-4 years
Teenagers: 15-19 years
Senior citizens: over 65 years
Traumatic causes of TBI
Falls
Car accidents
Sports related injuries
Non-accidental trauma
Violence-related
Acquired stroke causes of TBI
Anoxia
Arteriovenous
Malformation rupture
Tumor resection
Seizure activity
Infection
Metabolic disorders
Seizure foci resection
Taking out part of the brain to stop seizures from occurring
Infection (meningitis and encephalitis)
Brain inflammation
Metabolic disorders TBI
Condition leads to high BP or stroke that causes TBI
Functional prognosis of TBI
Severity
Location
Extent
Localized injury
Hit on one section of head
Diffuse injury
Brain shifts and rotates (worse)
Premorbid factors of TBI
Low SES
Behavior issues/poor academic performance
Glasgow Coma Scale
Hope for improvement, measures how they improve over time
Mild TBI brain injury
Loss of consciousness: <30 mins
Glasgow Coma Scale score : 13-15
Post-traumatic amnesia: <24 hours
Moderate TBI brain injury
Loss of consciousness: 30 minutes-24 hours
Glasgow Coma Scale score: 9-12
Observable finding on EEG, CT, or MRI
Severe TBI brain injury
Loss of consciousness: > 24 hours
Glasgow Coma Scale score: 3-8
Significant findings on EEG, CT, or MRI
Rancho Levels of Cognitive Functioning
Progression of recovery
What kind of impairments occur for a pediatric TBI?
Motor, neurological, cognitive
Return of function is much less predictable- younger can rewire better
Pediatric burn injury incidence
Approximately 450,000 per year.
Over 50% of that number consists of children.
Approximately 30,000 children per year require hospitalization for burns.
Causes of burns
Scald- 60% (steam or hot water)
Flame- 25%
Contact- 10%
Electrical/chemical- 5%
First degree burns
Does not enter dermis
Second degree burns
Enters dermis
Blister, painful
Can heal on own but might take ~2 weeks
Third degree burns
Entire dermis is damaged
White/charred
Need most attention
What is the first layer of skin?
Epidermis
What is the second layer of skin?
Dermis
What is the third layer of skin?
Subcutaneous
What is the #1 way to treat a burn that is not healing on its own?
Skin grafting
Autografting
Using person’s own skin for graft
Sheet grafting
Take piece of healthy skin with dermatome and replace it over burn, donor site becomes painful
Meshed grafting
Covering a large wound, run good skin through machine making it into a grid to cover more areas, not used often
What is a scar?
Develops any time the dermal layer of the skin is damaged.
Hypertrophic scarring
The collagen fibers in hypertrophic scarring are orientated in a “whorl-like” pattern, as compared to normal skin in which collagen aligns in a parallel pattern (Bumpy scar)
Keloid scar
Scar grows beyond original wound
Why is scar management important?
Scar tissue is estimated to have 12 times the contractile strength of normal skin, which is clearly strong enough to pull features and joints out of place.
- Affects function
Functional problems that occur from scarring
If a scar crosses a joint, it can limit range of motion and cause functional deficits.
Can’t talk or eat as well
Where are major impairments with pediatric burns?
Soft tissue, result in motor deficits
Treatment focus for burns
Maximizing skin integrity and function, then resuming participation in occupations
- Scar management
- Functional positioning to stop scars from taking over joints
- Discuss changes with patient (disfiguring disability is traumatizing)
In pediatric trauma care, who experiences orthostatic hypotension?
ALL (burns, SCI, TBI)
Who experiences autonomic storming?
TBI
Who experiences autonomic dysreflexia?
SCI
