Head injury and rehab after brain injury Flashcards
What are SMART goals?
Specific Motivating Achievable Rational and relevant to patient Time-defined
Percentage of people with job before and after brain injury?
80% have job before
20% have job after
What CPP should you aim for after head injury?
Aim for more than 60mmHg
CPP = cerebral perfusion pressure
i.e. MAP > 80mmHg and ICP less than 20mmHg
Normal adult ICP pressure
9-11 mmHg
Someone has “panda eyes” what type of fracture do they have?
Skull base: ANTERIOR cranial fossa
Someone has “raccoon eyes” what type of fracture do they have?
Skull base: ANTERIOR cranial fossa
raccoon eyes = panda eyes
Someone has a “battle sign” over the mastoid area, what type of fracture do they have?
Skull base: MIDDLE cranial fossa
Definition of coma
Does not open eyes
Does not respond to commands
Does not speak
Equivalent of GCS of 8 or less
Irreverxible neuronal damage occurs within how many minutes of circulatory arrest?
5 minutes
How much does the brain use?
15% of the cardiac output
20% of the carried oxygen
12% of the glucose
Why do you sedate patient in intensive care for management of head injury?
Reduces cerebral metabolic rate
Reduces cerebral blood flow
Reduces ICP
Oxygen partial pressure you should aim for in intensive care
13-15 kPa
C02 levels you should aim for in intensive care
4-4.5 kPa
Ways to protect brain after injury
CSF drainage
Mannitol
Hypertonic saline (may be better than mannitol)
Hyperventilation (benefit seen 2-4 hrs after)
Why do you give mannitol following injury?
Improves microperfusion
-increases amount of fluid excreted by the kidneys and helps the body to decrease the pressure in the brain and eyes
